PubMed · 14968683
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Roland W Gray. 2004. Here to help.. https://pubmed.ncbi.nlm.nih.gov/14968683/
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Fatigue is the most prevalent cancer-related symptom and has a significant adverse impact on patients' functional ability and quality of life. Hypotheses regarding the aetiology of cancer-related fatigue are discussed, and clinical practice guidelines for the evaluation and management of oncology patients with fatigue are reviewed. Both nonpharmacologic and pharmacologic strategies for the management of fatigue are summarised.
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Chronic fatigue is a typical symptom of neurological diseases, and is most disabling in multiple sclerosis, postpoliomyelitis, poststroke, and in chronic fatigue syndrome. Disorders of neuromuscular junction transmission and metabolic diseases cause muscle fatigability, which is characterised by failure to sustain the force of muscle contraction (peripheral fatigue). Fatigue is also seen in diseases that affect the central, peripheral, and autonomic nervous systems (central fatigue). Enhanced perception of effort and limited endurance of sustained physical and mental activities are the main characteristics of central fatigue. Metabolic and structural lesions that disrupt the usual process of activation in pathways interconnecting the basal ganglia, thalamus, limbic system, and higher cortical centre are implicated in the pathophysiological process of central fatigue. A state of pre-existing relative hypocortisolaemia might sensitise the hypothalamic-pituitary-adrenal axis to development of persistent central fatigue after stress. The contributions of physiological, cognitive, and affective changes underlying fatigue are variable, and treatment is largely symptomatic and rehabilitative.