Subjective feelings of tiredness, weakness and lack of energy.

Lack of energy and motivation.

Approximately 15% of women and 10% of men in the US feel either exhausted or extremely tired every day or most days of the preceding three months (Blackwell D).

Different from drowsiness, but can be symptom of fatigue.

A multidimensional symptom with physical, emotional and cognitive associated factors.

Characteristically manifests by an inability to initiate normal activities due to perceived weakness.

There is a reduced capacity to maintain activities.

Associated with difficulty with memory, concentration, and emotional stability.

Associated with decreased alertness, concentration, clarity of thoughts, and increased forgetfulness.

Associated with increased emotional lability, anger and depression.

May be associated with social isolation.

Alters physical function with reduced activities, prolonged periods of rest, increased uncoordinated movements, increased risk of falling, increased need for assistance to meet basic activities of daily living.

Depressed mood one of the strongest correlates.

Associated with disturbances in physiologic, biochemical and psychological processes.

Progressive  loss of the ability to generate maximum force during, or following, repeated or sustained muscle contractions.

Involves chronic exhaustion and diminished capacity for physical activity that is not relieved by rest.

Associated with  inability to maintain force during a task.

May originate from the cerebral cortex to muscle cross bridge cycling.

The basal ganglia influences motivation and drive with increased activity results in higher fatigue scores.

Increased levels of cytokines may alter blood flow in the cerebellum and lead to fatigue.

It is suggested the central nervous system has a significant role in cancer related fatigue.

Prevalence between 6 and 7 1/2%.

Estimated 21-33% of patients seek medical attention in primary care settings have significant fatigue.

Accounts was 7 million office visits per year in United States.

Majority of patients who present with fatigue are women.

Categorized by its duration of symptoms: recent-less than one month, prolonged- 1 to 6 months, or chronic-greater than six months.

Divided into central and peripheral types of fatigue.

Causes: organic (infectious, immunologic) , physiological, cancer related, toxin related, cardio-pulmonary disease related, chronic fatigue syndrome, and psychogenic

Common in many disorders including cancer, COPD, multiple sclerosis, mitochondrial diseases, Parkinson’s disease, neuromuscular disorders, post stroke and post polio.

Some common factors that can contribute to fatigue:

Lack of Sleep

Many medical conditions can cause fatigue, including chronic diseases such as diabetes, heart disease, thyroid disorders, anemia, autoimmune disorders, and infections like flu or mononucleosis. 

Mental health conditions like depression, anxiety, and chronic stress can also contribute to fatigue.

Medications:certain antihistamines, opioids, sedatives, muscle relaxants, and some antidepressants.

Lifestyle Factors: Poor diet, lack of regular exercise, excessive physical or mental workload, and high levels of stress can all contribute to fatigue. 

Unhealthy lifestyle choices can disrupt energy balance and affect the body’s overall functioning.

Nutritional Deficiencies: Inadequate intake or absorption of essential nutrients, such as iron, vitamin B12, folate, or vitamin D, can lead to fatigue. 

These nutrients play important roles in energy production and maintaining optimal bodily functions.

Hormonal changes, such as those that occur during menopause or specific conditions like hypothyroidism or adrenal insufficiency, can contribute to fatigue. 

Hormones play a key role in regulating the body’s energy levels.

Emotional and psychological factors, such as chronic stress, anxiety, grief, or depression, can lead to fatigue and impact overall well-being.

Fatigue can also be a symptom of more serious underlying medical conditions. 

Described as overwhelming tiredness at rest, exhaustion with any activity, a lack of energy, inertia, impaired endurance and lack of vigor.

Fatigue  that lasts six months without an underlying disorder is referred to as the chronic fatigue syndrome.

Central fatigue refers to impaired muscle performance arising from the central nervous system (Taylor JL).

Associated with sleep disturbances, pain, age and medical comorbid illnesses.

No real association with types of treatment or biological factors such as anemia.

75%-90% of patients with cancer or other chronic illness have this symptom.

Most common symptom experience by people with cancer.

Cancer related fatigue has an overall prevalence of 74%.

May become a chronic problem after treatment for cancer is completed.

Symptoms characterized by frequency, intensity, and chronicity can be evaluated by Fatigue Symptom Inventory or Profile of Mood States.

Increased during radiotherapy and decreases after its completion.


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