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Cancer related fatigue devitta presentation
- 1. CANCER FATIGUE DR.BAGHATH SINGH SECOND YEAR RESIDENT GENERAL MEDICINE GRH MADURAI
- 2. FATIGUE • Multifaceted condition characterized by • DIMINISHED ENERGY • INCREASED NEED TO REST DISPROPORTIONATE TO ACTIVITY • GENERALISED WEAKNESS • DIMINISHED MENTAL CONCENTRATION • SLEEP DISTURBANCES • EMOTIONAL REACTIVITY
- 3. PREVALENCE • 25 to 99 percent of cancer patients • Higher proportion of patients suffer compared to normal population • CRF leads to poor physical ,social, cognitive and vocational functioning. • Leads to emotional and spiritual distress in both patient and family members.
- 4. DEFINITION • Distressing persistent subjective sense of Physical ,emotional and or cognitive tiredness . exhaustion related to cancer Or cancer treatment ,that is not proportional to recent activity and that interferes with usual functioning.
- 5. RISK FACTORS FOR FATIGUE • Chemotherapy • Hormone therapy • Radiation therapy • Immunotherapy • Cumulative fatigue peaks in fractional radiation therapy
- 6. MECHANISMS • Genetic polymorphisms • HPA disruption • Altered circadian rhythm • Immune dysfunction • Mitochondrial dysfunction • Excess pro inflammatory cytokines • Impaired psychological coping mechanisms • Impaired neuro endocrine stress responses
- 8. ASSOCIATED FACTORS • Anemia • Hypothyroidism • Hypogonadism • Hepatic dysfunction • Renal failure • Infection • Electrolyte disturbances • Malnutrition • Dehydration • Drug induced
- 9. SCREENING AND EVALUATION National comprehensive cancer network GUIDELINES • Fatigue should be recognized, evaluated, monitored, documented, and treated promptly for all age groups, at all stages of disease, • prior to, during, and following treatment.
- 12. BARRIERS TO COMMUNICATION IN CRF • Patient and physicians view that fatigue is inevitable in the disease • Patients desire to go about without medications • Patients wish to be a non complainer • Patients fear of being treated with a modified less effective therapy
- 16. DIMENSIONS OF FATIGUE • Sensory dimension • Physiologic dimension • Performance dimension • Single screeningtool is inadequate to encompass all the dimensions • More than 20 different self reporting measures have been developed to measure fatigue in cancer patients
- 17. INTERVENTIONS • General supportive measures • Balanced diet • Balanced rest and physical activities • Exposure to natural environment • Pleasant distraction like music
- 19. PHARMACOLOGICAL INTERVENTION • Use of EPO analogues in severe anemia management. • Paroxetine ,bupropion and venlafaxine . • Paroxetine 10mg od increased 10mg per week to max 40mg per day. • BUPROPION 100mg BD to 100 mg q8h • Venlafaxine 37.5 mg BD
- 20. PSYCHOSTIMULANTS Drugs like methylphenidate and modafanil
- 21. • Steroids • Megestrol acetate • Ginseng • Harmone supplements not beneficial. • May be counter productive • Vitamin supplements, zinc ,omega 3 fatty acid supplements inconclusive evidence.
- 22. EXERCISE PHYSICAL ACTIVITY AND STRUCTURED REHABILITATION • Depending upon the status of the patient individualised exercise program to be instituted. • Patients should aim for 150 minutes of moderate intensity physical activity and strength training twice a week. • Yoga ,tai chi, organised sports also could be incorporated
- 23. PSYCHO EDUCATIONAL INTERVENTIONS • Cognitive behavioural therapy ,hypnosis • Psychological support • Coaching to enhance self efficiency • Energy conservation and activity management.
- 24. INTERVENTIONS TO IMPROVE SLEEP QUALITY AND CIRCADIAN RHYTHMICITY • Cognitive behavioural therapy • Sleep hygiene • Relaxation training • Avoiding stimulants at bed time • Morning bright light exposure • Strategies to reduce Cognitive arousal
- 28. THANK YOU