Fatigue, one of the biggest unmet needs in healthcare

Beyond tired

We’ve all experienced fatigue at some point in our lives. Whether it’s a flu that has knocked you for six or being a new parent living on stolen hours of sleep. For most of us, fatigue is a short-lived experience, which we can recover from with sleep and rest. However, for people living with certain health conditions, fatigue can be an ongoing and persistent problem. It is described as an extreme tiredness; an overwhelming sense of exhaustion that affects the patient both physically and mentally. ¹ Often this type of fatigue is not relieved by sleep or rest. The nature of this profound fatigue can make it difficult for others to understand.¹

Fatigue is a significant unmet need for patients across therapeutic areas and stages of treatment

‘Fatigue is considered one of the most important disease outcomes by patients with chronic health conditions.’²

Fatigue is one of the biggest problems faced by people with health conditions, even when their condition is under control or treatment has stopped.^1,3,4 It’s highly prevalent in oncology, immunology, and cardiovascular and kidney diseases, as described below. Fatigue is also common in rare diseases⁵ and affects both adults and children.⁶ Understanding, managing, and treating fatigue is a top research priority for many therapeutic areas.⁷

The impact of an invisible symptom

Living with persistent fatigue has a big impact on people’s lives. Fatigue is often reported as one of the most difficult symptoms patients have to deal with.^1,3,4 It is ranked as more bothersome than pain or nausea in breast cancer and two thirds of multiple sclerosis patients rate it as their most troubling symptom.^8,9 Fatigue in health conditions is associated with poorer quality of life, increased anxiety and depression, poorer cognition, increased disability and job loss. ^10–12

Fatigue also has implications for clinical outcomes. It impairs patients’ self-management and adherence to prescribed treatment and is associated with an increased risk of disability, physical decline, and mortality.^13,14  Research also shows that fatigue is more pronounced in underserved communities.^15,16 Targeting fatigue is therefore an important step in addressing health disparities.

Despite its prevalence and impact, fatigue is often under-recognised and under-treated by healthcare professionals.³  

‘Fatigue is often it’s overlooked. Yet there are things we can do to support patients with persistent fatigue.’

Understanding and treating fatigue

Currently, there are no effective pharmacological treatments for persistent fatigue.¹⁷ However, the good news is that we can support patients in managing and even reducing fatigue through tailored psychological interventions. Research shows that interventions which address factors such as sleep disturbances, physical inactivity, or self-efficacy are effective in reducing fatigue in a number of different conditions. ¹⁷ By addressing the under-treated symptom of fatigue, we have an opportunity to make a meaningful difference for patients.

To progress the field, fatigue needs to be included in health outcomes research. This requires a consensus on how to measure fatigue in different conditions.¹⁸ Measuring fatigue within health conditions is challenging given its subjective nature and close relationship with other aspects of illness (e.g., pain, depression, disability).¹² However, by listening to and working with patients it is possible to develop ‘gold-standard’ instruments that accurately capture the fatigue experience, which may be unique in different conditions.¹⁸

Recognizing the impact of fatigue on patients’ lives and routinely assessing fatigue is the first step in establishing the most effective treatments to manage this invisible but pervasive problem.

Dr Alicia Hughes has published on the topic of fatigue in chronic conditions and has developed programs to support patients with fatigue and other symptoms. To read a recent publication exploring cancer related fatigue click here. Please reach out to us at alicia.hughes@sprout-hs.com if you would like to discuss research related to support needs of patients or the development of measurement and evaluation techniques.

References:

1. Jaime-Lara, R. B., Koons, B. C., Matura, L. A., Hodgson, N. A. & Riegel, B. A qualitative metasynthesis of the experience of fatigue across five chronic conditions. Journal of pain and symptom management 59, 1320–1343 (2020).

2. Chalasani, M., Vaidya, P. & Mullin, T. Enhancing the incorporation of the patient’s voice in drug development and evaluation. Research involvement and engagement 4, 1–6 (2018).

3. Whitehead, L. C., Unahi, K., Burrell, B. & Crowe, M. T. The Experience of Fatigue Across Long-Term Conditions: A Qualitative Meta-Synthesis. Journal of Pain and Symptom Management 52, 131-143.e1 (2016).

4. Matura, L. A., Malone, S., Jaime-Lara, R. & Riegel, B. A Systematic Review of Biological Mechanisms of Fatigue in Chronic Illness. Biological Research For Nursing 20, 410–421 (2018).

5. Lasker, J. N., Sogolow, E. D. & Sharim, R. R. The Role of an Online Community for People With a Rare Disease: Content Analysis of Messages Posted on a Primary Biliary Cirrhosis Mailinglist. J Med Internet Res 7, e10 (2005).

6. Nap-van der Vlist, M. M. et al. Fatigue in childhood chronic disease. Arch Dis Child 104, 1090 (2019).

7. Top 10s of priorities for research | James Lind Alliance. https://www.jla.nihr.ac.uk/top-10-priorities/.

8. Vannorsdall, T. D. et al. Interventions for multidimensional aspects of breast cancer-related fatigue: a meta-analytic review. Support Care Cancer 29, 1753–1764 (2021).

9. Moss-Morris, R. et al. Which behavioural and exercise interventions targeting fatigue show the most promise in multiple sclerosis? A systematic review with narrative synthesis and meta-analysis. Behaviour Research and Therapy 137, 103464 (2021).

10. Schreiner, P. et al. Fatigue in inflammatory bowel disease and its impact on daily activities. Alimentary Pharmacology & Therapeutics 53, 138–149 (2021).

11. Santos, E. J. F., Duarte, C., da Silva, J. A. P. & Ferreira, R. J. O. The impact of fatigue in rheumatoid arthritis and the challenges of its assessment. Rheumatology 58, v3–v9 (2019).

12. Menting, J. et al. Is fatigue a disease-specific or generic symptom in chronic medical conditions? Health Psychology 37, 530–543 (2018).

13. Knoop, V. et al. Fatigue and the prediction of negative health outcomes: A systematic review with meta-analysis. Ageing Research Reviews 67, 101261 (2021).

14. Bullard, T. et al. A systematic review and meta-analysis of adherence to physical activity interventions among three chronic conditions: cancer, cardiovascular disease, and diabetes. BMC Public Health 19, 636 (2019).

15. Junghaenel, D. U., Christodoulou, C., Lai, J.-S. & Stone, A. A. Demographic correlates of fatigue in the US general population: Results from the patient-reported outcomes measurement information system (PROMIS) initiative. Journal of Psychosomatic Research 71, 117–123 (2011).

16. Engberg, I., Segerstedt, J., Waller, G., Wennberg, P. & Eliasson, M. Fatigue in the general population – associations to age, sex, socioeconomic status, physical activity, sitting time and self-rated health: the northern Sweden MONICA study 2014. BMC Public Health 17, 654 (2017).

17. Hulme, K. et al. Fatigue interventions in long term, physical health conditions: A scoping review of systematic reviews. PloS one 13, e0203367 (2018).

18. Christodoulou, C., Junghaenel, D. U., DeWalt, D. A., Rothrock, N. & Stone, A. A. Cognitive interviewing in the evaluation of fatigue items: results from the patient-reported outcomes measurement information system (PROMIS). Quality of Life Research 17, 1239–1246 (2008).