1. Significant fatigue, diminished energy, or increased need to rest, disproportionate to any recent change in activity level.

2. Complaints of generalized weakness or limb heaviness.

3. Diminished concentration or attention.

4. Decreased motivation or interest to engage in usual activities.

5. Insomnia or hypersomnia.

6. Experience of sleep as unrefreshing or nonrestorative.

7. Perceived need to struggle to overcome inactivity.

8. Marked emotional reactivity (e.g., sadness, frustration, or irritability) to feeling fatigued.

9. Difficulty completing daily tasks attributed to feeling fatigued.

10. Perceived problems with short-term memory.

11. Postexertional malaise lasting several hours.

B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

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

D. The symptoms are not primarily a consequence of comorbid psychiatric disorders, such as major depression, somatization disorder, somatoform disorder, or delirium.

Adapted with permission from Cella D, Peterman A, Passik S, et al. Progress toward guidelines for the management of fatigue. Oncology 1998;12:S369-S377.

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