NEW YORKManagement of anemia-related fatigue begins with good
communication, said Patricia Ann Kramer, RN, MSN, AOCN, a San Francisco-based
oncology nurse educator and consultant. Speaking at a Cancer Care
teleconference, she urged patients to report their fatigue to doctors, describe
it on a scale of 0 to 10, and not to feel they are taking up their doctor’s
valuable time talking about it. "The squeaky wheel," Ms. Kramer
observed, "gets the grease."
Ms. Kramer said patients should inform themselves about the meaning of
hematocrit and hemoglobin levels so that they can ask questions about their
blood work. "The more knowledge you have, the more empowered you can be
when you talk to your provider," she said.
Fatigue is an individual experience, she said, one affected by age and by
cancer diagnosis and treatment. And there are individual energy patterns that
lead some to feel more energetic in the morning and others to feel more so in
the afternoon or evening, patterns that patients have to recognize to help
manage their fatigue, she said.
Minimizing abnormalities and maximizing positives like nutrition, exercise,
and sleep are the essence of management, Ms. Kramer explained. Physicians
minimize the abnormalities by stimulating red blood cell growth; correcting
electrolyte imbalances, thyroid abnormalities and dehydration; or, in the most
severe cases, treating with blood transfusions.
Patients can maximize the positives by taking other steps to increase energy
and quality of life, Ms. Kramer said. She recommended that patients pace their
activities and lighten their schedules; take short naps, but not long ones that
may interfere with sleep at night.
Pharmacologic intervention can be appropriate for sleep difficulties, but
relaxation techniques and a regular sleep schedule may also overcome sleep
problems. Beverages after 7 pm should be avoided to prevent sleep interruption.
An exercise regimen, no matter how slight, should be followed, as long as it is
approved by a physician. "I don’t mean jumping jacks," Ms. Kramer
said. "I mean regular, consistent, physical activity in moderation. Start
The diet should include good amounts of complex carbohydrates and proteins,
she said. Meals should be small and frequent to sustain energy levels
throughout the day, and pantries should be stocked with foods that are both
nutritious and easy to prepare.