Fatigue And Asthenia Flashcards
List 3 key features of fatigue
- Easy tiring
- Generalized weakness
- Mental fatigue
Define “generalized weakness”
The anticipatory sensation of difficulty in initiating a certain activity.
Define “mental fatigue”
Defined as the presence of impaired mental concentration, loss of memory, and emotional lability.
Define cancer-related fatigue
A distressing persistent, subjective sense of physical, emotional and/or cognitive tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning.
List 3 tumour-produced byproducts that can cause fatigue.
- Lipolytic factors
- Proteolytic factors
- Cytokines
- Tumour degredation products
- Invasion of brain or pituitary gland
List 3 pro-inflammatory cytokines implicated in cancer-related fatigue.
- TNF-alpha
- IL-1
- IL-6
What body systems do pro-inflammatory cytokines act on to induce fatigue? (4)
- Brain
- Muscles (msk)
- Immune system
- Metabolism
What 3 host factors regulate pro-inflammatory cytokines implicated in fatigue?
- Genetic factors
- Immune factors
- HPA axis alterations
Contributors to Fatigue (14)
- Cachexia
- Mood disorders
- Inflammation
- Neuroendocrine alterations
- Poly pharmacy
- Cancer-related symptoms
- Anemia
- Tumour by-products
- Infections
- Dehydration
- Anti cancer treatments
- Comorbidities (renal, hepatic, heart disease).
- Autonomic dysfunction
- Deconditioning
List 6 causes of muscle abnormalities due to cancer or it’s treatment.
- Abnormalities in cytokine production
- Cachexia
- Increased lactate in muscle tissues
- Atrophy if type II muscle fibres
- Myopathies from anti cancer treatments
- Loss of muscle mass from corticosteroids
6 causes of anemia in cancer pts
- Myelosuppression by chemotherapeutic agents
- Iron deficiency
- Bleeding
- Haemolysis
- Nutritional deficiencies
- Anemia of chronic disease
List 7 physical effects of autonomic dysfunction.
- Malnutrition
- Delayed gastric emptying
- Chronic nausea
- Anorexia
- Poor performance status
- Fatigue
- Orthostatic hypotension
List 3 psychological issues that can cause fatigue.
- Depression
- Anxiety
- Adjustment reaction
List 4 electrolyte abnormalities that can cause fatigue.
- Hyponatremia
- Hypokalemia
- Hypomagnesemia
- Hypercalcemia
List 6 cancer-related symptoms that can cause fatigue.
- Pain
- Psychological symptoms
- Dyspnea
- Sleep disturbances
- Anorexia
- Constipation
List 9 paraneoplastic neurological syndromes associated with fatigue
- Progressive multifocal leucoencephalopathy
- Paraneoplastic encephalomyelitis
- Amyotrophic lateral sclerosis
- Subacute motor neuropathy
- Peripheral paraneoplastic neurological syndrome
- Ascending acute polyneuropathy
- Dermatomyositis polymyositis (neuromuscular)
- Eaton-lambert syndrome (neuromuscular)
- Myasthenia Gravis (neuromuscular)
List 4 anti cancer therapies that commonly contribute to fatigue.
- Cytotoxic therapeutic agents
- Radiotherapy
- Biological response modifiers (i.e interferon)
- Targeted therapy (I.e tyrosine kinase inhibitor)
List 11 medication classes commonly used in palliative care that can cause fatigue.
- Opioids
- Anxiolytics
- Anticholinergics
- Antiepileptics
- Neuroleptics
- Alpha-adrenergic blocking agents
- Diuretics
- SSRIs
- TCAs
- Benzos
6 components to assessment of fatigue
- Severity
- Duration
- Onset
- Level of interference with ever day life
- Associated psychological or social problems
- Possible underlying causes
Name 6 clinical assessment tools for fatigue.
- Visual analogue scale
- Numeric scales
- Functional assessment of cancer therapy-fatigue
- Brief Fatigue Inventory
- Piper Fatigue Scale
- Fatigue Questionnaire
- Multidimensional Fatigue Inventory
- Pearson and Byars Fatigue Feeling Checklist
List 4 approaches to assessing fatigue in the clinical setting.
- Functional capacity
- Performance status
- Task-related fatigue
- Subjective assessment tools
List 3 tools to assess performance status
- Karnofsky performance status
- European Cooperative Oncology Group score (ECOG)
- Edmonton functional assessment test
3 questions to consider in the assessment of fatigue
- Is fatigue a symptom of primary concern to the patient?
- What are the major, probable causes?
- Are there therapeutic measures available that have reasonable cost/benefit ratio?
List 5 non-pharm measures to manage fatigue.
- PT
- OT
- Counselling
- Acupuncture
- Exercise (early cancer and cancer survivors… not so much late stage)… best evidence.
List 3 classes of medications that can help manage fatigue.
- Corticosteroids (dex)
- Prgestational agents (megastrol acetate)
- Psychostimilants (methylphenidate)
List 10 specific measures to address in the evaluation and management of fatigue.
- Psychological issues
- Cachexia
- Anemia
- Infection
- Autonomic failure
- Metabolic and endocrine disorders
- Opioid induced sedation
- Hypoxia
- Dehydration
- Deconditioning
List 3 ways corticosteroids are thought to help combat fatigue.
- Inhibition of tumour induced substances
- Central euphoriant effects
- Improvement of physical symptoms
List 8 potentially reversible causes of fatigue in palliative care patients.
- Infection
- Anemia
- Autonomic factors
- Psychological factors
- Sleep disturbances
- Metabolic disorders
- Drug induced
- Nutritional deficiency
List 7 ways to manage fatigue caused by autonomic dysfunction.
- Midodrine (alpha-1 sumpathomimetic agent)
- Adjust doses of meds contributing to fatigue
- Decrease poly pharmacy
- Encourage exercise
- Increase salt intake
- Consider mineralocortocoid if indicated (fludricortisone)
- Avoid triggers of autonomic insufficiency.
List 4 triggers of autonomic insufficiency.
- Heat
- Large morning meals
- Etoh
- Motionless standing
What is one common nutritional deficiency in patients with advanced cancer?
Carnitine
List 4 nutritional supplements that may help combat cancer-related fatigue.
- L-carnitine
- Ginseng
- Co-Enzyme Q-10
- Guarana
What are common changes associated with cancer related fatigue? (6)
- Decreased cognitive function
- Decreased muscle endurance
- Decreased sleep quality
- Decreased control over body processes
- Increased social withdrawal
- Increased emotional reactivity
What is the pathophysiology of cancer related fatigue?
Proposed mechanisms include energy imbalance caused by a variety of mechanisms including:
- Pro-inflammatory cytokines
- HPA axis dysregulation
- Circadian rhythms desynchronization
- Persistent immune system activation
- Establishment of a chronic inflammatory state.
Describe the brief fatigue inventory?
0-10 numeric scale rating fatigue over designated time period.
0-3 mild
4-7 moderate
8-10 severe
List 8 psychosocial interventions to manage cancer related fatigue.
- CBT
- Behavioural therapy
- Psychotherapy
- Support groups
- Changing coping strategies
- Relaxation
- Energy conservation
- Stress management
What are 4 considerations when prescribing/recommending exercise to patients?
- Frequency
- Intensity
- Time
- Type
(FITT)
What advice would you give a patient to manage fatigue in advanced cancer? (6)
- Plan activities during times in the day when pt is least tired.
- Integrate regular, gentle activities into the day (stretching, sitting at table for meals).
- Avoid stress and include relaxation/meditation techniques throughout the day.
- Suggest multiple short naps throughout the day.
- Limit visiting hrs for family and friends.
- Look into home meal delivery options.
What are the five elements of the definition of fatigue according to the NCCN?
- Distressing
- Persistent
- Physical tiredness
- Emotional tiredness
- Cognitive tiredness
List 4 CNS abnormalities that may contribute to fatigue
- Primary and secondary tumours
- Anti neoplastic tx
- Drugs used to treat complications of cancer (ie opioids)
- Dis regulation of seretonin and or its receptors in the brain due to cancer tx.
- Circadian rhythm disruption
- Dysregulation of the HPA axis
What is the relationship between fatigue and cachexia?
Fatigue can be caused by muscle weakness and malnutrition which are characteristic of cachexia. But profound fatigue can exist in the absence of cachexia.
On a numerical rating scale what value has been shown to suggest clinically relevant fatigue?
> 5
3 benefits of exercising to manage fatigue.
- Maintain muscle mass
- Improved outcomes (ie maintaining independence)
- Improved self-reported physical functioning
- Improved sense of wellbeing
- Improved self esteem
List 4 lifestyle modifications that can be undertaken for management if fatigue and which can be explored in counseling.
- Adapting activities
- Spending more time in bed or exercise if deconditioned.
- Rearranging schedules with respect to fatigue patterns.
- Change causative medications
Treatment for what level of anemia is associated with improved fatigue in palliative care?
<80
List 2 disadvantages of epo for treatment of fatigue.
- It may decrease survival time
2. 4-8 weeks before hgb increases
What is the typical dose of corticosteroids for fatigue?
Prednisone 40mg daily
