Understanding and Managing Your Energy

Reserves

Lois Dumenko-Russell, RN BN CON(C)Terry Kelly, RN BScN

Fatigue Management NursesTom Baker Cancer Center

CANCER FATIGUE

The Symptoms Most Frequently Experienced by aCancer Patient are (n=918)

A Canadian Survey of Cancer Patients’ Experiences . Are Their Needs Being Met? Dr. F. Ashbury, Centre for BehavioralResearch and Program Evaluation, NCIC, 1995-96.

Symptom

Fatigue 78

Anxiety 77

Feeling low59

Sleep disturb55

Nausea48

Weight Change46

Hair loss44

Concentration42

Pain42

0 10 20 30 40 50 60 70 80 90 100

Mild

Moderate

Severe

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

Types of Fatigue

Normal Fatigue:The Usual Type of Fatigue at the End of a

DayRelieved by a Good Night’s Sleep

Chronic Fatigue:Persists Over Time

You Do Not Feel Rested After a Good SleepMay Delay Full Recovery from Cancer

Therapy

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

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

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)

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

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

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

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

Do I Have Fatigue?

Patient Self-assessment

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

Big Energy Savings

Planning

Prioritizing

Pacing

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

Tips for Coping With Fatigue

What Can You Do? Managing Symptoms And Lifestyle

Managing SymptomsTips 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)

Managing PainTips 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”

Managing PainTips 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

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

Managing AnemiaTips 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

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

Managing Lifestyle Tips for Coping With Fatigue

Manage areas in your life where you have control:

• Sleep/Rest• Nutrition• Exercise• Emotional stress • Memory and concentration• Activity and diversion• Social support

SleepTips 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

“Too much sleep as well as too little sleep can lead to increased feelings of fatigue”

RestTips 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.

“Rest is often as good as sleep during the day”

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

ExerciseTips 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

ExerciseTips 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

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

Activity and DiversionTips 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”

Social SupportTips 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

Social SupportTips 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”

Emotional StressTips 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 “When emotions become difficult to manage,

they use lots of energy and can lead to increased fatigue”

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

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

For Ongoing Fatigue:

Ask for a consult with a Fatigue Management Nurse:

• Lois Dumenko-Russell• Terry Kelly• 698-8104