Management Of Fatigue In Patients Research Articles

Optimal management of fatigue in patients with systemic lupus erythematosus: a systematic review.

Among the host of distressing pathophysiological and psychosocial symptoms, fatigue is the most prevalent complaint in patients with systemic lupus erythematosus (SLE). This review is to update the current findings on non-pharmacological, pharmacological, and modality strategies to manage fatigue in patients with SLE and to provide some recommendations on optimal management of fatigue based on the best available evidence. We performed a systematic literature search of the PubMed and Scopus databases to identify publications on fatigue management in patients with SLE. Based on the studies reported in the literature, we identified nine intervention strategies that have the potential to alleviate fatigue in patients with SLE. Of the nine strategies, aerobic exercise and belimumab seem to have the strongest evidence of treatment efficacy. N-acetylcysteine and ultraviolet-A1 phototherapy demonstrated low-to-moderate levels of evidence. Psychosocial interventions, dietary manipulation (low calorie or glycemic index diet) aiming for weight loss, vitamin D supplementation, and acupuncture all had weak evidence. Dehydroepiandrosterone is not recommended due to a lack of evidence for its efficacy. In addition to taking treatment efficacy and side effects into consideration, clinicians should consider factors such as cost of treatment, commitments, and burden to the patient when selecting fatigue management strategies for patients with SLE. Any comorbidities, such as psychological distress, chronic pain, sleep disturbance, obesity, or hypovitaminosis D, associated with fatigue should be addressed.

Modafinil for the treatment of fatigue in lung cancer: results of a placebo-controlled, double-blind, randomized trial.

Fatigue is a distressing symptom occurring in more than 60% of patients with cancer. The CNS stimulants modafinil and methylphenidate are recommended for the treatment of cancer-related fatigue, despite a limited evidence base. We aimed to evaluate the efficacy and tolerability of modafinil in the management of fatigue in patients with non-small-cell lung cancer (NSCLC). Adults with advanced NSCLC and performance status of 0 to 2, who were not treated with chemotherapy or radiotherapy within the last 4 weeks, were randomly assigned to daily modafinil (100 mg on days 1 to 14; 200 mg on days 15 to 28) or matched placebo. The primary outcome was change in Functional Assessment of Chronic Illness Therapy (FACIT) -Fatigue score from baseline to 28 days, adjusted for baseline fatigue and performance status. Secondary outcomes included safety and patient-reported measures of depression, daytime sleepiness, and quality of life. A total of 208 patients were randomly assigned, and 160 patients (modafinil, n = 75; placebo, n = 85) completed questionnaires at both baseline and day 28 and were included in the modified intention-to-treat analysis. FACIT-Fatigue scores improved from baseline to day 28 (mean score change: modafinil, 5.29; 95% CI, 2.57 to 8.02; placebo, 5.09; 95% CI, 2.54 to 7.65), but there was no difference between treatments (0.20; 95% CI, -3.56 to 3.97). There was also no difference between treatments for the secondary outcomes; 47% of the modafinil group and 23% of the placebo group stated that the intervention was not helpful. Modafinil had no effect on cancer-related fatigue and should not be prescribed outside a clinical trial setting. Its use was associated with a clinically significant placebo effect.

Screening, assessment, and management of fatigue in adult survivors of cancer: an American Society of Clinical oncology clinical practice guideline adaptation.

This guideline presents screening, assessment, and treatment approaches for the management of adult cancer survivors who are experiencing symptoms of fatigue after completion of primary treatment. A systematic search of clinical practice guideline databases, guideline developer Web sites, and published health literature identified the pan-Canadian guideline on screening, assessment, and care of cancer-related fatigue in adults with cancer, the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines In Oncology (NCCN Guidelines) for Cancer-Related Fatigue and the NCCN Guidelines for Survivorship. These three guidelines were appraised and selected for adaptation. It is recommended that all patients with cancer be evaluated for the presence of fatigue after completion of primary treatment and be offered specific information and strategies for fatigue management. For those who report moderate to severe fatigue, comprehensive assessment should be conducted, and medical and treatable contributing factors should be addressed. In terms of treatment strategies, evidence indicates that physical activity interventions, psychosocial interventions, and mind-body interventions may reduce cancer-related fatigue in post-treatment patients. There is limited evidence for use of psychostimulants in the management of fatigue in patients who are disease free after active treatment. Fatigue is prevalent in cancer survivors and often causes significant disruption in functioning and quality of life. Regular screening, assessment, and education and appropriate treatment of fatigue are important in managing this distressing symptom. Given the multiple factors contributing to post-treatment fatigue, interventions should be tailored to each patient's specific needs. In particular, a number of nonpharmacologic treatment approaches have demonstrated efficacy in cancer survivors.

Prevalence and characteristics of moderate to severe fatigue: a multicenter study in cancer patients and survivors.

The effective management of fatigue in patients with cancer requires a clear delineation of what constitutes nontrivial fatigue. The authors defined numeric cutpoints for fatigue severity based on functional interference and described the prevalence and characteristics of fatigue in patients with cancer and survivors. In a multicenter study, outpatients with breast, prostate, colorectal, or lung cancer rated their fatigue severity and symptom interference with functioning on the M. D. Anderson Symptom Inventory numeric scale of 0 to 10. Ratings of symptom interference guided the selection of numeric rating cutpoints between mild, moderate, and severe fatigue levels. Regression analysis identified significant factors related to reporting moderate=severe fatigue . The statistically optimal cutpoints were 4 for moderate fatigue and 7 for severe fatigue. Moderate=severe fatigue was reported by 983 of 2177 patients (45%) undergoing active treatment and was more likely to occur in patients receiving treatment with strong opioids (odds ratio [OR], 3.00), those with a poor Eastern Cooperative Oncology Group performance status (OR, 2.00), those who had >5% weight loss within 6 months (OR, 1.60), those who were receiving >10 medications (OR, 1.58), those with lung cancer (OR, 1.55), and those with a history of depression (OR, 1.42). Among survivors (patients with complete remission or no evidence of disease, and not currently receiving cancer treatment), 29% of patients (150 of 515 patients) had moderate=severe fatigue that was associated with poor performance status (OR, 3.48) and a history of depression (OR, 2.21). The current study statistically defined fatigue severity categories related to significantly increased symptom interference. The high prevalence of moderate=severe fatigue in both actively treated patients with cancer and survivors warrants the promoting of the routine assessment and management of patient-reported fatigue.

Fatigue management in patients with IBD: a randomised controlled trial

ObjectiveTo assess the effectiveness of solution-focused therapy (SFT) on fatigue and quality of life (QoL) in patients with fatigued inflammatory bowel disease (IBD).DesignRandomised controlled trial in two Dutch hospitals. Patients...

Adult patients living with heart failure: Experiences and management of fatigue in everyday life - a systematic review protocol of qualitative evidence

Adult patients living with heart failure: Experiences and management of fatigue in everyday life - a systematic review protocol of qualitative evidence

PC-FACS

PC-FACS

L-Carnitine Supplementation for the Management of Fatigue in Patients With Cancer: An Eastern Cooperative Oncology Group Phase III, Randomized, Double-Blind, Placebo-Controlled Trial

L-carnitine, a popular complementary and alternative medicine product, is used by patients with cancer for the treatment of fatigue, the most commonly reported symptom in this patient population. The purpose of this study was to determine the efficacy of L-carnitine supplementation as a treatment for fatigue in patients with cancer. In this double-blind, placebo-controlled trial, patients with invasive malignancies and fatigue were randomly assigned to either 2 g/d of L-carnitine oral supplementation or matching placebo. The primary end point was the change in average daily fatigue from baseline to week 4 using the Brief Fatigue Inventory (BFI). Three hundred seventy-six patients were randomly assigned to treatment with L-carnitine supplementation or placebo. L-carnitine supplementation resulted in significant carnitine plasma level increase by week 4. The primary outcome, fatigue, measured using the BFI, improved in both arms compared with baseline (L-carnitine: -0.96, 95% CI, -1.32 to -0.60; placebo: -1.11, 95% CI -1.44 to -0.78). There were no statistically significant differences between arms (P = .57). Secondary outcomes, including fatigue measured by the Functional Assessment of Chronic Illness Therapy-Fatigue instrument, depression, and pain, did not show significant difference between arms. A separate analysis of patients who were carnitine-deficient at baseline did not show statistically significant improvement in fatigue or other outcomes after L-carnitine supplementation. Four weeks of 2 g of L-carnitine supplementation did not improve fatigue in patients with invasive malignancies and good performance status.

Methylphenidate for the amelioration of cancer-associated fatigue

To the editor: I read with great interest the recent article by Romito et al. in a recent issue of your esteemed journal [1]. The article is highly thought provoking. Interestingly, recent studies have shown the significant effectiveness of psycho-stimulants such as methylphenidate in attenuating cancer-associated fatigue. For instance, both the “Brief Fatigue Inventory severity scores” and the “Brief Fatigue Inventory total scores” are decreased in prostate cancer patients following methylphenidate therapy [2]. Similarly, Cueva et al. in a recent study have shown the effectiveness of methylphenidate in attenuating asthenia in breast carcinoma patients who received chemotherapy with agents such as docetaxel [3]. Significant improvement in the quality of life index as well as a corresponding attenuation of fatigue is seen in patients with recurrent gynecological carcinomas following methylphenidate therapy [4]. Interestingly, marked improvement in fatigue has been seen after “patient-controlled” methylphenidate administration [5]. Treatment response at the initiation of therapy is a good predictor of ultimate and long-term response to methylphenidate therapy [6]. However, the blood pressure needs to be monitored closely in cancer patients on methylphenidate therapy. The above studies clearly demonstrate the effectiveness of methylphenidate in ameliorating cancer-associated fatigue. Hopefully, the coming few years will see an increased use of methylphenidate for the management of fatigue in patients with advanced and end-stage cancers.

La fatigue des patients atteints d’une maladie de Crohn en rémission : exploration du rôle du parcours médical et des facteurs psychologiques

ObjectivesFatigue is a common complaint in IBD disease. Medical factors (anemia, medicinal side effects, activity of the disease) partially explain IBD-related fatigue. Research has shown that fatigue is persistent even if the disease is in remission. Other factors need to be considered in order to understand this phenomenon. Fatigue could be considered as a consequence of disease history. But it also appears necessary to consider patients’ causal attribution of the disease, the perceived gravity of their trouble and the presence of psychological suffering. MethodsSeventy-seven patients with Crohn's Disease in remission were enrolled. They answered questionnaires assessing fatigue (MFI), depression (HADS), anxiety (HADS, STAI YA/B), perceived severity (CGI1), pain EVS and a causal attribution scale. Information about disease history was collected from the MICISTA database for the 10-year period preceding the assessments (the number and severity of clinical relapses, the number of hospitalizations due to a major degradation of the clinical condition, the number of intestinal surgeries, the severity of bowel resection evaluated by the Post Surgical Handicap Index, type of medical treatment taken at the time of evaluation). Patients were compared using the CGI1 median (ANOVA) and the General Fatigue median (t-test). Then MFI scores were analyzed with a multiple regression. ResultsThe results showed only one significant relation between perceived severity of the disease and pain. Dichotomization of patients according to the median level of general fatigue showed that patients were significantly more tired, more depressed, anxious, and in pain than less tired patients. They also had a more serious bowel resection and a significantly worse perception of the severity of their current troubles. The analysis of correlation showed that none of the medical disease-related history was linked in fatigue scores. In contrast, intensity of depression and anxiety-related variables (more particularly trait-anxiety) were the most involved in fatigue scores intensity. Only the perceived severity and the internal-external dimension of causal attributions respectively were linked to the severity of general fatigue and reduced activity. ConclusionThese results confirm that if fatigue is associated with medical factors including the period of clinical activity (as was demonstrated elsewhere), this medical reality would not play a role when the disease is in remission. The influence of anxiety and depression is consistent with that observed in other studies. Trait-anxiety would increase the vulnerability to the onset of fatigue. This could partially explain why some patients remain tired even in remission. Fatigue could be also understood as a manifestation of the work of the disease which can be conceived as the totality of psychic operations involved in the subject's relation to his illness. This psychic work is particularly difficult because it requires both development and a waiver of certain aspects of the self. This difficulty is reflected in the appearance of depression, but may also occur to a lesser extent by the complaint of being tired. In the context of chronic disease, it is then possible to hypothesize that fatigue could be a manifestation of the work of the disease in individuals already vulnerable because of an anxious dimension of personality. Understanding and management of fatigue in patients with Crohn's disease requires the transition to a more personal understanding of the meaning attributed to each patient's illness and fatigue. In any case, it seems essential to reconsider the weight of the patient's objective medical history in fatigue and the physicians’ attributions linking it to the disease.

Quality of life and barriers to symptom management in colon cancer

Purpose of the researchPain and fatigue are recognized as critical symptoms that impact QOL for patients with colon cancer. Barriers to optimum pain and fatigue relief include patient-related beliefs and attitudes about the treatment of cancer-related symptoms. The overall objective of this paper was to describe quality of life (QOL) and barriers to pain and fatigue management in patients with colon cancer. Methods and sampleThis longitudinal, descriptive study included was conducted in the ambulatory clinic of one NCI-designated comprehensive cancer center. A cohort of 56 patients with colon cancer and a pain and/or fatigue of ≥4 (moderate to severe) was recruited. Subjects completed questionnaires to assess subjective ratings of overall QOL, fatigue, barriers to pain and fatigue, and pain and fatigue knowledge. Key resultsThe majority of subjects (58%) reported having moderate to severe (4–6) fatigue at the time of accrual. Overall QOL score was moderate (M = 5.20, SD = 1.43), and the social well-being subscale had the lowest score (M = 4.57, SD = 1.82). Patient barriers to pain and fatigue existed in attitudes and beliefs regarding addiction, tolerance, and that fatigue is an inevitable part of cancer and its treatments. Patient knowledge of pain and fatigue was high (77%–88% correct), but lack of knowledge persisted in areas such as addiction to pain medications and utilizing physical activity to manage fatigue. ConclusionsSeveral patient-related attitudes and beliefs may hinder optimum relief of symptoms such as pain and fatigue. Social well-being may be a major determinant of overall QOL for patients with colon cancer.

Rheumatologists’ knowledge, attitude and current management of fatigue in patients with rheumatoid arthritis (RA)

To describe rheumatologists' knowledge, attitude and current management of fatigue in patients with rheumatoid arthritis (RA), a postal questionnaire was sent to all rheumatologists (N = 204) and trainees (N = 49), members of the Dutch Society of Rheumatology. The overall response rate was 44% (N = 110). In general, rheumatologists' knowledge about RA-related fatigue was in accordance with the literature but they perceive a lack of their own knowledge about aetiology and evidence-based interventions to prevent and treat fatigue. The majority of the rheumatologists believe that fatigue is a multi-disciplinary diagnosis and is preferably managed by the nurse specialist (34%). Assuming that the patient will raise the issue, most of the rheumatologists pay attention to fatigue during the first consultation and less often during follow-up consultations. There is a need for knowledge about causes and treatments for RA-related fatigue to ensure that patient outcomes are improved.

Reduced plasma dehydroepiandrosterone sulfate levels are significantly correlated with fatigue severity in patients with primary biliary cirrhosis

Fatigue is a common debilitating complication of primary biliary cirrhosis (PBC), the pathophysiologic mechanism of which is poorly understood. Recently, the neuroactive steroid dehydroepinadrosterone sulfate (DHEAS) was reported to be implicated in Chronic Fatigue Syndrome in the absence of liver disease. The present study was undertaken to analyse fatigue scores and their relationship with disease severity and circulating levels of DHEAS as well as its precursors DHEA and pregnenolone in PBC patients with ( n = 15) or without fatigue ( n = 10) compared to control subjects ( n = 11). Fatigue was assessed using the fatigue impact scale (FIS) including cognitive, physical and psychosocial subclasses. Steroids were measured by radioimmunoassay or gas chromatography/mass spectrometry. Plasma concentrations of DHEAS were significantly reduced in PBC patients with fatigue as compared to controls, while those of its precursors DHEA and pregnenolone remained within the control range. Plasma levels of DHEAS in PBC patients were significantly correlated with fatigue severity as reflected by total FIS scores including total (rp = −0.42; p = 0.018), as well as the cognitive (rp = −0.37; p = 0.03), physical (rp = −0.48; p = 0.006) and psychosocial (rp = −0.35; p = 0.04) subclasses of fatigue scores. No correlation of fatigue scores was observed with indices of liver function. These findings suggest that reduced levels of the neurosteroid DHEAS may contribute to fatigue in patients with PBC; substitutive therapy using DHEAS or its precursor DHEA could be beneficial in the management of fatigue in patients with low levels of DHEAS.

Role of Psychostimulants in the Management of Cancer-Related Fatigue in Patients with Advanced Cancer

Role of Psychostimulants in the Management of Cancer-Related Fatigue in Patients with Advanced Cancer

Management of fatigue in patients with multiple sclerosis.

As long as no causal treatment is available for multiple sclerosis (MS), and as long as only some patients with MS respond to immunomodulators, symptomatic treatment is of paramount importance. Fatigue is the most common symptom of MS and is associated with a reduced quality of life. It is described as the worst symptom of their disease by 50-60% of patients. The first step in managing MS-related fatigue is identifying and eliminating any secondary causes. Primary fatigue syndrome can be alleviated with drug treatment in many cases. Modafinil has been shown to be effective in some studies, and amantadine is an alternative for patients who do not respond to or cannot tolerate modafinil. The nonpharmacological management of fatigue in MS includes inpatient rehabilitation and aerobic endurance exercise. This article describes the pathophysiology, diagnosis and treatment of MS-related fatigue--the most common symptom of MS.

Patient-Controlled Methylphenidate for the Management of Fatigue in Patients With Advanced Cancer: A Preliminary Report

To assess the effects of patient-controlled methylphenidate for cancer-related fatigue. In this prospective open study, 31 patients with advanced cancer and fatigue who scored >/= 4 on a scale of 0 to 10 received methylphenidate 5 mg by mouth every 2 hours as needed for 7 days (maximum, 20 mg/d). Multiple symptoms were assessed daily; the primary end point, fatigue, was measured using the 0 to 10 scale, and the Functional Assessment for Chronic Illness Therapy-Fatigue (FACIT-F) was performed at baseline, day 7, and day 28. The following mean (+/- standard deviation) scores for 30 assessable patients improved significantly between baseline and day 7: fatigue (0 to 10 scale), 7.2 +/- 1.6 v 3.0 +/- 1.9 (P <.001); overall well-being (0 to 10 scale), 4.5 +/- 2.2 v 2.8 +/- 2.1 (P <.001); fatigue (FACIT-F) subscore, 17.5 +/- 11.3 v 34.7 +/- 10.0 (P <.001); functional well-being, 14.4 +/- 5.9 v 18.3 +/- 6.6 (P <.001); and physical well-being, 13.5 +/- 6.4 v 21.4 +/- 5.0 (P <.001). Anxiety, appetite, pain, nausea, depression, and drowsiness all improved significantly (P <.05). All patients took afternoon or evening doses, and 28 patients (93%) took three or more doses daily. All patients chose to continue taking methylphenidate after 7 days of treatment. No serious side effects were reported. These preliminary results suggest that patient-controlled methylphenidate administration rapidly improved fatigue and other symptoms. Randomized controlled trials are justified.

Assessment and management of fatigue in patients with advanced cancer: developing guidelines.

Cancer-related fatigue is one of the most important untreated symptoms of cancer, with a prevalence between 60 and 100%, but there has been a reluctance to prioritize fatigue and develop effective management strategies. The development of standards and guidelines will encourage a more systematic approach and help to stimulate further research. The Mersey Palliative Care Audit Group has developed guidelines for the assessment and management of fatigue. These guidelines were produced following a regional survey, which looked at both the educational needs of nurses, and the impact of fatigue on patients with advanced cancer.

1394 - Developing a psychoeducational programme for the management of fatigue in patients receiving chemotherapy

1394 - Developing a psychoeducational programme for the management of fatigue in patients receiving chemotherapy