Download Tips for Coping With Fatigue

CANCER FATIGUE
Understanding and
Managing Your Energy
Reserves
Lois Dumenko-Russell, RN BN CON(C)
Terry Kelly, RN BScN
Fatigue Management Nurses
Tom Baker Cancer Center
The Symptoms Most Frequently Experienced by a
Cancer Patient are (n=918)
Symptom
Fatigue
78
Anxiety
77
Feeling low
59
Mild
Sleep disturb
55
Nausea
Severe
48
Weight Change
46
Hair loss
44
Concentration
42
Pain
0
Moderate
42
10
20
30
40
50
60
70
80
90
100
A Canadian Survey of Cancer Patients’ Experiences . Are Their Needs Being Met? Dr. F. Ashbury, Centre for Behavioral
Research and Program Evaluation, NCIC, 1995-96.
Cancer Related Fatigue
Cancer-related fatigue is a distressing,
persistent, subjective sense of tiredness
or exhaustion related to cancer or cancer
treatment that is not proportional to
recent activity and interferes with usual
functioning
NCCN Clinical Practice Guidelines in Oncology v.2.2007
Types of Fatigue
Normal Fatigue:
The Usual Type of Fatigue at the End of a Day
Relieved by a Good Night’s Sleep
Chronic Fatigue:
Persists Over Time
You Do Not Feel Rested After a Good Sleep
May Delay Full Recovery from Cancer Therapy
What Causes Fatigue?
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Pre-existing Conditions
Greater Energy Needs
Direct Effects of Cancer – Tumor Growth
Cancer Treatment Effects – Toxic products
of cancer cells being destroyed by
treatment and treatment side effects
What Causes Fatigue?
Conditions related to cancer and
treatment:
• Underlying infection
• Cytokines, IL 1 and 2, TNF
• Altered muscle metabolism (decreased
protein synthesis or accumulation of
metabolites)
• Anemia
• Pain
• Nausea/Vomiting
What Causes Fatigue?
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Disruption of sleep/rest
Poor nutrition/hydration
Lack of exercise, deconditioning
Emotional demands of dealing with cancer
such as stress, anxiety, depression
• Likely unknown factors (metabolic,
molecular)
Fatigue and Surgery
• Almost 100% of patients have
fatigue
• Fatigue is often worse about 7
days after surgery
• Most people return to normal
about 1-3 months after surgery
Fatigue and
Radiation Therapy
• Almost 100% of patients
experience fatigue
• Fatigue often peaks a few
hours after each treatment
• Fatigue increases over the course of
treatment
• Fatigue begins to lessen 2-3 months after
treatment is finished
Fatigue and Chemotherapy
• Almost 100% of patients
experience fatigue
• The pattern of fatigue varies
• Fatigue is usually less just prior
to the next chemotherapy treatment
• Fatigue increases over the course of
treatment
• Fatigue begins to lessen 2-3 months
after treatment is finished
Cancer Related Fatigue
• Accumulative with multiple treatments
• May affect physical, emotional, sexual
aspects of life
• May affect work, exercise, relationships
and social activities
• Unique individual differences creates
variations in fatigue intensities
Do I Have Fatigue?
Patient Self-assessment
Balancing Energy
• Think of energy stores as a bank
• A balance needs to be maintained
between energy spent and energy
saved (Energy Conservation)
• It is important to save energy for those
things that need to be done and those
that you enjoy most
Big Energy Savings
Planning
Prioritizing
Pacing
Energy Balance
Promoters
• Nutrition
• Hydration
• Sleep/Rest
• Aerobic Exercise
• Fun/Relaxation
• Peace of Mind
• Meaningful Work
Drainers
• Poor Nutrition
• Sleep Deficit
• Emotional Stress
• Worry
• Lack of Exercise
• Deconditioning
• Work/Activity
Tips for Coping With
Fatigue
What Can You Do?
Managing Symptoms
And Lifestyle
Managing Symptoms
Tips for Coping With Fatigue
• Many symptoms may make fatigue
worse
• Learn what you can do to help
manage symptoms such as:
•
•
•
•
Anemia
Pain
Nausea/Vomiting
Emotional Distress (anxiety, depression)
Managing Pain
Tips for Coping With Fatigue
• Seek pain management strategies
• Report pain to your nurse or doctor if
it keeps you awake at night, or is
constantly bothersome during the day
“Whatever the cause, cancer pain can be relieved”
Managing Pain
Tips for Coping With Fatigue
• Manage pain with drug and non-drug
options:
• Drug options: take a pill by mouth, use
a skin patch or suppository
• Non-drug options: use relaxation,
distraction, imagery, acupuncture or TENS
therapy.
• Tell your family about your pain
management plan
Managing Nausea/Vomiting
Tips for Coping With Fatigue
• Nausea and vomiting should be prevented
and controlled
• Take all anti-nausea medications (pills or
suppositories) as prescribed
• Inform your nurse if you experience
nausea
Managing Anemia
Tips for Coping With Fatigue
• What is anemia?
Too few red blood cells
Not enough oxygen being carried to your
body parts
• Results: shortness of breath and feeling
tired
• Treatment: Blood transfusions or
Erythropoietin. In certain instances iron or
vitamin B12
Managing Emotional Distress
Tips for Coping With Fatigue
• Consider if anxiety and depression could
be contributing to fatigue
• Seek help for emotional distress from your
nurse or doctor
• See a psychologist for supportive
counseling through the Psychosocial
Resources Department
• Some emotional stress may be unrelated
to, but exacerbated by cancer
• Short term use of medication may help
Managing Lifestyle
Tips for Coping With Fatigue
Manage areas in your life where you have control:
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Sleep/Rest
Nutrition
Exercise
Emotional stress
Memory and concentration
Activity and diversion
Social support
Sleep
Tips for Coping With Fatigue
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Save your longest sleep for the night
Relax before bedtime
Keep a sleep routine
Avoid alcohol, caffeine, or smoking several
hours before bedtime
• Vary room temperature
• Seek help if sleep disturbance persists
• Short term use of medication can help prevent
a sleep deficit
 “Too
much sleep as well as too little sleep can lead to
increased feelings of fatigue”
Rest
Tips for Coping With Fatigue
• Plan rest before periods of activity
• Listen to quiet music, read a book, try
relaxation techniques
• Try to think of something pleasant
• Sometimes limiting activities/visitors and
careful planning maintains energy balance.
 “Rest is often as good as sleep during the day”
Nutrition
Tips for Coping With Fatigue
• Eat a good breakfast. You may find this gives
you more energy
• Plan meals ahead
• Cook several portions and freeze them
• Eat small meals often throughout the day
• Eat extra protein and carbohydrates
• Drink at least 8 glasses of liquid a day to get
rid of waste products that build up
Exercise
Tips for Coping With Fatigue
• Exercise increases ATP which provides energy
• Exercise increases endorphins (natural pain
killers) and improves sleep
• Try to exercise 3 to 4 times a week*
• Exercise can be a regular walking program
• Find a regular time to be active
*Check with your doctor before beginning an exercise
program
Exercise
Tips for Coping With Fatigue
• PROGRESS SLOWLY – Do activities you
enjoy
• Listen to your body, do not worry if you
miss a day or two
• Avoid vigorous exercising on
chemotherapy days and blood testing
days

Memory and
Concentration
Tips for Coping With Fatigue
• Plan activities that need thinking
when you are most rested
• Ask questions; Use notes
• Try walking outdoors, gardening, doing
crafts
• Ask a family member to help you
• Learn new information in small amounts
Activity and Diversion
Tips for Coping With Fatigue
• Often enjoyable activities are put on hold
• Stay physically and mentally active
• Do activities you enjoy such as crafts, reading,
billiards, puzzles, watching television
• Stay involved in social activities you enjoy such as
visiting with friends, dining out and going to
movies
• Laugh!
“A change is often as
good as a rest”
Social Support
Tips for Coping With Fatigue
• Make a list of activities that need
accomplishing and prioritize. Be realistic
about finishing tasks
• Make a list of activities that you could ask
someone else to do
• Make a list of friends, family
members or community groups
willing to help and what they
are willing to do
• Ask for help and delegate!
• Hire a student
Social Support
Tips for Coping With Fatigue
• Plan social activities with family and friends.
• Consider who gives you support and who may
drain your energy. Consider protecting your
personal boundaries.
“ Family members, friends or
community groups can help
you manage fatigue”
Emotional Stress
Tips for Coping With Fatigue
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Identify and acknowledge your stressors
Talk to someone about how you feel
Ask questions
Identify things you can control in your life
and take control of them
• Join a support group
• Learn relaxation techniques
• Focus on the positives
 “When emotions become difficult to manage, they
use lots of energy and can lead to increased fatigue”
Points to Remember
• Fatigue is expected
• Chronic fatigue is a different type of
fatigue than you are used to feeling
• Fatigue can often be managed
• You are not alone
Further Information On
Fatigue
Booklet: “Your bank to energy savings:
how people with cancer can handle
fatigue”
Website: www.cancersymptoms.org
Talk to a nurse, social worker, occupational
therapist, doctor, or another member of the
health care team
For Ongoing Fatigue:
Ask for a consult with a Fatigue
Management Nurse:
•
Lois Dumenko-Russell
•
Terry Kelly
•
698-8104