Download Fatigue in cancer

CANCER-RELATED FATIGUE
Almost all individuals undergoing cancer treatment will experience cancer-related fatigue at some point. Between
70% to 100% of those individuals receiving radiation therapy, chemotherapy, immunotherapy, or bone marrow
transplants have fatigue.1 Cancer-related fatigue may be short lived or last for months after therapy is completed.1
CAUSES OF FATIGUE2
Fatigue occurs as an isolated symptom or as one element in a cluster
of symptoms such as pain, depression, sleep disturbance, and anemia.
THE CANCER ITSELF
Fatigue can be one of the first symptoms of cancer. Depending on
the type of cancer, it could slow down the production of red blood
cells or affect the hormone levels of the patient.
OTHER HEALTH PROBLEMS
Various medical conditions may cause fatigue, such as heart problems,
diabetes, being overweight, trouble with their lungs, or depression.
SIDE EFFECTS OF TREATMENT
Treatment may also cause the patient to experience fatigue.
Common examples include surgery, radiation, chemotherapy
biological therapy, or various drug therapies.
KEY QUESTIONS2,3
Surveys suggest 80% of cancer patients receiving chemotherapy
and/or radiation experience fatigue, and these symptoms are
believed to be under-reported.3 In an effort to help patients
manage this distressful symptom, consider asking the patient:
WHAT IS CANCER-RELATED
FATIGUE?3
Cancer-related fatigue is defined as a
distressing, persistent, subjective sense
of physical, emotional, and/or cognitive
tiredness or exhaustion related to cancer or
cancer treatment that is not proportional
to recent activity and interferes with usual
functioning. Cancer-related fatigue is more
severe, more distressing and less relieved
by rest than the fatigue reported by
healthy individuals.
Fatigue severely interferes with activities
of daily living, function, and overall social
interaction. Cancer-related fatigue may
become chronic, lasting months or years
after treatment completion. Cancer-related
fatigue is under-diagnosed and undertreated. Because fatigue has a profound
influence on quality of life and well-being
and may be a warning of more serious
problems, it should not be ignored.
1 Do you experience fatigue, weakness, tiredness,
or exhaustion?
2 In the past two weeks, how would you rate your average
level of fatigue, using a scale of 0-10, with 0 being no
fatigue and 10 being the worst fatigue you can imagine?
3
4
5
6
When did the fatigue first begin? Has it become worse?
What factors help to relieve the fatigue?
What factors make the fatigue worse?
How does the fatigue impact your functioning?
Your quality of life?
Information should not replace the directions and advice of the healthcare provider.
QUICK TIP:1-3
Cancer patients rarely use the term
“fatigue” unless their oncology provider
suggests it. They may use the terms,
“tired,” “weak,” “wiped out,” “exhausted,”
or “bone tired” instead.
TREATMENT APPROACHES
Cancer-related fatigue can be managed with a multi-modal approach. Options include medications, self-care activities
to conserve energy, and non-pharmacological interventions. Specialty referrals and caregiver support are also important
aspects of care.3
PHARMACOLOGIC3
SPECIALIST REFERRAL
CAREGIVER SUPPORT4
• Medications, as appropriate,
for fatigue, depression,
and anxiety.
• Dietitian for suggestions
which may include high
calorie and protein rich foods.4
• Treatments can include:
psychostimulants,
antidepressants,
corticosteroids and
sedative-hypnotic agents.
• Physical therapist which
may include an appropriate
exercise routine.1
• Resources for practical
assistance, such as food
shopping, cooking,
laundry, cleaning, etc.
• Cognitive therapist for support
and stress management.4
ENERGY CONSERVATION3,4
In addition to being evaluated to identify and potentially treat the underlying cause of the fatigue, there are steps
that you can suggest to help your patients deal with fatigue. Practicing energy conservation is a good place to begin.
HELPFUL TIPS:3,4
1 Plan, prioritize and pace their activities. List their
activities in order of importance. When they feel best,
choose the things that are most important or the things
they like to do the most.
EXERCISE AND FATIGUE5
2 Ask for help and have other people do things for them
Clinical studies conducted to date on fatigue
indicate that the most helpful way to manage
fatigue is to exercise.
3 Focus on one thing at a time; don’t try to multi-task.
• More than 30 controlled clinical studies show
that exercise can be effective in reducing fatigue
associated with cancer. Exercise strengthens the
body and may help strengthen immunity.
when possible. Let others help when they offer. Ask them
to do the things that are least important. Letting family
and friends help makes them feel useful too.
4 Put frequently used items within easy reach.
5 Set up and follow a structured daily routine, keeping as
normal a level of activity as possible.
6 Begin a gentle exercise program to decrease fatigue.
Balance rest and activity throughout the day.
7 Schedule their activities so they have time for plenty of
rest that does not interfere with nighttime sleep.
REPORTING TO THE PHYSICIAN1
The following are a few examples of when to alert the physician:
• Patients who self-report a fatigue rating score of 4-6 (moderate)
or 7-10 (severe).
• When fatigue is interfering with quality of life.
• When fatigue affects adherence to treatment.
• The types of exercise that would be most
beneficial vary according to the current
lifestyle of the patient, the stage of their
disease, and the nature of their treatment.
• Low-impact exercises such as walking can help
their overall mood and energy level.
• Resistance exercises with elastic bands may
also help the patient to feel better and increase
their energy level. This type of exercise can
be done while sitting down if the patient has
trouble walking.
• A physical therapy referral can help patients
determine what may be appropriate.
Information should not replace the directions and advice of
the healthcare provider.
1. American Cancer Society. Fatigue in people with cancer. Available at: http://www.cancer.org/acs/groups/cid/documents/webcontent/002842-pdf.pdf Accessed November 3, 2013.
2. Cancer Research UK. Treating cancer fatigue. Available at: http://www.cancerresearchuk.org/cancer-help/coping-with-cancer/coping-physically/fatigue/causes-of-fatigue. Accessed November 3, 2013.
3. National Comprehensive Cancer Network. Clinical Practice Guidelines in Oncology Cancer-Related Fatigue. Available at http://www.nccn.org/professionals/physician_gls/pdf/fatigue.pdf. Accessed February 17. 2015.
4. MedicineNet. Coping with fatigue. Available at: http://www.medicinenet.com/cancer_fatigue/article.htm. Accessed November 3, 2013.
5. Coping With Cancer. ”Don’t Let Fatigue Get You Down.” Available at: http://copingmag.com/cwc/index.php/site/print_article/dont_let_fatigue_get_you_down. Accessed February 27, 2014.
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