1. Cancer Related Fatigue Suzy Coughlan Specialist Dietitian in Oncology

2. Fatigue What is fatigue/tiredness? How common is it?

3. What is Cancer Related Fatigue? (CRF) Described as a ‘persistent subjective sense of tiredness related to cancer or cancer treatment that interferes with usual functioning’ (Mock et al 2003)

4. What is CRF? World Health Organisation International classification of diseases (see sheet)

5. Incidence 82% have fatigue for a few days in a month 56% have fatigue most days 7% have never experienced fatigue Stone P, Richardson A, Ream E, Smith AG, Kerr DJ, Kearney N (2000) Cancer related fatigue. Results of a multi-centre patient survey: Annals of Oncology II pp 971-975

6. Impact of CRF Describe how CRF makes you feel.

7. Causes Surgery Radiotherapy Chemotherapy Adjuvant therapy i.e. hormone treatment Disease load Depression and anxiety Anaemia Hypothyroidism

8. Perpetuating factors Inactivity and de-conditioning Poor diet Belief that activity will make fatigue worse Sleep disturbance or disturbed circadian rhythm Pain and ongoing symptoms Drug side effects Psychological effects

9. Energy/Fuel Analogy Adds fuel to the tank Food/drink Sleep/rest Exercise Psychological/feel goods

10. Energy/fuel Analogy Uses fuel from the tank Activities of daily living Work/activity Exercise Physiological function

13. How to manage your energy Always Plan ahead Pace your self Prioritise Get the balance right (work, rest and play) Delegate What can you use to make it easier Talk to others – be honest about how you feel

14. Importance of Exercise Improves output from the heart Improves oxygenation Increases muscle strength Improves mobility Mobilises fat for energy Beneficial effect on mood

15. How to Exercise Try to include a cardiovascular exercise such as walking as able Consider strengthening exercises Plan exercise into your routine Remember 30 minute recovery rule Liaise with physio about adapting exercise suitable to your symptoms If exercise causes pain STOP and get advice

16. Importance of good nutrition Eat 3 meals a day and include snacks if very fatigued Do not skip meals or make do with non- nutritious snacks Include a carbohydrate at each meal Enrich meals and snacks if experiencing weight loss Plan meals Consider using convenience meals; Wiltshire Farm Foods; Meals on Wheels +/or batch baking

17. Personal Goals Plan ahead to maintain control and to achieve what is important to you. Be realistic! Consider how you are feeling Breakdown plans into manageable chunks Communicate to family/friends/work

18. Summary Cancer related fatigue is a very common and distressing symptom of cancer treatment You cannot just push through CRF, try and actively manage your energy levels effectively Ask for help from health professionals