Fatigue Management in Cancer Care

Transcription

1 Fatigue Management in Cancer Care

2 Overview 1. What is Cancer-Related Fatigue? Causes & symptoms 2. Negative cycles that fuel CRF 3. What are the consequences of CRF 4. Intervention & rehabilitation 5. Relaxation & sleep

3 What is fatigue? Extreme tiredness resulting from mental or physical exertion or illness: a reduction in the efficiency of a muscle or organ after prolonged activity (Oxford Dictionary, 2015) Cancer-related fatigue? Definition given by National Comprehensive Cancer Network: 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. (NCCN, 2014)

4 Is CRF overlooked? Despite being one of most common symptoms of cancer affecting about 80% of people in receipt of chemotherapy/radiotherapy, studies have shown that patients complaints and symptoms of CRF are often overlooked, and 80% of oncologists believe cancer related fatigue is undertreated (Weis, Horneber, 2015) (Kapoor et al. 2015) Implication for patient = decline in quality of life (Chakrabarty, et al. 2015)

5 Factors associated with CRF Koornstra et al (2014)

6 What affects CRF? Physical activity Cognitive activity Emotional activity Homeostatic processes Grief Loss

7 Symptoms of CRF Headaches Joint pain Muscle aches Low immunity Breathless after short task Nausea Dizziness Body/limbs feel heavy Cognitive difficulties memory, word finding etc. Reduced concentration span Brain fog Sleep disturbances Tearful Frustrated Depressed Irritable Anxious Difficulty making decisions

8 Negative Cycle Boom/Bust Over doing it Recovery Boom/ Bust Exhaustion Rest

9 Sleep Disturbances Insomnia Hypersomnia Altered circadian rhythm Fatigue

10 Negative Cycle Stress Response

11 Denial Denial Resist change Setback Increased fatigue Frustration

12 Negative Cycle - Loss Loss Reduced energy Low mood

13 Consequences of fatigue Activity reduced or stopped Loss of fitness Wanting to stay in bed Sleep during the day Loss of motivation Exertion worsens fatigue Lack of enjoyment Loss of rewarding activities Loss of social contact

14 Interventions for Cancer Related Fatigue Interventions likely to be beneficial for cancer related fatigue Address treatable contributors to fatigue / manage concurrent symptoms Physical activity/exercise Rehabilitation Psychoeducation Relaxation, meditation, mindfulness based stress reduction Cognitive behavioural therapy for sleep, depression, pain, fatigue According to ASCO, CPAC/CAPO, NCCN, ONS (2015) (Berger et al. 2015)

15 Rehabilitation Accept the illness & a need to change Access professional help Stop boom/bust cycle Establish a baseline/stabilise Rebuild tolerance to activity

16 Pacing/Routine Setting Establish energy capacity baseline of activity Pacing eliminate boom/bust cycle Set a daily routine of: - physical activity - mental activity/concentration - rest - relaxation

17 Activity diary Monday Tuesday Shower & Dress Make & eat breakfast Hoover 4 rooms Walk the dog Sit down on return Make & eat lunch Read newspaper Computer work Shower & Dress 10 minute relaxation Make & eat breakfast Read half newspaper Hoover 2 rooms 10 minute relaxation Make & eat lunch Computer work 10 minute relaxation Walk the dog Read half newspaper 10 minute relaxation Hoover 2 rooms Activity Level High Medium Low Relaxation

18 Relaxation & Rest Diaphragmatic Breathing Out breath longer than in breath 5/9 or 7/11 breath Square Breathing Visual Imagery Guided imagery Tense and relax Meditation Mindfulness Meditation and mindfulness improved both fatigue severity and fatigue related daytime interference in 5 RCTs during and after treatment for breast cancer and in 1 RCT among patients with mixed tumour sites. Berger et al. (2015)

19 Sleep Avoid daytime sleep Pre sleep wind down Regular bed & getting up time Normal number of hours Bed = sleep

20 Energy Balance PHYSICAL DEMANDS HEALTHY DIET COGNITIVE DEMANDS STRESS EMOTIONS NEGATIVE THOUGHTS RELATIONSHIPS BEREAVEMENT DEMAND SUPPLY POSITIVE THOUGHTS REST RELAXATION PLEASURE/FUN ACHIEVEMENT FRESH AIR RELATIONSHIPS PAIN

21 Any Questions?

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23 References Berger, A. M., Mitchell, S. A., Jacobsen, P. B. and Pirl, W. F. (2015), Screening, evaluation, and management of cancer-related fatigue: Ready for implementation to practice?. CA: A Cancer Journal for Clinicians. doi: /caac Chakrabarty, J., Vidyasagar, M., Fernandes, D., Joisa, G., Varghese, P., & Mayya, S. (2015). Effectiveness of pranayama on cancer-related fatigue in breast cancer patients undergoing radiation therapy: A randomized controlled trial. International Journal of Yoga, 8(1), doi: / (2015) Kapoor, A., Singhal, M. K., Bagri, P. K., Narayan, S., Beniwal, S., & Kumar, H. S. (2015). Cancer related fatigue: A ubiquitous problem yet so under reported, under recognized and under treated. South Asian Journal of Cancer, 4(1), doi: / x R.H. Koornstra, M. Peters, S. Donofrio, et al. Management of fatigue in patients with cancer a practical overview Cancer Treat Rev, 40 (2014), pp NCCN Clinical Practice Guidelines in Oncology: Cancer-Related Fatigue. Version 1. National Comprehensive Cancer Network ed. [Accessed 15 March2015]. Available from: Weis, J. Horneber, M. (2015) Cancer-Related Fatigue: Springer Healthcare Communications Abbreviations ASCO, American Society of Clinical Oncology; CPAC/CAPO, Canadian Partnership Against Cancer/Canadian Association of Psychosocial Oncology; NCCN, National Comprehensive Cancer Network; ONS, Oncology Nursing Society