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Sympthoms in the elderly Asthenia

Sympthoms in the elderly Asthenia. Marta Mazzoli, Settimio Tempera Hospice residenziale e domiciliare Casa di Cura Merry House, Roma. Fatigue in Hospice: Patients. 60 inpatients from May 2012 to September 2012. Fatigue in Hospice: Patients. Fatigue in Hospice: Patients.

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Sympthoms in the elderly Asthenia

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  1. Sympthoms in the elderlyAsthenia Marta Mazzoli, Settimio Tempera Hospice residenziale e domiciliare Casa di Cura Merry House, Roma

  2. Fatigue in Hospice: Patients 60 inpatients from May 2012 to September 2012

  3. Fatigue in Hospice: Patients

  4. Fatigue in Hospice: Patients

  5. Fatigue in Hospice: Methods

  6. Fatigue in Hospice: Results 11 patients > 65 ys > 2 wks

  7. Fatigue in Hospice: Results 28 patients > 65 ys < 2 wks

  8. Definition of Cancer-Related Fatigue Definition of fatigue in the internationalclassification of disease (ICD-10) Asthenia include three different major simptoms: 1. fatigue or lassitude defined as easy tiring and decreased capacity to maintan perfomance 2. generalized weakness defined as the anticipatory sensation of difficulty in initiating a certain activity 3. mental fatigue defined as the presence of impaired mental concentration, loss of memory and emotional lability (Oxford Textbook of Palliative Medicine 1998) Fatigueas a subjective feeling of tiredness, weakness or lack of energy (EAPC 2008) Cancer-related fatigue is a distressing persistent, subjective sense of physical, emotional and/or cognitive tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning (NCCN 2012)

  9. Prevalence of Cancer-Related Fatigue • 1.000 pat in an American palliative care program: fatigue (84%), weakness (66%) and lack of energy (61%) • In palliative care for non cancer patients: HIV, multiple sclerosis, chronic obstructive pulmonary disease, heart failure • 60% patients during chemotherapy rate fatigue as the symptom with the highest impact of daily living more than pain, whereas physicians believe the pain adversely affects their patients more than fatigue • Fatigue can be a long-term problem in disease-free patients • > 50% of the patients had never talked about fatigue with their physician: • The doctors failure to offer interventions • The patients lack of awareness of effective treatment

  10. Barriers to fatigue’s treatment • Insufficient knowledge about fatigue and its treatments • Understimate the impact of fatigue on quality of life • Consider fatigue an unavoidable and irremediable side-effects and fear that reporting it may incite a change toward less aggressive cancer treatment Physician Patient

  11. Pathogenesis of Cancer-Related Fatigue • Disturbance of hypothalamic-pituitary-adrenal axyslow cortisol production or other endrocrine changes • A defect in the mechanism of regenerating ATP in musclefeelinfs of weakness and lack of energy • Dysregulation of proinflammatory cytokines, such as TNF • For a systematicapproach: • Primaryfatigue • Secondaryfatigue

  12. Assessment of fatigue…depend on the setting In nonspecialized settings such as oncology departments or general practice single-item questions such as “Do you feel unusually tired or weak?” In specializedsettingssuchas palliative care units Edmonton SymptomAssessmentScore Radbruch L. e al; Palliative Medicine, 2008

  13. Diagnosis and treatment of cancer-related fatigue SETTING DI CURA PAP SCORE Campos M.P.O. e al; Annals of Oncology, 2011

  14. Nonpharmacological treatment • Cognitive-behavioral interventions-interventions specifically focused on fatigue are more effective than general interventions • Exercise-activity enhancement and sleep therapy – in patients receiving cancer treatment • Counselling for energy conservation principles • Complementary and alternative medicine – in patients receiving cancer treatment Campos M.P.O. e al; Annals of Oncology, 2011

  15. Pharmacological treatment • Methylphenidate – no differences comparing methylphenidate and placebo in elderly patients with fatigue • Modafinil • Pemoline – superior to placebo in patients with AIDS • Donazepil • Erythropoietin – in anemic cancer patients receiving chemotherapy • Corticosteroids – may be used to alleviate fatigue for well-defined goals Campos M.P.O. e al; Annals of Oncology, 2011

  16. Take home messages Fatigue in cancer and non cancerelderly palliative care patientsis under-recognized, under-assessed and under-treated Screening and Assessment Combinedapproach and individualized treatment plans in the setting of a dedicatedcancer-relatedfatigue clinic Fatigueshould be treated more aggressively in patientsactivelyundergoinganticancer treatment with curative or palliative intent In end of life, fatiguemayprovideprotection and shielding from suffering for olderpatient and treatment of fatiguemay be detrimental

  17. THANK YOU FOR YOUR ATTENTION!!

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