Introduction

Fatigue and asthenia are present in some extent in 70–90% of patients with advanced cancer., Nevertheless until now this symptom has been widely neglected by clinical attention and by research, for several reasons:

• It is not reported by patients because they accept it as inevitable.

• It is therefore not identified by the physician, since it is not visible.

• Even if it is identified it is not therapeutically addressed.

Fatigue and asthenia are usually inseparably associated with the tumor by patient and caregiver. Since a well-trained palliative care team may be able to control frequent major symptoms such as pain, nausea or dyspnea, asthenia will become the most important cause of physical and psychosocial suffering.

Clinical features

The onset of fatigue may be one of the first symptoms and even precede the diagnosis of a malignancy. It may be present during the whole course of a disease and increase following anticancer treatments. However, in the palliative care setting it is usually not an issue for aggressive assessment or treatment.

Fatigue is a multidimensional symptom. It can be divided roughly into physical and mental aspects. Patients report muscle weakness and effort intolerance, in the meantime also a lack of motivation and interest, and difficulty in maintaining concentration. In a more advanced stage, patients do not start an activity since they know or fear that they will not be able to accomplish it. Other than in a physiological tiredness neither rest nor sleep may improve performance.