From the Guidelines
To evaluate fatigue, start with a comprehensive medical history and physical examination to identify potential causes, as recommended by the American Society of Clinical Oncology 1. This approach is crucial because fatigue significantly impacts quality of life and may signal serious underlying conditions that require specific treatment. The evaluation should include:
- A focused fatigue history, including onset, pattern, duration, change over time, and associated or alleviating factors 1
- An assessment of disease status, including the risk of recurrence based on stage, pathologic factors, and treatment history 1
- A review of systems to determine if other symptoms substantiate suspicion for recurrence 1
- An evaluation of treatable contributing factors, such as comorbidities, medications, alcohol/substance abuse, nutritional issues, and deconditioning 1
- Laboratory tests, including complete blood count, comprehensive metabolic panel, thyroid function tests, and inflammatory markers like ESR or CRP, as indicated by the presence of other symptoms and the onset and severity of fatigue 1
- Screening for depression and anxiety using standardized questionnaires such as PHQ-9 or GAD-7 [@Example@]
- Additional testing, such as sleep studies, if sleep apnea is suspected, or more specialized tests based on clinical findings [@Example@] Treatment should target the underlying cause, whether it's anemia, hypothyroidism, depression, or sleep disorders, and lifestyle modifications are essential regardless of cause, including regular exercise, consistent sleep schedule, stress management techniques, and proper nutrition [@Example@, 1]. Some key points to consider in the evaluation and management of fatigue include:
- The importance of a thorough history and physical examination to identify potential causes of fatigue 1
- The need to assess for treatable contributing factors, such as comorbidities and medications 1
- The role of laboratory tests in evaluating fatigue, including complete blood count, comprehensive metabolic panel, thyroid function tests, and inflammatory markers like ESR or CRP 1
- The importance of screening for depression and anxiety using standardized questionnaires such as PHQ-9 or GAD-7 [@Example@]
- The need for lifestyle modifications, including regular exercise, consistent sleep schedule, stress management techniques, and proper nutrition, regardless of the underlying cause of fatigue [@Example@, 1]
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Fatigue Evaluation
- Fatigue is a common presenting symptom in primary care, negatively impacting work performance, family life, and social relationships 2.
- The differential diagnosis of fatigue includes lifestyle issues, physical conditions, mental disorders, and treatment side effects 2, 3.
- Fatigue can be classified as secondary to other medical conditions, physiologic, or chronic 2, 4.
Causes of Fatigue
- Sleep disorders and sleep-related disorders of breathing, depression, and excessive psychosocial stress are the most common causes of persistent fatigue 3.
- Previously undiagnosed cancer is a rare cause of fatigue, accounting for only 0.6% of cases 3.
- Anemia and other organic causes are also rare, accounting for 4.3% of cases 3.
Diagnosis and Management
- A comprehensive history and physical examination should focus on identifying common secondary causes and life-threatening problems 2, 4.
- Laboratory studies are only necessary in the presence of additional symptoms or findings, and repeat testing is generally not indicated if initial results are normal 2, 3.
- Treatment of fatigue should include a structured plan for regular physical activity, such as walking, and may also include cognitive behavior therapy, exercise therapy, and acupuncture 2, 4.
- Patients with chronic fatigue may benefit from psychoeducative and psychotherapeutic approaches, as well as an individually adapted exercise program 3, 4.