• Fatigue and tiredness are two different sensations
  • Tiredness is a universal sensation, usually has an identifiable cause, is short-lived, and is dissipated by a rest or sleep
  • fatigue experienced by people with cancer is often described as unusual or excessive whole-body tiredness, disproportionate to or unrelated to exertion, and is not easily expelled by sleep or rest
  • it can be acute or more long-term
  • it can have a profound negative impact on the person's quality of life by interfering in the ability to perform activities and roles, as a result, care givers begin to assume many roles and activities previously held by the patient
  • many factors may contribute to fatigue, including:
    • changes in energy production
    • loss of weight and appetite
    • decreased nutritional status
    • overactive or hyper metabolic state due to tumor growth
    • anemia
    • side effects of therapy (chemotherapy, radiation, biotherapy)
    • neurotoxicities of cancer or its treatment
    • changes in activity and rest patterns
    • depression
    • sleep disturbances


  • instruct patient and family to keep a diary for one week to identify time of day when they are most fatigued or have the most energy
  • - look at the contributing factors
  • be aware of warning signs of impending fatigue, including tired eyes, stiff shoulders, decreased or lack of energy, inability to concentrate, increased irritability, nervousness, anxiety, impatience
  • identify which activities or situations make fatigue better or worse
  • a "1 to 10" scale can be used to assess levels of fatigue, with 1 being the least amount of fatigue and 10 being the worst possible sensation of fatigue


  • develop a plan to pace activities by scheduling activities according to fatigue/energy patterns, see Suggestions for Energy Conservation
  • exercise may improve fatigue, develop an appropriate exercise program with the physician and physical therapist
  • monitor the effectiveness of medications and other strategies that you are using to control other symptoms such as pain, nausea and vomiting and insomnia
  • encourage a balanced diet with complex carbohydrates (grains, legumes, vegetables) that provide a more sustained source of energy over time
  • encourage plenty of water (8-10 glasses/day if not contraindicated) to maintain hydration and to excrete toxins that may be associated with fatigue
  • use distraction techniques to focus on things other than tiredness, illness or disease


Cimprich, B. (1995). Symptom management: loss of concentration. Seminars in Oncology Nursing, 11, (4), 279-88.

Kalman, D. and Villani, LJ. (1997). Nutritional aspects of cancer-related fatigue. Journal of the American Dietetic Association, 97 (6), 650-4.

McCorkle, R., Grant, M., Frank-Stromborg, M., Baird, S. Cancer Nursing: A Comprehensive Textbook, 2nd ed. Philadelphia: WB Saunders Company, 1996

Nail, LM and Winningham, ML. (1995). Fatigue and weakness in cancer patients: the symptoms experience. Seminars in Oncology Nursing, 11 (4), 272-8.

Piper, BW., Rieger, PT., Brophy, L., Haeuber, D., Hood, LE., Lyver, A. & Sharp, E. (1989). Recent advances in the management of biotherapy-related side effects: Fatigue. Oncology Nursing Forum, 16 (6), supplement.

Winningham, ML, Nail, LM, Burke, MB, Brophy, L, Cimprich, B. Jones, LS., Pickard-Holley, S., Rhodes, V., St. Pierre, B., Beck, S. et al. (1994). Fatigue and the cancer experience: the state of the knowledge. Oncology Nursing Forum, 21 (1), 23-36.

Early Palliative Care in Lung CA Focuses on Coping, Symptoms

Jan 31, 2013 - Early palliative care clinic visits, integrated with standard oncologic care for patients with metastatic lung cancer, emphasize symptom management, coping, and psychosocial aspects of illness, according to research published online Jan. 28 in JAMA Internal Medicine.

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