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Kari Anderson, OTR/L and Megan Webster, PT

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Managing Cancer Related Fatigue

Managing Cancer Related Fatigue

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  • 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
  • KARL
  • MEGAN
  • KARL
  • MEGAN
  • MEGAN 9 corresponds to "very light" exercise. For a healthy person, it is like walking slowly at his or her own pace for some minutes 13 on the scale is "somewhat hard" exercise, but it still feels OK to continue. 17 "very hard" is very strenuous. A healthy person can still go on, but he or she really has to push him- or herself. It feels very heavy, and the person is very tired. 19 on the scale is an extremely strenuous exercise level. For most people this is the most strenuous exercise they have ever experienced. Borg RPE scale © Gunnar Borg, 1970, 1985, 1994, 1998
  • MEGAN too fast – executive; too slow – won’ t make a difference
  • Megan: stay independent: have strong legs
  • MEGAN Complete BFI
  • KARL
  • Transcript

    • 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 fatigueThe 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 March2 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 in4 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 impactof 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 FatiguePrimary Fatigue• Fatigue that results from the result of a disease or medical condition.• Fatigue that is related to your diagnosisCancer 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, 20138
    • 9. Types of Cancer-Related FatigueSecondary Fatigue -Fatigue that is a result of factors beyond your diagnosisContributors 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 20129 [Materials developed by Kara Stout]
    • 10. Types of Cancer-Related FatigueCognitive/mental fatigue -Fatigue that makes it difficult to concentrate or do activities that involve thinking -Not always obvious, but it is realCommon 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 FatigueOccupational Therapy Physical TherapyEnergy 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 SurvivorsExercise during and after cancer treatment is safe andpositively 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 MedicineRoundtable 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 parts15
    • 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 onbank by resting what is important to you•Deposit energy by resting to •It can be hard to decide how tostrengthen your account use your energy•Save energy so you can do the •Think about your activities andthings you want and need to do how much energy they require•Always keep a little energy in thebank for emergencies or special17occasions
    • 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 ContinuedImpairments• 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
    • 23. Discharge Status Fatigue Scores 23
    • 24. Case Study ContinuedDischarge 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
    • 25. Borg’s Scale of Perceived Exertion Borg RPE scale © Gunnar Borg, 1970, 1985, 1994, 199825
    • 26. What can you do today? Begin a walking program•Start walking once each day for 3-5 minutes, at a perceived exertionof 11-13 (light to somewhat hard)•Add 1-2 minutes every 3 days with a goal of 30 minutes most days ofthe week. As you increase the amount of time, gradually increase yourpace so you are working at a “somewhat hard” pace with perceivedexertion of 12-14•When you feel like you need a nap, try a short walk26
    • 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 improvement27
    • 28. 28
    • 29. How to access services Fairview Cancer Rehab 612-273-6228 & Managing Cancer-Related Fatigue Group 612-672-727229
    • 30. Questions30
    • 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): 1409-142631