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Kari Anderson, OTR/L and Megan Webster, PT
1. Managing Cancer Related Fatigue
Megan Webster, PT, Certified Personal Trainer, Certified
Lymphedema Therapist
Karl Anderson, OTR/L, MOT
April 6th, 2013
2. What is cancer-related fatigue
The National Comprehensive Cancer Network definition(NCCN):
• “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.”
National Cancer Institute: PDQ Fatigue. Bethesda, MD: National Cancer Institue. Available
at:http://cancer.gov/cancertopics/pdq/supportivecare/fatigue/HealthProfessional. Accessed March
2 24, 2013
3. Acute Fatigue vs. Cancer-Related Fatigue
‘Healthy’ Fatigue Cancer-related Fatigue
• Acute •Chronic
• Relieved by sleep and rest •Not completely relieved by sleep and rest
• Has an identifiable cause •Severe
•Mechanism poorly understood
3
4. Prevalence
• 70-100% of cancer patients are affected by CRF during
treatment
• For 30% or more, it can linger long after treatment is
completed
• Many people are fully functioning prior to cancer
diagnosis
• Treatment leads to:
− Reduced strength and endurance, fatigue, cognitive impairments
and pain
− Difficulty returning to previous activities and responsibilities
Cramp F, Danial J. Exercise for the management of cancer-related fatigue in
4 adults. Cochrane Database System Review. 2008:CD006145
5. Fatigue Affects Quality of Life
Daily activities affected included:
• Walking distances • Social activities with friends/family
• Cleaning the house • Climbing stairs
• General household chores • Running errands
• Getting exercise • Taking care/meeting needs of family
• Straightening up the house • Concentrating on things
• Lifting things • Preparing food
Curt, GA, Breitbart, W. Impact of cancer-related fatigue on the lives of patients: new findings from
5 the Fatigue Coalition. Oncologist. 2000;5(5):353-60.
6. Fatigue affecting one’s occupation and the impact
of cancer treatment on primary caregivers
• Accepted fewer responsibilities
• Reduced work hours
• Took days off work
• Stopped working altogether
• Went on disability
• Used unpaid family and medical leave time
Curt, GA, Breitbart, W. Impact of cancer-related fatigue on the lives of patients: new findings from
the Fatigue Coalition. Oncologist. 2000;5(5):353-60.
6
7. Cancer Related Fatigue
• Fatigue is a highly distressing symptom of cancer
− It negatively impacts:
• Physical performance
• Mood
• Social interaction
• Cognitive performance
• Sense of self
7
8. Types of Cancer-Related Fatigue
Primary Fatigue
• Fatigue that results from the result of a disease or medical condition.
• Fatigue that is related to your diagnosis
Cancer treatments contribute to primary fatigue
• Chemotherapy
• Radiation
• Surgery
• Blood & Marrow Transplants(BMT)
National Cancer Institute: PDQ Fatigue. Bethesda, MD: National Cancer Institue. Available
at:http://cancer.gov/cancertopics/pdq/supportivecare/fatigue/HealthProfessional. Accessed March
24, 2013
8
9. Types of Cancer-Related Fatigue
Secondary Fatigue
-Fatigue that is a result of factors beyond your diagnosis
Contributors to secondary fatigue
•Poor sleep •Depression/anxiety
•Physical de-conditioning •Emotional distress/stress
•Infection •Nutrition
•Medication side-effects
Department of Occupational Therapy, University of Illinois-Chicago 2012
9 [Materials developed by Kara Stout]
10. Types of Cancer-Related Fatigue
Cognitive/mental fatigue
-Fatigue that makes it difficult to concentrate or do activities that
involve thinking
-Not always obvious, but it is real
Common descriptors
•Sleepy brain •Haziness, dullness
•In a fog: cloudy thinking •Total confusion
•Mind goes blank •Can not think straight
Department of Occupational Therapy, University of Illinois-Chicago 2012
[Materials developed by Kara Stout]
10
11. NCCN Interventions for Fatigue
Occupational Therapy Physical Therapy
Energy Conservation Activity enhancement
− Set priorities − Initiate endurance and
− Pace/Delegate resistance exercise
− Referral to PT/OT/physical
− Scheduling
medicine
− Structured daily routine
Nutrition consultation
Psychosocial interventions
Psychological consult
− Educational and supportive
therapies
11 National Cancer Institute: PDQ Fatigue. Bethesda, MD: National Cancer Institue.
Available at:http://cancer.gov/cancertopics/pdq/supportivecare/fatigue/HealthProfessional.
Accessed March 24, 2013
12. Fairview Cancer Rehab Program
• Occupational and Physical Therapy Evaluations
− Therapists have extensive training and experience with cancer
survivors
− In depth knowledge of medical records and able to adjust your
treatments to your specific and current needs (i.e. lab values,
precautions/contraindications)
12
13. PT sessions
• Individualized exercise prescription
− Aerobic and endurance training, strength training, ROM
− Manual therapy for myofascial restrictions, joint mobilization, and
to decrease pain
13
14. American College of Sports Medicine Roundtable
on Exercise Guidelines for Cancer Survivors
Exercise during and after cancer treatment is safe and
positively impacts:
• Aerobic capacity
• Quality of Life
• Body composition
• Fatigue
• Strength
• Function
•Schmitz KH, Courneya KS, Matthews C, Demark-Wahnefried W, et al. American College of Sports Medicine
Roundtable on Exercise Guidelines for Cancer Survivors. Medicine & Science in Sports & Exercise. 2010;42(7): 1409-
1426
15. OT sessions
• Occupational Therapy:
− Energy management training
• Planning for physical and “brain” rest break
• Pacing, delegating
− Cognitive compensatory strategies
• Mapping strategies for organization of thoughts
• Problem-solving to beak down tasks into manageable parts
15
16. The Fatigue Cycle
Department of Occupational Therapy, University of Illinois-Chicago 2012
[Materials developed by Kara Stout]
16
17. How to Manage Fatigue (The Basics)
Banking and Budgeting your Energy
• Banking your energy = • Budgeting your energy =
saving energy when you deciding how to spend
can your energy
•The goal is to put energy in the •The goal is to spend energy on
bank by resting what is important to you
•Deposit energy by resting to •It can be hard to decide how to
strengthen your account use your energy
•Save energy so you can do the •Think about your activities and
things you want and need to do how much energy they require
•Always keep a little energy in the
bank for emergencies or special
17
occasions
18. Who is Fairview Cancer Rehab for?
• Significant fatigue, diminished energy, increased need
to rest
• Diminished concentration or memory
• Difficulty completing daily tasks
• Anyone who previously exercised and has difficulty
returning to work/leisure activities
• Anyone who has never exercised and doesn’t know
where to begin
18
19. Case Study
• 46 y.o. female
• Stage IIIc R breast cancer, 16 nodes positive
• R mastectomy and Ax LND, chemo/radiation
• All treatment finished 2008
• Osteopenia, hyperlidipemia, asthma, migraines
19
20. Case Study Continued
Impairments
• Cognitive and physical fatigue
• Cognitive changes with decreased short term
memory
• Weakness:
-Decreased shoulder strength
-Decreased leg strength
-Decreased endurance on 6 min walk test
20
21. Case Study Continued
Treatment: Occupational Therapy
− Energy management training
− Cognitive compensatory strategies
21
22. Case Study Continued
Treatment: Physical Therapy
-Education on how to increase aerobic capacity without undue fatigue
using bike and eliptical machines
-Training in slow progression in weight lifting to avoid lymphedema and
undue muscle soreness.
-Myofascial release to R shoulder, upper ¼.
22
24. Case Study Continued
Discharge Status Physical Functioning
• 6 minute walk test at 97% of norm
• Leg press increased from 80# to 120# (90%of norm)
• Able to vacuum, carry groceries
• Returned to health club for weight lifting and aerobic workouts 3x
week.
24
26. What can you do today?
Begin a walking program
•Start walking once each day for 3-5 minutes, at a perceived exertion
of 11-13 (light to somewhat hard)
•Add 1-2 minutes every 3 days with a goal of 30 minutes most days of
the week. As you increase the amount of time, gradually increase your
pace so you are working at a “somewhat hard” pace with perceived
exertion of 12-14
•When you feel like you need a nap, try a short walk
26
27. What can you do today?
• Decrease unnecessary muscle tension
• Strengthen your legs
-Find a chair with arms and push it up against the wall. Using your
arms as little as possible, see how many times you can go from
sitting to standing in 30 seconds
-Repeat it every other day and keep track of improvement
27
31. References
• National Comprehensive Cancer Network: NCCN Clinical Practice Guidelines in
Oncology: Cancer-Related Fatigue. Version 1.2010. Rockledge, Pa: National
Comprehensive Cancer Network, 2010.Available online. Last accessed March 26,
2013
• Cramp F, Danial J. Exercise for the management of cancer-related fatigue in adults.
Cochrane Database System Review. 2008:CD006145
• Curt, GA, Breitbart, W. Impact of cancer-related fatigue on the lives of patients: new
findings from the Fatigue Coalition. Oncologist. 2000;5(5):353-60.
• National Cancer Institute: PDQ Fatigue. Bethesda, MD: National Cancer Institue.
Available
at:http://cancer.gov/cancertopics/pdq/supportivecare/fatigue/HealthProfessional.
Accessed March 24, 2013
• Schmitz KH, Courneya KS, Matthews C, Demark-Wahnefried W, et al. American
College of Sports Medicine Roundtable on Exercise Guidelines for Cancer Survivors.
Medicine & Science in Sports & Exercise. 2010;42(7): 1409-1426
31
Notas del editor
Introductions; Megan-posture
-MEGAN
KARL
KARL -Often patients aren’t given education on how to return to a healthy lifestyle after treatment. -Many patients may accept decreased function as the price they have to pay for getting rid of the cancer
MEGAN Telephone survey of 6, 125 households in the United States identified as having a member with cancer. Patients reporting fatigue at least a few times a month were asked a series of questions to better describe their fatigue and its impact on quality of life. Of those reporting fatigue Ninety-one percent of those who experienced fatigue reported that it prevented a "normal" life, and 88% indicated that fatigue caused an alteration in their daily routine
MEGAN Barriers: feel that it is inevitable, feel that som one would ask about it if it was important,
MEGAN often under treated even tho it has a significant impact on QOL
KARL
KARL
KARL
KARL---National Comprehensive cancer network recommends these strategies.
MEGAN
MEGAN Aerobic assess: 6 min walk/TUG, eval soft tissue restrictions, check for lymphedema Individualized tx based on former activity level and current status. Use of Nu-step, treadmill, weight machines. 2-3 x week for some 1 x eval for others.
Megan Pts told to rest…get weaker. Prescribing ex counterintuitive.. But research shows that it can reduce fatigue and improve function. You can’t sit still waiting to feel better. Am College of Sports Med released guidelines for exercise for cancer survivors for the 1 st time in July 2010. They concluded that exercise is safe during and after tx for cancer and that it positively impacts: aerobic…qol…
KARL
MEGAN
MEGAN
KARL/MEGAN(weakness) Multi dimensional Fatigue Inventory score looks at 3 types of fatigue
