Fatigue in palliative care

For most patients receiving palliative care, fatigue as a symptom has a major detrimental effect on quality of life. Fatigue is rarely the only symptom experienced. For a patient with an advanced illness, fatigue is often a combination of symptoms caused by medications and their side effects, progression of illness, and psychosocial factors, and it’s difficult to parse the role of each factor.

Fatigue is sometimes caused by an infection, anaemia, or dehydration. However, as the patient’s cancer or other illness advances, their significance as causes of fatigue diminishes.

In the final stages of illness, fatigue is a natural part of the dying process.

Fatigue may manifest as general weakness involving rapid muscle fatigue, reduced activity levels, lack of initiative, and sometimes, mental fatigue and trouble concentrating. Fatigue may negatively impact both the patient’s social life and mood.

As the patient’s strength decreases, the need for rest and sleep increases. For someone with an advanced illness, fatigue is not the kind of tiredness normally caused by exertion that passes with adequate rest; instead, the patient is usually fatigued despite resting. This may lead to disruptions in the patient’s circadian rhythm, an increased need to take naps during the day, and disruptions in sleep during the night. This, in turn, may result in a vicious circle of sorts: the more the patient sleeps during the day, the worse their sleep is during the night, which then leads to fatigue during the day, as well as an increased need to take naps.

There is no single cure for fatigue. It’s a good idea to talk to the attending physician about what might be contributing to fatigue, as well as potential ways to do something about these contributing factors.

Corticosteroids can sometimes be used to increase activity levels and appetite temporarily. Treatment with corticosteroids works best as a short-term course over a few weeks, since long-term use is associated with adverse effects, such as increasing muscle weakness or swelling. Corticosteroids also raise blood sugar levels.

Fatigue syndrome is often the sum of various factors and a normal part of the progression of illness. If the patient has the sufficient energy, muscle training may help slow down the progression of fatigue. In addition, exercise can make it easier to relax and aid sleep at night. However, overexertion only leads to more fatigue.

In the case of advanced illness, measures such as hydration support, nutrition interventions, and the use of nutritional supplements have been found largely unhelpful in decreasing fatigue.

Just knowing that fatigue is caused by the progression of illness may help the patient adapt to the situation. Sometimes the best help comes in the form of peer support.