Cancer Related Fatigue
Summer 2009
Fatigue in cancer is nothing new, but increasingly, researchers appreciate the impact it has on patients’ quality of life and on their ability to function.
Fatigue has been adopted by the Oncology Nursing Society as the sixth vital sign. However, the diagnosis of cancer related fatigue (CRF) may be difficult due to a lack of established guidelines and symptom lists.
Additionally, the fatigue varies temporally; some patients may experience it concurrent with treatment while others may develop it after treatment has ended.
CRF appears to be multi-factorial in nature and cumulative in effect.
Contrary to normal fatigue, which is directly related to level of exertion and can be remedied by rest, food, and sleep, CRF is defined as a distressing persistent, subjective sense of tiredness or exhaustion related to cancer treatment that is not proportional to recent activity and interferes with usual functioning.
Because fatigue cannot be directly observed, the need for treatment may be overlooked.
Fewer than 50% of patients discuss fatigue with their healthcare providers; they may believe nothing can be done, that fatigue is inevitable or unimportant, or fear distracting their physician or delaying treatment. Some may not want to complain.
Studies have found that patients typically do not volunteer this information unless specifically asked (i.e. “How is your fatigue?” versus “How are you?”). It is important to note that IF FATIGUE IS NOT RECOGNIZED, IT CANNOT BE TREATED.
CRF is NOT an inevitable part of cancer treatment; however, an estimated 70-100% of patients currently experience fatigue (two to three times more common than pain, nausea, or vomiting) and it appears to be more profound in those undergoing multimodality therapy.
Chemotherapy usually creates a cyclical pattern that follows treatment timing, while radiation-induced fatigue gradually increases over time and then gradually declines after the completion of treatment.
Many patients inadvertently climb on the activity/fatigue roller coaster: when they feel rested, they overdo which makes them tired and they do nothing until they feel rested. Then the cycle repeats—day after day.
Like the diagnosis of CRF, treatment can be tricky because there is no definitive cure.
Researchers agree, however, that treatment should be comprehensive, multidimensional and include pharmacological and non-pharmacological therapies.
Pharmacological therapies include those for sleep, depression, and appetite, among others.
Non-pharmacological treatment could include dietary and psychological counseling, stress reduction, and exercise. Currently, exercise is the only treatment endorsed by the Oncology Nursing Society for clinical practice, and the National Cancer Care Network (NCCN) has deemed exercise as the most effective non-pharmacological intervention used to manage CRF.
An activity/exercise program must be tailored to the individual with attention to the specifics of his disease, treatment regimen, and reflect any special needs or limitations.
The ultimate goal is to restore normal function and quality of life through a well-outlined program; one that builds a strong base of muscular strength and endurance, with a steady and consistent level of activity.
The program must have clear expectations and step-wise progressions because an inverse relationship exists between fatigue and activity level--with a point of diminishing returns.
Progress may be slow, so it is equally important for the professional and patient to identify potential barriers to adherence and problem-solve how best to work through them.
Prevention may be the best treatment. A study presented at the American Society of Clinical Oncology (ASCO) this year showed that breast cancer patients who exercised aerobically for 30 minutes, five days per week developed significantly less fatigue than the control group.
Such a plan seems daunting; however, to a woman already so tired she can barely make it through the day.
Salem Cancer Institute and Salem Health Rehabilitation Services are working together to develop educational materials for patients and caregivers about cancer-related fatigue and its management.
Physical therapists are available in Building C one day a week to perform an evaluation and a limited course of treatment for cancer patients with fatigue, musculoskeletal pain due to disease or treatment, decreased mobility, and/or deconditioning.
For more information or to schedule an appointment, call Marie at 503-562-4321.