Cella et al listed criteria for cancer-related fatigue that have been proposed for ICD-10. These criteria can help identify a patient with cancer whose quality of life is impacted by fatigue.

Criteria - all of the following:

(1) The presence of significant fatigue, diminished energy or increased need to rest, disproportionate to any recent change in activity level.

(2) 5 or more additional symptoms (see list below)

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

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

(5) The symptoms are not primarily a consequence of a comorbid psychiatric disorder (major depression, somatization disorder, somatoform disorder, delirium, etc.).


Additional symptoms to consider include:

(1) complaints of generalized weakness or limb heaviness

(2) diminished concentration or attention

(3) decreased motivation or interest to engage in usual activities

(4) insomnia or hypersomnia

(5) experience of sleep as unrefreshing or nonrestorative

(6) perceived need to struggle to overcome inactivity

(7) marked emotional reactivity (sadness, frustration, or irritability) to feeling fatigued

(8) difficulty completing daily tasks, attributed to feeling fatigued

(9) perceived problems with short-term memory

(10) postexertional malaise lasting several hours


The symptoms should be present every day or nearly every day during the same 2 week period in the past month.

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