Assessment and management of fatigue in patients with cancer

Published Date: 20th September 2021

Publication Authors: Hynes J

Background
Fatigue is a common and debilitating symptom experienced by patients with life limiting illness.

Aim(s)
To audit clinical practice against regional standards and to use outcomes to update regional standards and guidelines.

Methods
A systematic literature review of the management of fatigue in cancer patients was performed. The practice of Healthcare Professionals working in specialist palliative care was surveyed and a multi-centre retrospective case note audit was performed.

Results
There is evidence for corticosteroid use and for educational and exercise interventions in the management of fatigue. There is limited evidence for the use of acupressure, acupuncture or psychostimulants. 58 clinicians participated in the survey. 9% report using an assessment tool to evaluate fatigue. 94% consider reversible causes. 54% reported their service area provided educational sessions covering fatigue. 52% refer patients for exercise based interventions or psychological support. Of those with access, 33% consider referral for acupuncture/acupressure. 80% use corticosteroids in fatigue management, with 93% using Dexamethasone 4mg. 17% consider use of psychostimulants. 116 case notes were reviewed. 32% of patients were screened using an assessment tool. A reversible cause was considered in 79%. 25% were referred for educational intervention, 18% for exercise intervention and 38% for psychological support. 37% of patients were commenced on a corticosteroid, with 51% prescribed Dexamethasone 4mg. No patients were referred for acupuncture/acupressure or commenced on psychostimulants.

Conclusion
The majority surveyed did not use an assessment tool. Most clinicians considered corticosteroids. However, around half did not consider referral for educational or exercise interventions. Psychostimulants were not prescribed. Respondents would consider referral for acupuncture/ acupressure but this was not widely available.

McDougall, AJ; Hynes, J et al. (2021). Assessment and management of fatigue in patients with cancer: A multi-centre regional audit. Palliative Medicine. 35 (Supp 1), 65

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