1. Understanding and Managing Your Energy Reserves Lois Dumenko-Russell, RN BN CON(C) Terry Kelly, RN BScN Fatigue Management Nurses Tom Baker Cancer Center CANCER FATIGUE

3. Cancer Related Fatigue Cancer-related fatigue is a distressing, persistent, subjective sense of tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning NCCN Clinical Practice Guidelines in Oncology v.2.2007

4. Types of Fatigue Normal Fatigue: The Usual Type of Fatigue at the End of a Day Relieved by a Good Night’s Sleep Chronic Fatigue: Persists Over Time You Do Not Feel Rested After a Good Sleep May Delay Full Recovery from Cancer Therapy

5. What Causes Fatigue? Pre-existing Conditions Greater Energy Needs Direct Effects of Cancer – Tumor Growth Cancer Treatment Effects – Toxic products of cancer cells being destroyed by treatment and treatment side effects

6. What Causes Fatigue? Conditions related to cancer and treatment: Underlying infection Cytokines, IL 1 and 2, TNF Altered muscle metabolism (decreased protein synthesis or accumulation of metabolites) Anemia Pain Nausea/Vomiting

7. What Causes Fatigue? Disruption of sleep/rest Poor nutrition/hydration Lack of exercise, deconditioning Emotional demands of dealing with cancer such as stress, anxiety, depression Likely unknown factors (metabolic, molecular)

8. Fatigue and Surgery Almost 100% of patients have fatigue Fatigue is often worse about 7 days after surgery Most people return to normal about 1-3 months after surgery

9. Fatigue and Radiation Therapy Almost 100% of patients experience fatigue Fatigue often peaks a few hours after each treatment Fatigue increases over the course of treatment Fatigue begins to lessen 2-3 months after treatment is finished

10. Fatigue and Chemotherapy Almost 100% of patients experience fatigue The pattern of fatigue varies Fatigue is usually less just prior to the next chemotherapy treatment Fatigue increases over the course of treatment Fatigue begins to lessen 2-3 months after treatment is finished

11. Cancer Related Fatigue Accumulative with multiple treatments May affect physical, emotional, sexual aspects of life May affect work, exercise, relationships and social activities Unique individual differences creates variations in fatigue intensities

12. Do I Have Fatigue? Patient Self-assessment

13. Balancing Energy Think of energy stores as a bank A balance needs to be maintained between energy spent and energy saved (Energy Conservation) It is important to save energy for those things that need to be done and those that you enjoy most

14. Big Energy Savings zPlanning zPrioritizing zPacing

15. Energy Balance Promoters Nutrition Hydration Sleep/Rest Aerobic Exercise Fun/Relaxation Peace of Mind Meaningful Work Drainers Poor Nutrition Sleep Deficit Emotional Stress Worry Lack of Exercise Deconditioning Work/Activity

16. Tips for Coping With Fatigue What Can You Do? Managing Symptoms And Lifestyle

17. Managing Symptoms Tips for Coping With Fatigue Many symptoms may make fatigue worse Learn what you can do to help manage symptoms such as: Anemia Pain Nausea/Vomiting Emotional Distress (anxiety, depression)

18. Managing Pain Tips for Coping With Fatigue Seek pain management strategies Report pain to your nurse or doctor if it keeps you awake at night, or is constantly bothersome during the day “Whatever the cause, cancer pain can be relieved”

19. Managing Pain Tips for Coping With Fatigue Manage pain with drug and non-drug options: Drug options: take a pill by mouth, use a skin patch or suppository Non-drug options : use relaxation, distraction, imagery, acupuncture or TENS therapy. Tell your family about your pain management plan

20. Managing Nausea/Vomiting Tips for Coping With Fatigue Nausea and vomiting should be prevented and controlled Take all anti-nausea medications (pills or suppositories) as prescribed Inform your nurse if you experience nausea

21. Managing Anemia Tips for Coping With Fatigue What is anemia? Too few red blood cells Not enough oxygen being carried to your body parts Results: shortness of breath and feeling tired Treatment: Blood transfusions or Erythropoietin. In certain instances iron or vitamin B12

22. Managing Emotional Distress Tips for Coping With Fatigue Consider if anxiety and depression could be contributing to fatigue Seek help for emotional distress from your nurse or doctor See a psychologist for supportive counseling through the Psychosocial Resources Department Some emotional stress may be unrelated to, but exacerbated by cancer Short term use of medication may help

23. Managing Lifestyle Tips for Coping With Fatigue zManage areas in your life where you have control: Sleep/Rest Nutrition Exercise Emotional stress Memory and concentration Activity and diversion Social support

24. Sleep Tips for Coping With Fatigue Save your longest sleep for the night Relax before bedtime Keep a sleep routine Avoid alcohol, caffeine, or smoking several hours before bedtime Vary room temperature Seek help if sleep disturbance persists Short term use of medication can help prevent a sleep deficit z“ Too much sleep as well as too little sleep can lead to increased feelings of fatigue ”

25. Rest Tips for Coping With Fatigue Plan rest before periods of activity Listen to quiet music, read a book, try relaxation techniques Try to think of something pleasant Sometimes limiting activities/visitors and careful planning maintains energy balance. z“Rest is often as good as sleep during the day”

26. Nutrition Tips for Coping With Fatigue Eat a good breakfast. You may find this gives you more energy Plan meals ahead Cook several portions and freeze them Eat small meals often throughout the day Eat extra protein and carbohydrates Drink at least 8 glasses of liquid a day to get rid of waste products that build up

27. Exercise Tips for Coping With Fatigue Exercise increases ATP which provides energy Exercise increases endorphins (natural pain killers) and improves sleep Try to exercise 3 to 4 times a week* Exercise can be a regular walking program Find a regular time to be active *Check with your doctor before beginning an exercise program

28. Exercise Tips for Coping With Fatigue PROGRESS SLOWLY – Do activities you enjoy Listen to your body, do not worry if you miss a day or two Avoid vigorous exercising on chemotherapy days and blood testing days z

29. Memory and Concentration Tips for Coping With Fatigue Plan activities that need thinking when you are most rested Ask questions; Use notes Try walking outdoors, gardening, doing crafts Ask a family member to help you Learn new information in small amounts

30. Activity and Diversion Tips for Coping With Fatigue Often enjoyable activities are put on hold Stay physically and mentally active Do activities you enjoy such as crafts, reading, billiards, puzzles, watching television Stay involved in social activities you enjoy such as visiting with friends, dining out and going to movies Laugh! “A change is often as good as a rest”

31. Social Support Tips for Coping With Fatigue Make a list of activities that need accomplishing and prioritize. Be realistic about finishing tasks Make a list of activities that you could ask someone else to do Make a list of friends, family members or community groups willing to help and what they are willing to do Ask for help and delegate! Hire a student

32. Social Support Tips for Coping With Fatigue Plan social activities with family and friends. Consider who gives you support and who may drain your energy. Consider protecting your personal boundaries. “ Family members, friends or community groups can help you manage fatigue”

33. Emotional Stress Tips for Coping With Fatigue Identify and acknowledge your stressors Talk to someone about how you feel Ask questions Identify things you can control in your life and take control of them Join a support group Learn relaxation techniques Focus on the positives z“When emotions become difficult to manage, they use lots of energy and can lead to increased fatigue”

34. Points to Remember Fatigue is expected Chronic fatigue is a different type of fatigue than you are used to feeling Fatigue can often be managed You are not alone

35. Further Information On Fatigue Booklet: “Your bank to energy savings: how people with cancer can handle fatigue” Website: www.cancersymptoms.org Talk to a nurse, social worker, occupational therapist, doctor, or another member of the health care team

36. For Ongoing Fatigue: zAsk for a consult with a Fatigue Management Nurse: Lois Dumenko-Russell Terry Kelly 698-8104