Cancer Related Fatigue

Suzy Coughlan Specialist Dietitian in Oncology

Fatigue

What is fatigue/tiredness?

How common is it?

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)

What is CRF?

World Health Organisation

International classification of diseases

(see sheet)

Incidence

• 82% have fatigue for a few days in a month

• 56% have fatigue most days

• 7% have never experienced fatigueStone 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

Impact of CRF

• Describe how CRF makes you feel.

Causes• Surgery

• Radiotherapy

• Chemotherapy

• Adjuvant therapy i.e. hormone treatment

• Disease load

• Depression and anxiety• Anaemia• Hypothyroidism

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

Energy/Fuel Analogy

Adds fuel to the tank

Food/drink

Sleep/rest

Exercise

Psychological/feel goods

Energy/fuel Analogy

Uses fuel from the tank

Activities of daily living

Work/activity

Exercise

Physiological function

Use of energy

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TypicalFatiguePatternNormal

Use of Energy

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TypicalfatiguePattern

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

Importance of Exercise

• Improves output from the heart

• Improves oxygenation

• Increases muscle strength

• Improves mobility

• Mobilises fat for energy

• Beneficial effect on mood

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

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

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

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