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Prostate Care: Fatigue


Cancer-related fatigue a different kind of tiredness. Defining cancer-related fatigue ' A subjective, unpleasant symptom which ... Physiotherapy for exercise ... – PowerPoint PPT presentation

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Title: Prostate Care: Fatigue

Prostate Care Fatigue
  • Mei Krishnasamy
  • Nursing Research Fellow

Establishing clarity
  • Cancer-related fatigue a different kind of

Defining cancer-related fatigue
  • A subjective, unpleasant symptom which
    incorporates feelings ranging form tiredness to
    exhaustion, creating an unrelenting condition
    which interferes with individuals ability to
    function to their normal capacity
  • (Ream Richardson, 1996)

Talking about fatigue
  • Its just so heavy this tiredness, its like a
    weight coming down on you and you cant move
    (Allan, Case 11)
  • Sitting about all day doing nothing.if its not
    being out of breath its the tiredness (Michael,
    Case 7)
  • No energy to lift my head up (Gordon, Case 14)
  • Its become like an exhaustion (April, Case 5)

Talking about fatigue Impact on family members
  • "I was already exhausted, physically and
    emotionally. It was not easy to switch gears and
    summon whatever reserves still existed inside of
    me, but I knew it was absolutely necessary to do
  • (family carer of patient with AIDS - Brown
    Stetz 1999)
  • "I counted up one day- because she lies on here
    and I sit over there-and within 10 minutes I was
    up 15 times. Just put me pillow right, just pick
    me up, just put me down, you know, frustration
    really (husband - Thomas et al 2002)

Cancer-related fatigue the magnitude of the
  • Chemotherapy
  • Radiotherapy
  • Surgery
  • Immunotherapies and hormone therapies

Fatigue and cancer diagnoses
  • Patients with melanoma, lung, and ovarian cancer
    experience the greatest level of cancer-related
  • Patients with breast and testicular cancer
    experience the lowest levels of fatigue

Fatigue in prostate cancer
  • Health related quality of life is a primary
    endpoint of treatment evaluation for patients
    with prostate cancer
  • Fatigue is a primary concern

The evidence (1)
  • Fatigue, social functioning, sleep disturbance,
    and cognitive function identified as the most
    frequent dimensions of quality of life affected
    moderately or severely in 262 men receiving RAD
    or PRECT
  • Fatigue, physical functioning, and emotional
    function identified as independent predictors of
    quality of life
  • (Lilleby et al. 1999)

The evidence (2)
  • Fatigue severity shown to increase from point of
    initiation of hormone therapy in a group of 58
    men receiving Goserelin (LHRH)
  • 66 of the sample reported a significant increase
    in fatigue severity from baseline to three months
    post initiation of therapy
  • The increase experienced in fatigue level
    comparable to that in men receiving RAD
  • (Stone et al. 2000)

The evidence (3)
  • A study of 41 men receiving radiotherapy as
    primary treatment (54), after TURP (10) and
    after PREC (36)
  • A moderate worsening of fatigue noted during
    radiotherapy that returned to normal levels by 6
    weeks post radiotherapy
  • (Janda et al. 200)

The evidence (4)
  • Vordermark et al 2002 chronic fatigue (median
    2 years post completion of therapy) shown to be a
    problem after radical or post-operative
    radiotherapy for 103 men with T1-T3 disease
    receiving median total dose of 66Gy
  • 18 of men reported experiencing severe fatigue
  • (31 radical radiotherapy
  • 12 post-operative radiotherapy
  • 15 of men receiving hormone therapy)

The evidence (5)
  • 26 of 206 men aged between 48-85 years between
    one month and 5 years post diagnosis identified
    lack of energy and tiredness as a moderate or
    high area of unmet care need
  • (Steginga et al. 2001)

The evidence (6)
  • Men who receive androgen deprivation therapy
    experienced more fatigue, more loss of energy,
    emotional distress and lower overall QL than men
    who deferred hormone therapy
  • Study of 144 men with asymptomatic,
    non-metastatic prostate cancer 79 men receiving
    androgen therapy, 65 not.
  • (Herr OSullivan 2000)

Fatigue as an overlooked and under-treated problem
  • Data from the CAPSURE study of 2,252 men
    demonstrated significant differences (p0.002)
    between physician and patient assessments of
    sexual, urinary, bowel function, fatigue and bone
    pain (Litwin et al. 1998)
  • Similar findings presented in studies of
    heterogeneous groups of cancer patients
  • (Vogelzang et al 1997 Curt et al. 2000)

Strategies for managing fatigue
  • Pharmacological approaches
  • Non-pharmacological approaches

  • Fatigue
  • Social functioning
  • Sleep disturbance
  • Cognitive function (Lilleby et al. 1999)
  • Hot flashes
  • (Stone et al. 2000. Herr et al. 2000)

Pharmacological approaches
  • Psychostimulants
  • - Methylphenidate
  • -Pemoline
  • -Dextroamphetamine
  • Corticosteroids
  • - Dexamethasone
  • - Prednisolone

  • Anaemia Blood transfusion/ Erythropoietin
    androgen therapies
  • Depression
  • Pain control
  • Other symptoms

Non-pharmacological approaches
  • Patient education
  • Exercise associations between loss of muscle
    bulk and neuromuscular function (Stone et al.
  • Psychosocial interventions
  • Sleep therapy

Patient education (Ream Richardson 1997
Johnson et al. 1997 Berglund et al. 2003)
  • Well-being and health promotion
  • Problem/symptom management
  • Depression
  • Breathlessness
  • Pain
  • Sleep disruption
  • Self-care strategies
  • Family centred

Exercise (Segal et al. 2003, 2001 Berglund et
al. 2003 Porock et al. 2000 Mock et al. 1997
Dimeo et al. 1997 Mac Vicar et al. 1986)
  • Benefits include
  • Increased energy
  • Maintenance or restoration of prioritised
    physical functioning
  • Enhanced mood
  • Improved sleep quality
  • Reduced nausea and complications of prolonged bed
  • Aerobic exercise walking, treadmill,
  • Low to moderate intensity
  • 10-30 minutes
  • 3-4 times/week

Psychosocial interventions
  • Encourage and support discussion of concerns and
    worries about prostate cancer, its treatment and
    outcome (Clark et al. 1997, Johnson et al. 1997)
  • Introduce relaxation, mediation, group support
    (as appropriate)
  • Cognitive behavioural strategies

Sleep therapy
  • Daytime inactivity and night-time restlessness
    associated with increased\levels and perception
    of cancer-related fatigue
  • Inactivity is de-conditioning
  • Balance energy conservation with prioritised
  • Plan a structured approach to sleep, rest, and
    activity based\on individual needs

Pulling it all together
  • Screen
  • Assess
  • Plan strategy for living with cancer-related
  • Implement
  • Re-assess regularly
  • Modify strategy

Planning and co-ordinating a strategy Nursings
  • Set the agenda ask about fatigue and discourage
  • Identify the core facet of the individuals
    fatigue experience
  • Identify interested/core members of the health
    care team

Refer for
  • Medical advice low hb, depression,
    consideration of steroids
  • Dietician- nutritional evaluation and support
  • Physiotherapy for exercise
  • Occupational therapy for physical functioning
    skills, stress management

  • Evaluate the components of the strategy
  • Re-assess fatigue duration, severity, and
  • Plan, deliver, and evaluate strategies within a
    framework of family centred care