Fatigue - Multiple Myeloma Center for Nurses



Fatigue is prevalent among patients with cancer and is commonly related to their therapy: about 80% of patients receiving chemotherapy or radiotherapy will experience fatigue, and immunomodulatory agents and proteasome inhibitors used in multiple myeloma (MM) can also contribute to it. In patients with MM, fatigue can also be driven by anemia, kidney damage, or immunosuppression.1,2

Cancer-related fatigue typically is not alleviated with rest. Patients can become both physically and psychologically fatigued, and quality of life can be adversely affected.1

Signs and Symptoms1

  • Physical: An unrelenting feeling of tiredness or exhaustion that is not relieved by rest
  • Psychological: Absentmindedness, forgetfulness, difficulty communicating, unpleasant emotions, mental exhaustion, and impaired concentration and memory
  • Social: Limited ability to socialize, impaired relationships, feelings of isolation or loneliness


Conduct a focused patient history and evaluation

  • Disease status and treatment
  • Review of systems
  • Review of concomitant medications
  • In-depth fatigue history (eg, onset, pattern, duration, change over time, associated or alleviating factors, and interference with function)
  • Social support status/availability of caregivers
  • Economic status and resources for obtaining support

Survey symptoms and contributing factors

  • Pain
  • Emotional distress (eg, depression, anxiety)
  • Anemia
  • Sleep disturbance/poor sleep hygiene
  • Nutritional deficits or imbalance
  • Decreased functional status
  • Comorbidities: alcohol/substance abuse, organ system dysfunction (eg, cardiac, endocrine, gastrointestinal, hepatic, neurologic, pulmonary, renal), infection


Nonpharmacologic interventions include:

  • Exercise, including yoga
  • Cognitive behavioral interventions
  • Sleep interventions
  • Massage and/or aromatherapy
  • Stress reduction techniques
  • Nutritional support
  • Referral to rehabilitation

Pharmacologic interventions include:

  • Low-dose corticosteroids
  • Erythropoiesis-stimulating agents

For Your Patients2

Encourage patients to talk about their fatigue, especially known patterns during and following treatment.

  • Assure patients that increasing fatigue is not necessarily related to disease progression

Suggest ways patients can manage fatigue

  • Self-monitoring of fatigue levels
  • Energy conservation techniques (eg, set daily priorities, pace activities, schedule activities at peak energy, utilize labor-saving devices, limit naps to ensure nighttime sleep quality, maintain a structured routine, and avoid multitasking)


  1. Catamero D, Noonan K, Richards T, et al. Distress, fatigue, and sexuality: understanding and treating concerns and symptoms in patients with multiple myeloma. Clin J Oncol Nurs. 2017;21(5 suppl):7-19.
  2. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Cancer-Related Fatigue V.1.2021. © National Comprehensive Cancer Network, Inc. 2021. All rights reserved. Accessed March 15, 2021. To view the most recent and complete version of the guideline, go online to NCCN.org. NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way.