From the Guidelines
To assess fatigue, healthcare providers should use a 10-point numerical rating scale (NRS) for fatigue as the primary screening tool, and for scores of 4 or higher, use a more specific questionnaire such as the Brief Fatigue Inventory (BFI) to evaluate the impact of fatigue on daily activities. This approach is supported by the most recent and highest quality study 1, which emphasizes the importance of self-report measures in assessing cancer-related fatigue.
When assessing fatigue, healthcare providers should ask patients about:
- The duration, onset, pattern, and severity of their fatigue
- Associated symptoms such as sleep quality, mood changes, pain, shortness of breath, and changes in appetite or weight
- The impact of fatigue on daily functioning, including work, exercise, and completion of daily tasks
- Potential contributing factors, including recent illnesses, medication changes, stress levels, and diet and exercise habits
A focused fatigue history should include:
- Onset, pattern, and duration of fatigue
- Change over time
- Associated or alleviating factors
- Interference with function and daily activities
Additionally, a thorough medical examination, evaluation of the status of the underlying malignant disease, review of body systems, mental status examination, and laboratory blood tests should be performed to identify contributing and comorbid conditions that require treatment 1.
It is also important to consider social and environmental contributors to fatigue, as well as the patient's self-assessment of the causes of fatigue 1.
By using a combination of self-report measures and clinical evaluation, healthcare providers can develop an effective treatment plan to manage fatigue and improve the patient's quality of life.
From the FDA Drug Label
Fatigue 2 1 The question of assessing for fatigue is not directly addressed in the provided drug labels. Main points:
- The drug labels for modafinil and armodafinil do not provide a direct answer to the question of assessing for fatigue.
- The labels do mention fatigue as an adverse reaction, but this is not directly relevant to assessing for fatigue.
- No conclusion can be drawn from the provided information. 2 3
From the Research
Assessment of Fatigue
To assess fatigue, a comprehensive approach is necessary, including:
- A thorough history to determine the type of fatigue and establish an effective therapeutic relationship 4
- A complete physical examination to guide the workup and diagnosis 5, 6
- Identification of common secondary causes, such as medications, anemia, and pregnancy 7
- Consideration of lifestyle issues, physical conditions, mental disorders, and treatment side effects 7, 8
Classification of Fatigue
Fatigue can be classified as:
- Physiologic, which can be addressed by proper sleep hygiene, a healthy diet, and balancing energy expenditure 5
- Secondary, which is improved by treating the underlying condition 5, 6
- Chronic, which may require cognitive behavior therapy, exercise therapy, and acupuncture 5, 6
Diagnostic Evaluation
The diagnostic evaluation of fatigue should focus on:
- A thorough history and complete physical examination to rule out most medical causes of fatigue 8, 6
- Screening laboratory tests to identify potential underlying medical conditions 7, 8
- Avoiding unnecessary laboratory tests and "fishing expeditions" 8, 6
Management of Fatigue
The management of fatigue should prioritize:
- Treating underlying medical conditions 5, 6
- Individualized exercise therapy and cognitive behavioral therapy 6
- Educating patients about pacing their activity and not exceeding their limited energy capacity, especially for those with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) 5
- A commitment to long-term follow-up and an effective therapeutic relationship with the patient 4