Table 2. Centrally Acting Stimulants for Adult Cancer Patients continued...
Much of the management of chronic fatigue in people with cancer involves promoting adaptation and adjustment to the condition. The possibility that fatigue may be a chronic disability should be discussed. Although fatigue is frequently an expected, temporary side effect of treatment, the problem may persist if other factors continue to be present.
An important goal of management is to facilitate self-care for the person with cancer. Since fatigue is documented as the most commonly reported symptom in individuals receiving outpatient chemotherapy (81% of cancer patients report fatigue), a shift in responsibility for control of side effects from the health care professional to the individual is important. It is imperative that individuals with cancer are educated about fatigue before it occurs and are taught about self-care strategies necessary to manage fatigue.
Specific techniques for the management of fatigue include the following:
- Differentiation of fatigue from depression.
- Assessment for presence of correctable correlates or causes of fatigue (e.g., dehydration, electrolyte imbalance, dyspnea, anemia).
- Evaluation of patterns of rest and activity during the day as well as over time.
- Determination of the level of attentional fatigue and encouragement of the planned use of attention-restoring activities (e.g., walking, gardening, bird watching).
- Providing anticipatory guidance regarding the likelihood of experiencing fatigue, and the fatigue patterns associated with particular treatments.
- Encouragement of activity/planned exercise programs within individual limitations; making goals realistic by keeping in mind the state of disease and treatment regimens.
- Education of individuals and families about fatigue related to cancer and its treatment.
- Helping people with cancer and their families identify fatigue-promoting activities and develop specific strategies to modify these activities.
- Suggesting individualized environmental or activity changes that may offset fatigue.
- Maintaining adequate hydration and nutrition.
- Recommending physical therapy referral for people with specific neuromusculoskeletal deficits.
- Recommending respiratory therapy referral for people with dyspnea that is a contributing factor to fatigue.
- Scheduling important daily activities during times of least fatigue and eliminating nonessential, stress-producing activities.
- Addressing the negative impact of psychologic and social stressors and how to avoid or modify them.
- Evaluating the efficacy of fatigue interventions on a regular and systematic basis.