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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. MCM/091814/0019