Efforts to address
the problem of fatigue are part of a steadily increasing focus
on the quality of life concerns of patients with serious illness.
The management of fatigue can be broadly subsumed under the
therapeutic model known as palliative care, which is primarily
focused on these quality-of-life concerns. Palliative care is
an interdisciplinary approach that emphasizes the comprehensive
management of the physical, psychological, social and spiritual
needs of patients with progressive incurable illnesses and their
families (Billings,
1998). To optimize palliative care, clinicians attempt
to ensure that physical comfort is a priority, that practical
needs are addressed, that psychosocial and spiritual distress
is managed, values and decisions are respected, and opportunities
become available for growth and closure. Although the need for
palliative care intensifies as death approaches, the concerns
addressed by this model, including fatigue, are relevant at
any point during the course of a life-threatening illness.
The prevalence rates
for fatigue in populations with serious medical illnesses are
far higher than the base rate of less than 20% that exists in
the general population (Pawlikowska
et al., 1994; Loge
et al., 1998). A recent population-based survey observed
that 78% of cancer patients had experienced significant fatigue
(Vogelzang
et al., 1997) and that the symptom had adversely
affected function in most of these patients. Other surveys confirm
that more than 75% of patients with metastatic neoplasms report
clinically significant fatigue (Curtis
et al., 1991; Dunphy and Amesbury,
1990; Dunlop, 1989; Portenoy
et al., 1994; Ventafridda
et al., 1990), and that prevalence rates even higher
than this occur in association with chemotherapy, radiation
therapy, and the administration of biologic response modifiers
such as the interferons and interleukins (Greenberg
et al., 1992; Haylock
and Hart, 1979; Hickok
et al., 1996; Smets
et al., 1996; Irvine
et al., 1991; Irvine
et al., 1994; Dean
et al., 1995; Pickard-Holley,
1991). A few studies have documented the potential
for chronic fatigue in long-term cancer survivors (Fobair
et al., 1986; Joly
et al., 1996; Berglund
et al., 1991; Okuyama
et al., 2000; Loge
et al., 1999; Loge
et al., 2000). Most of these surveys demonstrate
relationships between fatigue and various phenomena related
to impaired quality of life, including negative mood, diminished
performance status, and sleep disturbance.