Oncology Rehab For Fatigue
- By Emma Najman
Pathological fatigue:
- Occurs during normal activities
- Is persistent and pervasive
- Does not respond to rest
- Forces reduction in normal activity
Contributors to fatigue:
- Anaemia
- Infection
- Chemotherapy
- Radiotherapy
- Metabolic Problems
- Dehydration
- Psychological Distress
- Pain
- Drug Side Effects
- Autonomic Failure
- Muscular/Neuromuscular Abnormalities
- Weight Loss/ Muscle Loss
- Reduction or Absence of Hormone Secretion
- Immune Response Substances
Cancer Fatigue can be Multifactorial- biological, psychological and social:
- Pain
- Electrolyte/Fluid Imbalances
- Anaemia
- Impaired Nutritional Status/ Weight Loss
- Sleep Disturbances
- Metabolic Alterations/Systemic Pathology
- Drug Reactions on the Central Nervous System
- Psychological Factors
Types of Cancer Fatigue:
Contributors to fatigue:
Physical Fatigue
- Tiredness/exhaustion from usual physical activities.
- Organic cause related to muscular energetics or oxygen absorption, transport and release.
Psychological Fatigue
- Mental fatigue- lack of concentration, memory loss.
- Volitional fatigue- inability to begin tasks and avoidance of social contacts
When assessing fatigue we look at:
- Onset, pattern, duration
- Change over time
- Associated or alleviating factors
- Physical, emotional and mental symptoms
- Effect on usual function
- Sleep Issues
Primary Causative Factors:
- Pain
- Emotional Distress
- Sleep Disturbance
- Anaemia
- Hypothyroid
Interventions For Fatigue:
Education/Counselling:
- Known Pattern of Fatigue from Treatment
- Reassurance Fatigue is Manageable
- Coping Strategies- Energy Conservation, Distraction, Stress Management
Specific Interventions:
- Anemia- Iron, Folic Acid
- Hypothyroid- Thyroid Replacement
- Pharmacologic- Psycho Stimulants, Anti-Depressants, Steroids
Treatment For Fatigue:
- Exercise
- Restorative Therapy- Yoga, Stress Management, Breathing Techniques
- Nutrition
- Sleep Therapy
Active Coping Strategies to Break the Cycle of Fatigue from Treatment, Illness and Deconditioning Causing Sedentary Habits, Self Perpetuating Fatigue:
Physical training, activity and stress management have been shown in numerous studies to reduce fatigue, improve energy levels and improve the feeling of vitality.
Passive Coping Strategies:
Such as rest, sleep and decreasing physical activity, in contrast seem inefficient in relieving fatigue, creating a vicious cycle of immobility and de-conditioning further contributing to more fatigue and low energy.
Exercise Management
Physical activity has provided evidence of therapeutic benefits on fatigue, stamina, energy levels, improvement in fitness and quality of life.
Exercise is adapted to each cancer patient in terms of intensity, duration, frequency and type.
Screening is conducted to check for other health problems and complications.
For inactive individuals or those reporting high levels of fatigue exercise programs begin with low intensity and duration, progress slowly and are modified as indicated by changes in patient’s condition.
Strategies to assist with participation in exercise to alleviate fatigue:
- A personal exercise program
- A written exercise program
- Frequency and intensity documented to follow
- Log book for self monitoring
- Regular monitoring
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