What are the causes of exhaustion (fatigue)?

From the Guidelines

Exhaustion, or fatigue, is a complex condition with multiple contributing factors, including the cancer itself, effects of cancer treatments, physical and psychological comorbidities, and cognitive, emotional, and behavioral responses to diagnosis and treatment, as noted in the most recent guideline update by the American Society of Clinical Oncology (ASCO) and the Society for Integrative Oncology 1. To address exhaustion, it is essential to consider the multifaceted nature of this condition. The following factors can contribute to fatigue:

• The cancer itself
• Effects of cancer treatments
• Physical and psychological comorbidities, such as depression and anxiety
• Other physical symptoms, like pain and sleep disturbance
• Physical inactivity and deconditioning
• Cognitive, emotional, and behavioral responses to diagnosis and treatment Given the complexity of fatigue, managing it requires a comprehensive approach that includes lifestyle modifications, such as prioritizing sleep, maintaining a balanced diet, staying hydrated, and engaging in regular physical activity, as well as addressing underlying medical conditions and psychological factors, as recommended in the ASCO-Society for Integrative Oncology guideline update 1. Some key strategies for managing exhaustion include:
• Prioritizing sleep and aiming for 7-9 hours of quality sleep nightly
• Maintaining a balanced diet that includes complex carbohydrates, lean proteins, and healthy fats
• Staying hydrated by drinking 2-3 liters of water daily
• Engaging in regular physical activity, such as walking or light exercise, to help improve energy levels and reduce fatigue
• Implementing stress management techniques, like deep breathing, meditation, or gentle yoga, to help cope with the emotional and psychological aspects of fatigue
• Consulting a healthcare provider to rule out underlying medical conditions, such as anemia, thyroid disorders, or depression, which can contribute to fatigue, and to discuss potential treatments, including medications and therapy, as outlined in the guideline update 1. By taking a comprehensive approach to managing exhaustion, individuals can help alleviate their symptoms, improve their quality of life, and reduce the impact of fatigue on their daily functioning, as supported by the evidence from the ASCO-Society for Integrative Oncology guideline update 1.

From the Research

Causes of Exhaustion (Fatigue)

The causes of exhaustion, also known as fatigue, can be complex and multifaceted. According to various studies, some of the key factors that contribute to exhaustion include:

• Mental illness, particularly stress-related disorders such as exhaustion disorder 2
• Persistent non-traumatic stress 3
• Burnout, which is often characterized by emotional exhaustion, cynicism, and reduced performance 3
• Lack of sleep, sleep disturbances, and other sleep-related problems 2, 4
• Gastrointestinal symptoms, back pain, and other physical complaints 2
• Anxiety, depression, and other mental health conditions 5, 2, 6
• Trauma, although some studies focus on non-traumatic stress 3

Risk Factors

Certain individuals may be more prone to exhaustion due to various risk factors, including:

• Age, with older adults being more likely to experience exhaustion 2, 6
• Gender, although some studies found no significant gender differences 2
• Comorbidity, with patients having mental or somatic comorbidity being more likely to experience exhaustion 2
• Sickness absence, with patients having a higher frequency of sickness absence being more likely to experience exhaustion 6

Diagnostic Considerations

It is essential to accurately diagnose exhaustion disorder and distinguish it from other conditions, such as major depressive disorder and adjustment disorder 6. The diagnostic criteria for exhaustion disorder may include general fatigue, cognitive deficits, and other symptoms 6. Healthcare professionals should be attentive to presenting complaints, such as stress-related symptoms, anxiety, and depression, to identify patients at risk of developing exhaustion disorder 2.