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Fatigue is a symptom.
Its presence and all its characteristics can only be validly
ascertained through patient report. Although objective measurements,
such as exercise tolerance, can be illuminating, fatigue itself
is inherently subjective. Case ascertainment and measurement
of outcomes relies on the use of valid and reliable questionnaires.
Research is focused
on pathologic fatigue. The development of a well accepted definition
of pathologic fatigue would be a useful foundation for the questionnaires
that elicit information about the symptom. Unfortunately, there
is no definition of pathologic fatigue that has yet been validated
in any patient population. A definition of cancer-related fatigue
developed for the International Classification of Diseases (ICD
10th Revision-Clinical Modification) (Cella
et al., 1998) is a good model, however, and is currently
undergoing validation.
| Table
3.1: Proposed Criteria for Cancer-Related Fatigue
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- The
following symptoms have been present every day
or nearly every day during
the same 2-week period in the past month:
- Significant
fatigue, diminished energy, or increased need
to rest, disproportionate to any recent change
in activity level.
Plus
five (or more) of the following:
- Complaints
of generalized weakness or limb heaviness
- Diminished
concentration or attention
- Decreased
motivation or interest in engaging in usual
activities
- Insomnia
or hypersomnia
- Experience
of sleep as unrefreshing or nonrestorative
- Perceived
need to struggle to overcome inactivity
- Marked
emotional reactivity (e.g., sadness, frustration,
or irritability) to feeling fatigued
- Difficulty
completing daily tasks attributed to feeling
fatigued
- Perceived
problems with short-term memory
- Post-exertional
malaise lasting several hours
The
symptoms cause clinically significant distress
or impairment in social,
occupational, or other important areas of functioning.
There
is evidence from the history, physical examination,
or laboratory findings
that the symptoms are the consequence of cancer
or cancer-related therapy.
The symptoms are not primarily a consequence of
comorbid psychiatric disorders
such as major depression, somatization disorder,
somatoform disorder,
or delirium.
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