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Fatigue

Introduction

  • Fatigue and tiredness are two different sensations
  • Tiredness is a universal sensation, usually has an identifiable cause, is short-lived, and is dissipated by a rest or sleep
  • fatigue experienced by people with cancer is often described as unusual or excessive whole-body tiredness, disproportionate to or unrelated to exertion, and is not easily expelled by sleep or rest
  • it can be acute or more long-term
  • it can have a profound negative impact on the person's quality of life by interfering in the ability to perform activities and roles, as a result, care givers begin to assume many roles and activities previously held by the patient
  • many factors may contribute to fatigue, including:
    • changes in energy production
    • loss of weight and appetite
    • decreased nutritional status
    • overactive or hyper metabolic state due to tumor growth
    • anemia
    • side effects of therapy (chemotherapy, radiation, biotherapy)
    • neurotoxicities of cancer or its treatment
    • changes in activity and rest patterns
    • depression
    • sleep disturbances

Assessment

  • instruct patient and family to keep a diary for one week to identify time of day when they are most fatigued or have the most energy
  • - look at the contributing factors
  • be aware of warning signs of impending fatigue, including tired eyes, stiff shoulders, decreased or lack of energy, inability to concentrate, increased irritability, nervousness, anxiety, impatience
  • identify which activities or situations make fatigue better or worse
  • a "1 to 10" scale can be used to assess levels of fatigue, with 1 being the least amount of fatigue and 10 being the worst possible sensation of fatigue

Intervention

  • develop a plan to pace activities by scheduling activities according to fatigue/energy patterns, see Suggestions for Energy Conservation
  • exercise may improve fatigue, develop an appropriate exercise program with the physician and physical therapist
  • monitor the effectiveness of medications and other strategies that you are using to control other symptoms such as pain, nausea and vomiting and insomnia
  • encourage a balanced diet with complex carbohydrates (grains, legumes, vegetables) that provide a more sustained source of energy over time
  • encourage plenty of water (8-10 glasses/day if not contraindicated) to maintain hydration and to excrete toxins that may be associated with fatigue
  • use distraction techniques to focus on things other than tiredness, illness or disease

References

Cimprich, B. (1995). Symptom management: loss of concentration. Seminars in Oncology Nursing, 11, (4), 279-88.

Kalman, D. and Villani, LJ. (1997). Nutritional aspects of cancer-related fatigue. Journal of the American Dietetic Association, 97 (6), 650-4.

McCorkle, R., Grant, M., Frank-Stromborg, M., Baird, S. Cancer Nursing: A Comprehensive Textbook, 2nd ed. Philadelphia: WB Saunders Company, 1996

Nail, LM and Winningham, ML. (1995). Fatigue and weakness in cancer patients: the symptoms experience. Seminars in Oncology Nursing, 11 (4), 272-8.

Piper, BW., Rieger, PT., Brophy, L., Haeuber, D., Hood, LE., Lyver, A. & Sharp, E. (1989). Recent advances in the management of biotherapy-related side effects: Fatigue. Oncology Nursing Forum, 16 (6), supplement.

Winningham, ML, Nail, LM, Burke, MB, Brophy, L, Cimprich, B. Jones, LS., Pickard-Holley, S., Rhodes, V., St. Pierre, B., Beck, S. et al. (1994). Fatigue and the cancer experience: the state of the knowledge. Oncology Nursing Forum, 21 (1), 23-36.





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