Sleep is not the answer to fighting cancer fatigue
Teach variety of methods for symptom control
While a good night’s sleep usually rejuvenates those suffering from exhaustion, if the fatigue is cancer-related, rest does not help the patient recover. "Cancer fatigue is prevalent, even with rest," says Heather Brumbaugh, RN, MSN, ANP, a nurse practitioner at Duke University Medical Center in Durham, NC. It is a persistent fatigue that has been present for at least two weeks or more rather than just a few days.
Cancer patients describe the fatigue in various ways. Some say it is a lack of energy while others say it is a lack of motivation. "Some patients say that they feel lazy and they have never been lazy before," says Brumbaugh. Frequently, cancer patients are not able to do the usual mental tasks they have done in the past and have trouble making decisions because they can’t focus.
Sometimes the fatigue impacts the patient’s ability to function. They are unable to do their work, and it interferes with their activities of daily life.
Although the cause of the fatigue is not known, there are several factors that medical professionals say contribute to the cause, says Brumbaugh. The disease can contribute to the symptoms because cancer cells release cytokines that can cause fatigue. The treatment also can cause fatigue whether it is chemotherapy, radiation, surgery, or some of the newer biological agents. Physiological disturbances can be a factor in fatigue, which include anemia, dehydration, and infection.
Things that disturb sleep, such distress and concerns about the disease, can be a factor in the fatigue. Also physical symptoms that are not well controlled and therefore keep the patient awake at night, such as pain and nausea. The multiple medications that people often take can make them more depressed and fatigued.
"Also, a low level of activity will cause fatigue. It becomes a vicious cycle. If they don’t keep doing things, their energy is not going to come back; so just sitting in the chair waiting for it to return is a factor," says Brumbaugh.
Controlling symptoms
When patients have a lot of difficulty with fatigue they need to know that it is important to discuss their concerns with their nurse or physician. Often they don’t mention their fatigue because they are afraid that their physician will cut back on their treatment, and the cancer will not be controlled or cured.
Another reason is that patients fear the physician might find out the disease is getting worse. Therefore, it’s important that they understand that when they start chemotherapy they begin to feel better because the cancer is back in control. However, near the end of the treatments, they are fatigued because the treatment is making them feel tired. They think the cancer is returning because they feel like they did when their cancer was first diagnosed, says Brumbaugh.
Patients may have to plan their day so they have time to rest in the afternoon or save their energy by skipping the housework so that they can go to a family gathering in the evening. They need to learn how to prioritize their time better, says Brumbaugh. Friends and family will often ask how they might help and it’s important that cancer patients assign tasks when help is offered.
Exercise is beneficial in fighting fatigue, so it is important that cancer patients do some sort of activity each day, such as taking a short walk. Activities that take people’s minds off the stress and fatigue of the disease and treatment is useful as well. "They need to make sure they do something for fun or that is of interest to them, such as listening to music or taking a walk in the garden," says Brumbaugh. Yoga and meditation sometimes helps to divert patients’ thinking so they aren’t worrying about everything and that will increase their energy level.
Goal: Improve quality of life
Some people find that it is helpful to talk to others who are experiencing similar symptoms and share ideas, so support groups help with fatigue management. Journaling or keeping a diary where the patient would write down their thoughts and feelings also is helpful to some.
Helping patients address cancer fatigue will help them have a better quality of life during treatment. "If we can make the fatigue a little bit better, even if it is just so much as helping them understand that part of treatment and that things will get better, I think their quality of life should be improved," says Brumbaugh.
Source
For more information about teaching patients how to control cancer fatigue, contact:
- Heather Brumbaugh, RN, MSN, ANP, Nurse Practitioner, Duke University Medical Center, Hematology Oncology Clinic, DUMC Box 3872, Durham, NC 27710. E-mail: [email protected].
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