Fatigue/ Insomnia

Question 1

Fatigue

Answer 1

• A multidimensional phenomenon that develops over time, diminishing energy, mental capacity, and psychologic condition.
• NOT relieved by REST and NOT primarily consequences of depression

Question 2

Cancer-related fatigue

Answer 2

1. The following symptom has been present every day or almost 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.

NO persistent self-deprecation, SAD, worthless

2. In addition, five (or more) of the following symptoms have been present every day or almost every day during the same 2-week period in the past month:

• 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, irritability) to feeling fatigued Difficulty completing daily tasks attributed to feeling fatigued
• Perceived problems with short-term memory
• Postexertional malaise lasting several hours

3. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

4. There is evidence from the history, physical examination, or laboratory findings that the symptoms are a consequence of cancer or cancer-related therapy.

5. The symptoms are not primarily a consequence of co-morbid psychiatric disorders such as major depression, somatization disorder, somatoform disorder, or delirium.

Question 3

Cancer-related fatigue PATTERN

Answer 3

• Radiation therapy typically causes a slow progression followed by gradual resolution. Severity relates to fraction size and duration of treatment.
• Chemotherapy tends to be more CYCLIC, with an episode of fatigue occurring shortly after treatment and lasting several days, followed by a second peak if neutropenia occurs.

Question 4

PHARMACOLOGICAL INTERVENTIONS

Answer 4

Psychostimulant

Antidepressants

Steroids

Donepezil

Multivitamin

Question 5

Choosing drugs

Answer 5

1) other comorbid symptoms that might be addressed with the same medication (e.g., depression, fatigue,and sedation with methylphenidate)
2) life expectancy (e.g., dexamethasone for short-term use
3) cost (e.g., modafinil)