Fatigue in palliative care patients

Categories: Research.

Fatigue is a well-known and closely monitored symptom in palliative care patients and is associated with a broad range of illnesses.  According to the researchers, when measured in cancer patients undergoing palliative care, or having just completed radio- and/or chemotherapy, fatigue is present in 80%-99%, a significantly high measurement. However, fatigue should not be considered a “cancer only” problem in palliative care.  Fatigue complicates palliative care measures in patients with diseases including, “HIV, multiple sclerosis, chronic obstructive pulmonary disease or heart failure” (Palliative Medicine, 2008).  The widespread prevalence of fatigue occurring in patients undergoing palliative care served as the inspiration for this study.  The study outlines clear goals which are:

•    Evaluate available evidence on diagnosis and treatment of fatigue in palliative care patients.
•    Analyze findings to provide the basis for future discussions on the issue.
•    Examine how cultural issues effect the treatment of fatigue in palliative care.

•    Adequate recognition, assessment and treatment of fatigue in palliative care.

Defining Fatigue in Palliative Care

For the purpose of this study, fatigue was defined as, “a subjective feeling of tiredness, weakness or a lack of energy” (Palliative Medicine, 2008).  Reaching this definition was a significant challenge for researchers because of the multidimensional nature of fatigue, however researchers eventually came to a mutually agreed-upon and functioning definition of “fatigue” in palliative care.  It is arguable that there are too many different degrees of fatigue being felt by palliative care patients to encapsulate the term into one definition. According to this study’s authors, “The pathophysiology of fatigue in palliative care patients is not fully understood.”  Although difficult to decide, once agreed upon, the researchers posited their definition in designing the remainder of their research.

Determining Fatigue: Physical, Mental and Emotional

As noted in the above section, simply determining what fatigue was and how it was effecting palliative care patients proved to be a herculean task for this study’s researchers.  Fatigue is known to be a widespread symptom in those undergoing palliative care, but researchers wanted to understand exactly how much fatigue impacted the quality of life of palliative care patients.  According to this study, “Fatigue in cancer and non-cancer palliative care patients is under-recognized, under-assessed and under-treated.”

Fatigue diminishes quality of life for palliative care patients because it makes it significantly more difficult to engage in previously enjoyable activities and furthermore, adds a degree of difficulty to everyday acts of independent living.  Fatigue does not always manifest itself physically.  Cognitive fatigue can make activities such as reading or other simple leisure activities extremely difficult to partake in.  The emotional effects of fatigue on palliative treatment patients is not entirely understood due to a lack of research on the topic.  However as deduced by this study, “Fatigue often is associated with affective disturbances and patients feel listless, depressed, irked or paralyzed.”  Although some of the aforementioned ascribing adjectives are somewhat abstract, it is reasonable to infer that fatigue manifests itself negatively in a palliative care patient as well.  Although it is a common (possibly one of the MOST common) symptoms in palliative care patients, attention to it as a research topic has been dwarfed due to other more noticeable/worrisome symptoms such as pain or dysponea (Palliative Medicine, 2008).

Findings of the Study

The study advances several interesting findings on the topic of fatigue as well as laying foundational work for future studies on fatigue in palliative care.  NHPCO strongly encourages readers to turn to the original text to gain a better understanding of these findings.  But in brief, a summary is provided below:

•    Researchers acknowledged both a physical and cognitive dimension to fatigue.
•    The proposed term “weakness” now refers to the physical dimension of fatigue.
•    The proposed term “tiredness” now refers to the cognitive dimension of fatigue.

•    The topic of fatigue is so complicated that this study was limited in information gathering.  For future research, “multidimensional specific questionnaires” should be used to accurately capture physical, cognitive and emotional characteristics of fatigue.

Although it did yield some concrete facts, this study developed a more exploratory focus due to the complexity of the topic.  Possibly the most important result of the study is that, a universal understanding that fatigue has both a physical and cognitive dimension is entirely new to the medical community and will shape how fatigue is interpreted in palliative care plans.

The Need for Self -Assessment

Gathering usable data from participants was one of the researcher’s largest problems.  In attempting to devise accurate measuring tools such as surveys and questionnaires, researchers missed out on the nuances of fatigue. According to the researchers of the study, the most effective way to measure both the level of fatigue in a patient and the effect of the fatigue on the patient is by subjective self- evaluation by the actual patient.  This self- assessment does not put all the onus on the patient to self-deduce their condition but rather, their self-assessment is the most organic and accurate.  The results will be given to the palliative care staff who will use it as a gauge for understanding the patients well-being.  Until the point of this study’s publication, previous tools implemented for measuring and assessing fatigue have been found to be ineffectual.

Treating Fatigue

Currently, there are some experimental treatments when treating fatigue, while others are more accepted.  According to the study at hand. “Casual treatment of primary fatigue with anti-cytokine or anti-inflammatory pharmacological approaches is under investigation although is currently lacking both promising results and a favorable risk-benefit relationship.”  Although these new approaches are not ready for widespread use, the researchers do advocate a proper way to effectively treat fatigue.  Researchers state that the large majority of palliative care patients will utilize both symptomatic treatment for fatigue along with pharmacological and/or non-pharmacological interventions in their palliative care treatment program (Palliative Medicine, 2008).  Treatment options are typically grouped into two categories, Symptomatic nonpharmacological treatment and Symptomatic pharmacological treatment which are briefly outlined below:

•    Symptomatic nonpharmacological treatment – monitoring activities, planning rest & re-cooperation, holistic approaches with no chemical intervention

•    Symptomatic pharmacological treatment – utilization of stimulating drugs to achieved desired effects.

Conclusion and Publication Information

This study is useful in that it helped define a previously ambivalent term in the medical industry.  With a universally understood definition, research efforts can begin to coordinate efforts in better understanding and developing treatments for fatigue in palliative care patients.  This study also proposes several testing protocols that utilize patient self-subjective testing.  The format of NHPCO’s summary does not allow for us to include all the protocols which this study generated.  Those interested in seeking out these innovative processes should access the original text using the information below.

Publication Information: Palliative Medicine, 2008; vol. 22 I 3-32
Author Information:
•    Lukas Radbruch
•    Florian Strasser
•    Frank Elsner
•    Jose Ferraz Goncalves
•    Stein Kaasa
•    Friedemann Nauck
•    Patrick Stone

•    European Association for Palliative Care (EAPC)

URL: http://pmj.sagepub.com/search/results?fulltext=Fatigue+in+palliative+care+patients+%E2%80%93+an+EAPC+approach&x=0&y=0&submit=yes&journal_set=sppmj&src=selected&andorexactfulltext=and

doi: 10.1177/0269216307085183

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As a continuing part of NHPCO’s mission to expand access of educational material on the topics of hospice and palliative care available to the public, NHPCO will provide comprehensive summaries on the latest and most influential research in the field today.  All findings, facts and figures are accredited to the original author(s).  We encourage readers to investigate the full text of these studies. Information on where to acquire the original text will be provided at the end of the summary.