What are the recommended treatments for fatigue?

Recommended Treatments for Fatigue

Physical activity is the most effective intervention for managing fatigue and should be recommended as the first-line approach for most patients experiencing moderate to severe fatigue. 1, 2

Evaluation of Fatigue

• Screen for fatigue using a 0-10 scale, with moderate to severe fatigue defined as a score of 4-10 1
• Conduct a focused history and physical examination for patients with moderate to severe fatigue to identify treatable contributing factors 1
• Assess for common contributing factors including:
  • Emotional distress and depression 1
  • Sleep disturbances 1
  • Pain 1
  • Medication effects 1
  • Medical conditions (cardiac disease, hypothyroidism, anemia) 1
• Laboratory evaluation may include complete blood count and thyroid function tests based on symptoms 2

First-Line Interventions

Physical Activity (Category 1 recommendation)

• Gradually increase physical activity with a goal of 150 minutes of moderate aerobic exercise weekly plus 2-3 strength training sessions 1, 2
• Regular exercise improves strength, energy, fitness, decreases anxiety/depression, and increases activity tolerance 1
• For significantly deconditioned patients, consider referral to a physiatrist or supervised rehabilitation program 1
• Caution: Exercise may be harmful for patients with myalgic encephalomyelitis/chronic fatigue syndrome due to risk of post-exertional malaise 3

Psychosocial Interventions (Category 1 recommendation)

• Cognitive behavioral therapy (CBT) has strong evidence for reducing fatigue 1, 2
• Psychoeducational therapy and supportive expressive therapy (including support groups, counseling, journal writing) are effective 1
• CBT specifically targeting sleep quality can improve both sleep and fatigue 1

Energy Conservation and Planning

• Teach patients to monitor and plan activities according to energy levels using a daily/weekly diary 1, 2
• Prioritize essential activities and delegate less important tasks 1
• Schedule activities during peak energy periods 1, 2
• Limit daytime naps to less than one hour to avoid disturbing nighttime sleep 1

Additional Interventions

Sleep Hygiene Improvements

• Establish consistent sleep and wake times 2
• Create a restful sleep environment 2
• Avoid caffeine, alcohol, and electronic devices before bedtime 2
• Consider CBT for sleep (Category 1 recommendation) 1, 2

Nutritional Interventions

• Consider nutritional consultation for patients with nutritional deficits 1
• A nutrient-rich diet including green vegetables, quality protein sources, and adequate fat intake may help reduce fatigue symptoms in some patients 4

Pharmacologic Interventions

• Treat underlying medical conditions contributing to fatigue 1
• Consider short-term hypnotics for insomnia if non-pharmacologic approaches are insufficient 1
• Psychostimulants like methylphenidate may be considered for short-term use in advanced cancer after ruling out other causes of fatigue 1
• Corticosteroids like methylprednisolone may provide short-term benefit in advanced cancer 1

Special Considerations

• For cancer-related fatigue, education about expected fatigue patterns during and after treatment is essential 1
• For chronic fatigue syndrome/ME/CFS, focus on pacing activities within energy limits rather than pushing through fatigue 3, 5
• Fatigue at end of life often occurs with multiple symptoms and may require different management approaches 1

Monitoring and Follow-up

• Regular self-monitoring of fatigue levels using a diary helps document improvement 2
• Reassess fatigue levels at regular intervals to evaluate treatment effectiveness 2
• If fatigue persists despite interventions, consider referral to specialists 2