1. Cancer-Related Fatigue

2. Objective The learner will be able to discuss the nursing management of cancer-related fatigue.

3. Problem Fatigue is a distressing, persistent, and subjective sense of tiredness or exhaustion that is not proportional to recent activity and interferes with usual functioning.

4. Incidence Often cited as the most common symptom Occurs with other symptoms in a cluster Contributing factors: – Anemia – Sleep disturbances – Poor nutrition – Fluid/electrolyte abnormalities

5. Pathophysiology Elevated cytokine release Altered skeletal muscle metabolism Dysregulation of the hypothalamic pituitary- adrenal (HPA) axis Sickness behavior

6. Assessment Elevated cytokine release Altered skeletal muscle metabolism Dysregulation of the hypothalamic pituitary- adrenal (HPA) axis Sickness behavior

7. Evidence-Based Interventions Recommended for practice: – Exercise Likely to be effective – Energy conservation – Education – Measures to optimize sleep quality – Complementary therapies (massage, relaxation) Balance benefit with harms. – Correction of anemia

8. References Irwin, M., Poirier, P., & Mitchell, S.A. (2014). Fatigue. In M. Irwin & L. Johnson (Eds.). Putting evidence into practice: A pocket guide to cancer symptom management (pp. 111- 117). Pittsburgh, PA: Oncology Nursing Society. Mitchell, S.A. (2015). Fatigue. In C.G. Brown (Ed.). A guide to oncology symptom management. (2 nd ed., pp. 385-407). Pittsburgh, PA: Oncology Nursing Society. National Comprehensive Cancer Network. (2015). NCCN clinical practice guidelines in oncology: Cancer-related fatigue [V.2.2015]. Fort Washington, PA: Author.