Cancer related fatigue is an unusual sense of tiredness related to cancer treatment that interferes with usual functioning.
Cancer related fatigue is the most common unmanaged symptom from cancer and treatments reducing capacity for normal activity.
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Pathological fatigue:
Occurs during normal activities.
Is persistent and pervasive.
Does not respond to rest.
Forces reduction in normal activity.
Contributors to fatigue:
Anaemia
Infection
Chemotherapy
Radiotherapy
Metabolic Problems
Dehydration
Psychological Distress
Pain
Drug Side Effects
Autonomic Failure
Muscular/Neuromuscular Abnormalities
Weight Loss/ Muscle Loss
Reduction or Absence of Hormone Secretion
Immune Response Substances
Cancer Fatigue can be Multifactorial- biological, psychological and social:
Pain
Electrolyte/Fluid Imbalances
Anaemia
Impaired Nutritional Status/ Weight Loss
Sleep Disturbances
Metabolic Alterations/Systemic Pathology
Drug Reactions on the Central Nervous System
Psychological Factors
Types of Cancer Fatigue:
Physical Fatigue
Tiredness/exhaustion from usual physical activities.
Organic cause related to muscular energetics or oxygen absorption, transport and release.
Psychological Fatigue
Mental fatigue- lack of concentration, memory loss.
Volitional fatigue- inability to begin tasks and avoidance of social contacts
When assessing fatigue we look at:
Onset, pattern, duration
Change over time
Associated or alleviating factors
Physical, emotional and mental symptoms
Effect on usual function
Sleep Issues
Primary Causative Factors:
Pain
Emotional Distress
Sleep Disturbance
Anaemia
Hypothyroid
Interventions For Fatigue:
Education/Counselling:
Known Pattern of Fatigue from Treatment
Reassurance Fatigue is Manageable
Coping Strategies- Energy Conservation, Distraction, Stress Management
Specific Interventions:
Anemia- Iron, Folic Acid
Hypothyroid- Thyroid Replacement
Pharmacologic- Psycho Stimulants, Anti-Depressants, Steroids
Treatment For Fatigue:
Exercise
Restorative Therapy- Yoga, Stress Management, Breathing Techniques
Nutrition
Sleep Therapy
Active Coping Strategies to Break the Cycle of Fatigue from Treatment, Illness and Deconditioning Causing Sedentary Habits, Self Perpetuating Fatigue:
Physical training, activity and stress management have been shown in numerous studies to reduce fatigue, improve energy levels and improve the feeling of vitality.
Passive Coping Strategies:
Such as rest, sleep and decreasing physical activity, in contrast seem inefficient in relieving fatigue, creating a vicious cycle of immobility and de-conditioning further contributing to more fatigue and low energy.
Exercise Management
Physical activity has provided evidence of therapeutic benefits on fatigue, stamina, energy levels, improvement in fitness and quality of life.
Exercise is adapted to each cancer patient in terms of intensity, duration, frequency and type.
Screening is conducted to check for other health problems and complications.
For inactive individuals or those reporting high levels of fatigue exercise programs begin with low intensity and duration, progress slowly and are modified as indicated by changes in patient's condition.
Strategies to assist with participation in exercise to alleviate fatigue:
A personal exercise program
A written exercise program
Frequency and intensity documented to follow
Log book for self monitoring
Regular monitoring
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