Fatigue

1. Fatigue Tanya Navarro 2011 Occupational Therapist With materials from Gemma Lindsell and Allie Harding

2. Fatigue Common BUT • Persistent fatigue • Affecting daily life

3. Fatigue WearinessAches and pains Exhaustion Difficulty Concentrating Lack of Energy Weakness Difficulty carrying out usual activities Poor appetite Forgetting things Increased need for rest having to push self to do things

4. Aims • Identify various causes and how it may affect you • Discuss fatigue management tips • Feel more in control over fatigue

5. What Causes Fatigue?

6. Chemotherapy • Up to 96% of people having chemotherapy feel fatigued at some stage. • Causes anaemia, drop in counts • If people get an infection this may make the fatigue more severe. • Causes changes in sleep • Anxiety/depression

7. Drug Therapy Drugs with sedative effect, such as anti-emetics (prevent vomiting) and analgesics (pain relief) may bring on fatigue.

8. Radiotherapy • Between 65-100% of people who have had radiotherapy feel fatigued • Can last up to three months after treatment. • Cause unknown but may be because body uses up more energy to repair tissue damaged by radiation.

9. Loss of body strength • Muscle wasting as a result of the disease. • More energy being used to perform any physical activity.

10. Nutrition Less energy from food Decreased appetite Eat less Fatigue Nausea vomiting Less energy from food Eat less Fatigue

11. Supportive Therapies • Travel to hospital for transfusions • Intensive regimes (Azarcitidine) • Travel to hospital for hormone therapy • Long distances

12. Sleep problems • Difficulty in getting / staying asleep • Interrupted sleep • Poor quality sleep • Disorders of sleep / wake pattern • 50% of people with a chronic illness/cancer may have sleep disturbance • 85% of people with a chronic illlness/cancer who have sleep problems do not report it to the doctor

13. How can fatigue affect you?

14. Sleeplessness • Fatigue • Sleepiness • Poor concentration • Irritability • Long term can lead to low mood • Slower recovery from infection • Body will repair damaged body tissue more slowly

15. Thinking • hard to concentrate • hard to focus attention on things • difficulty remembering things • feeling overloaded • Decreased interest • Worry about treatment /finances/family

16. Behaviour • avoiding going out • avoiding usual activities • seeing less of friends / family • accepting fewer responsibilities

17. Physical • tiredness • lower energy levels • need to slow down normal pace • general sense of sluggishness • more need for sleep and rest

18. Emotions • Frustration • Irritation • Feelings of never being "normal" again • Feeling like no-one really understands • Sadness/grief at the changes

19. Severity • changes from day to day • may feel more tired after certain activities • tiredness may last for days • may experience ups and downs • may be linked to symptoms (e.g. pain, nausea and vomiting, etc.)

20. The good news…

21. How is Fatigue Managed? • Education • Exercise • Changing the way you do things • Getting a balance of activity and rest • Managing stress • Getting enough energy from food and water.

22. Posture • Energy can be lost through poor posture and pain • Try to maintain a good posture when sitting or standing • Try not to tense muscles to protect painful areas as this can use up lots of energy • Try to be aware of your position to ensure that you can keep a good posture to avoid excessive and repetitive bending, twisting or reaching

23. Pacing yourself • Good and bad days • Do more on a good day, often takes days to recover • Little activity the rest • Try to do same amount of activities every day

24. Planning your days • Organise your activities around chemo/therapy • Consider which times of the day are best for you – consider using a diary to help with this • Avoid unnecessary exertion • Try to space activities out during the week and not cram it all in to one day

25. Prioritising • Decide which activities are of most value to you each day • Cut out any unnecessary tasks, or delegate if you can

26. Imagine having a jar of energy each day. Your energy jar is topped up once over night. What would you like to use your energy on?

27. Looking after yourself • Keep all toiletries in one place within easy reach • Collect all clothes / items needed and put them within easy reach • Rest elbows over this sink or on a dressing table • Try to sit down to wash and dress • When showering place the showerhead on the stand rather than holding it • Put a dressing gown on to dry self rather than using a towel

28. Meals • Gather all required items before starting task • Use lightweight plastic mixing bowls • Freeze food left over to be used another day • Try to cook vegetables together to avoid using lots of pans • Use a vegetable basket to drain veg • Soak used pans to avoid having to scrub dirty pans • Can any one else do the washing up?

29. Laundry • Avoid excessive bending to sort out washing – place basket on a chair / table • When hanging out clothes try to lower the line or put the basket on a chair • Fold clothes as you take them off the line to minimise creases and need for ironing • Use a peg basket or leave pegs on the line • Sit down to iron

30. Shopping • Look into shopping from home by phone or internet • Make lists to organise the shopping trip • Can anyone go with you? • Does the shop have a delivery service? • Use trolley to transport items to the car • If possible, plan to shop at a quiet time to avoid “rush-hour” • If possible, stop for a rest / tea / coffee before returning home to unpack shopping

31. Childcare • Explain to family and children how you feel • Try not to lift smaller children – use a pushchair when possible • Play games / activities sitting down • Make a game out of household chores to involve children and allow them to do small tasks

32. Change the way you do things • Be aware of your limitations • Tell others when you feel overwhelmed or overloaded • Cut down distractions when try to concentrate on a task • If it helps, keep a diary to help you remember your plan for the day / week

33. Talking • Sharing problems can help • Talking can make the situation “normal” and help you realise that you are not alone • Write down questions to ask your doctor, nurse, therapist

34. Treatment of sleep problems • Try to keep a regular sleep / wake pattern • Get up at the same time every morning • Try not to nap during the day • Identify worries before bedtime • Keep as active as possible during the day • Avoid strenuous exercise after 7pm • Avoid caffeine and alcohol after 7pm • Cool room

35. Meaningful Life • Do something you enjoy every day • Break cycle of lethargy • Get in control of your fatigue

36. Summary • Very common during illness and treatment • Important to let people know how you are feeling. • You can get in control of your life!!!

37. References • Carpenter J S et al (2001) Circadian rhythm of objectively recorded hot flushes in post menopausal breast cancer survivors. Menopause. 8 (3) 181-8 • Crisp A H (1980) Sleep activity, nutrition and mood. British Journal of Psychiatry 137, 1-7 • Engstrom C A et al (1999) Sleep alterations in cancer patients. Cancer Nursing 22 (2) 143-8 • Portenoy R K et al (1994) Symptoms prevalence, characteristics and distress in a cancer population. Quality of Life Research 3 (3) 183-9