A Clinician's Approach to Fatigue of Cancer Patients Jau-Yih Tsauo PT, PhD, Professor National...
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Transcript of A Clinician's Approach to Fatigue of Cancer Patients Jau-Yih Tsauo PT, PhD, Professor National...
A Clinician's Approach to A Clinician's Approach to Fatigue of Cancer PatientsFatigue of Cancer Patients
Jau-Yih TsauoPT, PhD, ProfessorNational Taiwan University
OutlineOutlineStandards of care of cancer-
related fatigueCRF screening & assessmentCRF managementConclusions
ICD-10 criteria for CRFICD-10 criteria for CRFThe following symptoms have been present every day or nearly
every day during the same 2-week period in the past month: Significant fatigue, diminished energy, or increased need to rest,
disproportionate to any recent change in activity level, plus five or more of the following: ◦ Complaints of generalized weakness, limb heaviness. ◦ Diminished concentration or attention.◦ Decreased motivation or interest to engage in usual activities.◦ Insomnia or hypersomnia.◦ Experience of sleep as unrefreshing or nonrestorative.◦ Perceived need to struggle to overcome inactivity.◦ Marked emotional reactivity (e.g., sadness, frustration, or irritability) to
feeling fatigued.◦ Difficulty completing daily tasks attributed to feeling fatigued.◦ Perceived problems with short-term memory.◦ Postexertional fatigue lasting several hours.
The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
There is evidence from the history, physical examination, or laboratory findings that the symptoms are a consequence of cancer or cancer therapy.
The symptoms are not primarily a consequence of comorbid psychiatric disorders such as major depression, somatization disorder, somatoform disorder, or delirium.
What is Cancer-related What is Cancer-related Fatigue?Fatigue?CRF is related to cancer or cancer
treatment which causes physical, emotional and /or cognitive tiredness or exhaustion and interferes patients’ functioning.
CRF is reported at all age groups and all stages of the cancer, prior to, during and following treatment.
So, CRF should be screened, assessed and managed for all the cancer patients.
Standards of Care of CRFStandards of Care of CRF
NCCN Clinical Practice Guidelines
Screening & AssessmentScreening & AssessmentAge 5-6 y/o: not tired, tiredAge 7-12 y/o: 1-5 scale
◦1-2: mild◦3: moderate◦4-5: severe
Age >12 y/o: 0-10 scale◦0-3: none to mild◦4-6: moderate◦7-10: severe
Non to MildNon to MildNot tired in age 5-6, scores 1-2 in
age 7-12, or scores 0-3 in age>12Education
◦Active treatment◦Post treatment◦End of life
General strategies to manage fatigue◦Active treatment◦Post treatment◦End of life
Non to Mild: Active Non to Mild: Active TreatmentTreatment
Non to Mild: Post Non to Mild: Post TreatmentTreatment
Non to Mild: End of LifeNon to Mild: End of Life
Moderate to SevereModerate to SevereTired in age 5-6, scores 3-5 in age
7-12, or scores 4-10 in age>12Education
◦Fatigue is not an indicator of disease progression
◦Self-monitoring of the fatigue level◦Expected the end-of life symptom and
the fatigue intensity may varyPrimary evaluationInterventions
Primary EvaluationPrimary Evaluation
Interventions: Active Interventions: Active TreatmentTreatment
Interventions: Post Interventions: Post TreatmentTreatment
Interventions: End of LifeInterventions: End of Life
Activity Enhancement (I)Activity Enhancement (I)Fatigue: **
◦during cancer treatment◦following cancer treatment
Aerobic capacity:◦11/22: significant difference between
intervention and control group◦3/22: significant pre-post difference◦8/22: non significant difference
Quality of life: --Anxiety: --Depression: --
Cramp et al, 2008
Activity Enhancement (II)Activity Enhancement (II)↑ functional capacity so↓effort in activities15~45min/session (no more than I hour)1-5 sessions/week3~32 weeks, average: 12 weeks25~80% age-predicted HRmax (220-age)walk, bicycle, ergometer, treadmill, yoga,
tai-chi, multidimensional (aerobic+stretching+resistance exercise)
group/individualized, supervised/home-based , mixture of supervised and home-based
Psychosocial InterventionsPsychosocial InterventionsEducation:
◦energy conservation and activity management to balance rest and activity
◦planning, delegating, prioritizing, pacing, resting
Support groupIndividual counselingComprehensive coping strategyStress management trainingBehavioral intervention
Sleep TherapySleep TherapyStimulus control
◦go to bed when sleepy, get out of bed after 20 min of wakefulness
◦Have a routine bedtime and rising timeSleep restriction
◦avoidance of long or late day naps◦Limiting total time in bed
Sleep hygiene◦caffeine and exercise avoidance near
bedtime◦comfortable sleep surroundings (dark,
relaxing…)◦soothing activities at bedtime (music, …)
Conclusions
Thank you for your attention!
Questions?