Transcript A Clinician`s Approach to Fatigue of Cancer Patients

A Clinician's Approach to
Fatigue of Cancer Patients
Jau-Yih Tsauo
PT, PhD, Professor
National Taiwan University
Outline
Standards of care of cancer-related fatigue
 CRF screening & assessment
 CRF management
 Conclusions

ICD-10 criteria for CRF
The 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:
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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.
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What is Cancer-related 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.
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Standards of Care of CRF
NCCN Clinical Practice Guidelines
Screening & Assessment
Age 5-6 y/o: not tired, tired
 Age 7-12 y/o: 1-5 scale
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◦ 1-2: mild
◦ 3: moderate
◦ 4-5: severe
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Age >12 y/o: 0-10 scale
◦ 0-3: none to mild
◦ 4-6: moderate
◦ 7-10: severe
Non to Mild
Not tired in age 5-6, scores 1-2 in age 712, or scores 0-3 in age>12
 Education
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◦ Active treatment
◦ Post treatment
◦ End of life
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General strategies to manage fatigue
◦ Active treatment
◦ Post treatment
◦ End of life
Non to Mild: Active Treatment
Non to Mild: Post Treatment
Non to Mild: End of Life
Moderate to Severe
Tired in age 5-6, scores 3-5 in age 7-12, or
scores 4-10 in age>12
 Education
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◦ 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 vary
Primary evaluation
 Interventions
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Primary Evaluation
Interventions: Active Treatment
Interventions: Post Treatment
Interventions: End of Life
Activity Enhancement (I)
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Fatigue: **
◦ during cancer treatment
◦ following cancer treatment
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Aerobic capacity:
◦ 11/22: significant difference between intervention
and control group
◦ 3/22: significant pre-post difference
◦ 8/22: non significant difference
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Quality of life: -Anxiety: -Depression: --
Cramp et al, 2008
Activity Enhancement (II)
↑functional capacity so↓effort in activities
 15~45min/session (no more than I hour)
 1-5 sessions/week
 3~32 weeks, average: 12 weeks
 25~80% 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
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Psychosocial Interventions
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Education:
◦ energy conservation and activity management
to balance rest and activity
◦ planning, delegating, prioritizing, pacing, resting
Support group
 Individual counseling
 Comprehensive coping strategy
 Stress management training
 Behavioral intervention
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Sleep Therapy
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Stimulus control
◦ go to bed when sleepy, get out of bed after 20
min of wakefulness
◦ Have a routine bedtime and rising time
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Sleep restriction
◦ avoidance of long or late day naps
◦ Limiting total time in bed
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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?