Cancer Related Fatigue - MD Anderson Cancer Center · 2020-04-03 · cancer patients have sleep...
Transcript of Cancer Related Fatigue - MD Anderson Cancer Center · 2020-04-03 · cancer patients have sleep...
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Cancer Related Fatigue
Ellen Manzullo, MD, FACP
Professor of Medicine Deputy Division Head, Internal Medicine
Deputy Department Chair, General Internal Medicine
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Fatigue
Cancer-related fatigue is a distressing, persistent, subjective sense of physical, emotional and/or cognitive
tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and
interferes with usual functioning.
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• Most common complaint of cancer patients.
• Most distressing symptom reported.
• Up to 30% of cancer survivors report fatigue years after completion of treatment.
• Often patients are unprepared for this symptom.
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Causes of Cancer-related Fatigue
Cancer-related fatigue
correlates with:
• Decreased daytime activity
• Increased nocturnal wakefulness
Symptoms
Cancer Treatment
PoorNutrition
Medications
Cancer-relatedFatigue
Co-morbidConditions
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Medical Conditions Causing Fatigue
• Uncontrolled diabetes
• Thyroid disorders
• Heart disease
• Lung disease
• Rheumatologic disorders and many others
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Sleep Disorders in Cancer Patients
• Approximately 30% to 88% of cancer patients have sleep disorders.
• Lack of sleep is associated with depression, anxiety, decreased cognitive function, an impaired immune system, and reduced quality of life.
• Poor sleep can last far beyond cancer treatment.
• Sleep apnea is more common among cancer patients than the general population.
• Cancer patients are twice as likely as people without cancer to experience insomnia.
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Evaluation of the Fatigued Patient
• History Includes complete medication list
• Physical Examination
• Diagnostic laboratory evaluation
• Measurement of fatigue, pain, depression, anxiety, sleep disturbance
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Fatigue Score
0-3 None to mild4-6 Moderate7-10 Severe
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History
In-depth fatigue assessment:
• Onset, pattern, duration
• Change over time
• Associated or alleviating factors
• Interference with function
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UT MDACC CRF Clinic• Started in 1998 – Multidisciplinary Effort
• Dedicated to evaluating and treating cancer related fatigue
• Dr. Carmen Escalante and Dr. Ellen Manzullo
• Internal/External Patients
• Comprehensive Evaluation
Fatigue ClinicLocation: Mays Clinic, 6th Floor
713-563-7100
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CRF Clinic Assessment Packet
Assessment Tool Name Entity AssessedBrief Fatigue Inventory (BFI) Fatigue
Brief Pain Inventory Pain
Beck Depression Inventory II (BDI – II) Depression
Patient-Generated Objective Global Assessment of Nutrition (PG-SGA) Nutrition
Brief Sleep Disturbance Scale (BSDS) Sleeping habits
M.D. Anderson Cancer-Related Symptom Inventory (MDASI) Multiple cancer-related symptoms
Functional Status Index (FSI) Physical function or mobility
SF-12 Health Survey Standard Scoring Patient opinions on his/her health
Beck Anxiety Inventory Anxiety
Eppworth Sleepiness Scale Sleep
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Cancer related fatigue frequently has several causes in an
individual patient.
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Managing Fatigue
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Optimize the treatment of any existing medical condition
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Reversible causes of fatigue
• Anemia
• Hypothyroidism
• Sleep apnea
• Other poorly controlled medical conditions (i.e., heart disease, diabetes)
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Obstructive Sleep Apnea Treatment:Positive Airway Pressure (CPAP/BiPAP)
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Treatment
Depression
• It has been found that depression correlates with the degree of fatigue in cancer patients.
• Some patients benefit from antidepressants.
• Exercise can also have a positive effect on depression.
Pain
• What is the severity of the pain?
• Prescription of medication to alleviate the pain
• Possible referral to Pain Clinic
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Prescribed Stimulants
• Methylphenidate
• Modafinil
• Armodafinil
* The use of these medications will have to be discussed with your physician after a full medical
examination
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General Strategies
• Energy Conservation
Set priorities
Pace yourself
Delegate chores
• Schedule activities at times of peak energy
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Energy Conservation
• Postpone nonessential activities
• Naps that do not disrupt night-time sleep
• Structured daily routine
• Attend to one activity at a time
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Exercise
• Exercise may improve a patient’s functional performance, thus decreasing fatigue.
• An exercise program should be individualized for each patient.
• A good goal is 30 minutes of exercise 5 days per week.
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Walking
• Walking is one of the best forms of exercise for cancer patients for several reasons.
• Safe, convenient, cheap, stimulates energy, maintains balance & mobility, major component of ADL
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Good Sleep Hygiene
• Set a constant sleep schedule Go to bed at the same time and wake up at the same time.
• Regular bed time rituals Same activity every night before bedtime like a warm bath, listen to music,
reading an inspirational book.
• Get regular exercise At least 2 hours before bedtime.
• Healthy Diet Avoid large meals before bedtime. A small snack tends to promote sleep.
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Good Sleep Hygiene
• Limit Caffeine Limit intake to less than 2 servings per day and don’t drink after noon.
• Avoid Nicotine Tobacco users who stop smoking are able to fall asleep faster and sleep better once
withdrawal symptoms subside.
• Avoid alcohol 4 to 6 hours before bedtime.
• Limit afternoon naps to less than 30 minutes.
• Use your bedroom for sleep only.
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Relaxation & Self Hypnosis
• New alternative therapy for the treatment of fatigue
• Provides: tranquility, less pain , concentration, hope, healing, love oneself, etc.
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Nutrition
• Efforts to improve or maintain nutrition can decrease or prevent fatigue.
• Minimize gastrointestinal side effects of cancer treatment: nausea, vomiting, and diarrhea.
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Education
• All cancer patients should be educated about cancer-related fatigue with respect to their cancer treatment.
• Fatigue does not necessarily mean the cancer has gotten worse or has recurred.
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What about our caregivers?
Tips:
• Take some quality time for yourself: schedule off a day at home
• Watch for signs of stress
• Don’t be afraid to ask or accept help from friends
• Use resources
• Ventilate your feelings
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Resources
Fatigue ClinicLocation: Mays Clinic, 6th Floor
713-563-7100