Symptom: Fatigue

Initial Grading Reminder

CTCAE grading of fatigue:

Grade 1 (Mild): Relieved by rest
Grade 2 (Moderate): Not relieved by rest but limiting instrumental ADLs [e.g., handling transportation, shopping, housework, etc.]
Grade 3 (Severe): Not relieved by rest and affecting self-care ADLs [e.g., bathing, toileting, feeding]

Assessment and Grading

Characterize the symptom (onset, pace)

Ask the patient:

Have you had any issues with fatigue in the past? Is this a new or worsening symptom? When did it start or get worse? Has it developed gradually or suddenly? How does your energy level compare now vs before treatment began?

More sudden onset would be suggestive of an endocrinopathy.

Grade the symptom

Ask the patient:

Is your fatigue relieved by rest? If not, are you able to take care of yourself (feed yourself, bathe, use the bathroom)?

Patient Query Regarding Other Symptoms/Red Flags

Ask the patient:

Have you fainted? Are you short of breath? Do you have chest pain?

Patient Factors to Consider That Affect the Approach to Intervention

Consider the following in individualizing the intervention: Is the patient a good or poor historian? Any language barriers or cognitive deficits? Is the patient reliable (able to carry out treatment recommendations)? Does this patient have alcohol/substance abuse issues? Does the patient have transportation? Is there sufficient caregiver support?

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    Suggested Intervention

    Patients with new onset severe or worse (or worsening) fatigue should be seen.

    Patient with any of the red-flag symptoms should be seen immediately. If they have fainted, they should be driven to the office or ED. For severe shortness of breath or chest pain, they should go right to the ED.

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    Nursing Assessment of Potential Causes

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    Differential Diagnosis

    What do you suspect is the cause of the fatigue?