Fatigue and Weakness Management Algorithm
Hyperlinks indicate additional
information available in Fatigue Screen
guideline sections above: Numeric Rating Scale
(0–10 scale)
A = Assessment
M = Management
Fatigue Assessment Reversible Causes of Fatigue (A3)
• History • Anemia
• Physical Exam • Dehydration
• Labs • Hypokalemia
• Hyponatremia
• Hypomagnesemia
• Hypo/hypercalcemia
Muscle Weakness (A1) Assess for and treat persisting
• Hypothyroidism
pain, dyspnea, and nausea
Localized Weakness • Medicationinduced
contributing to fatigue
• Cerebral metastases • Alcohol/drugabuse
• Cerebral vascular accident • Infection
• Radiculopathy • Sleepdisorder
Assess for other causes of • Obstructive sleep apnea
Generalized Weakness
fatigue and treat, if appropriate • Chronic fatigue syndrome
• Deconditioning
• Paraneoplastic syndrome • Reversible causes of fatigue
• Polymyalgia • Depression
Distinguish fatigue from depression
• Polymyositis • Muscle weaknesss
See BCGuidelines.ca – Palliative Care Part 2 –
• Steroid induced myopathy
Depression Management Algorithm
• Steroid withdrawal, abrupt
Palliative Care Consult
for refractory symptoms
Non-pharmacological Treatments
General measures Education of patient and Stress management
• Individualized graded caregivers • Cognitive behavioural
exercise program • Normalize interventions
• Nutrition • Energy conservation • Support groups
• Assessment by Home • Sleep hygiene
and Community Care for • Fatigue scale
support in home
Pharmacological treatments (M1)
No Terminal phase Yes
of illness?
Methylphenidate OR Steroids
Dextroamphetamine OR (may be useful)
Modafanil (only if fatigue > 6/10)
BCGuidelines.ca: Palliative Care for the Patient with Incurable Cancer or Advanced Disease
Part 2: Pain and Symptom Management – Fatigue and Weakness (2017)
