NEW YORK--Fatigue is too often a part of life for cancer patients
and can erode their quality of life. "We need to talk to
cancer patients about their energy level and ability to cope,
and educate them about how to deal with the treatment and the
disease itself," said Lois Almadrones, RN, MPA, OCN, clinical
research associate, Memorial Sloan-Kettering Cancer Center.
Ask patients to do their own fatigue assessment by keeping a log
for a few days or a week to determine when they feel the most
and least fatigued. This could lead to an educational intervention,
Ms. Almadrones said at a symposium on fatigue presented by Cancer
Patients on a 3-week cycle of chemotherapy, for example, are likely
to feel most fatigued 7 to 11 days after administration, she said,
while patients on radiation therapy will feel most tired toward
the end of therapy. "We need to tell them that that is when
they need to schedule in more rest periods," she said.
A symptom assessment should also be done, in addition to blood
work, she said. Questions to ask include: Are you having diarrhea?
Do you have difficulty concentrating, reading, or watching TV?
Do you have tingling and numbness in your hands and feet? Chest
pains? Pains in the arms or shoulders? Rapid heart beat?
A special sleep assessment may also be necessary. Ask patients
what wakes them up at night, Ms. Almadrones said, and suggest
that they not think about things that bother them right before
going to sleep. If pain is waking them up, a long-acting pain
medication that could provide even an hour's more rest would be
of benefit, she said. If nausea, vomiting, or diarrhea is awakening
them, taking medication before retiring could help.
Since patients often continue to work, they need to think about
when they are best able to concentrate. "Sometimes they say,
I'm only good for 2 hours in the morning," Ms. Almadrones
said. "So all the things that take the most concentration
should be done in the morning."
Patients should also be advised to eat healthy, high-caloric food
that goes down easily and does not require a lot of chewing. They
should be discouraged from using alcohol, cigarettes, or caffeine
to cope with their anxiety or stress, and counseled instead to
learn relaxation techniques or to join support groups.