Professional Documents
Culture Documents
z Section One:
Overview of Cancer-Related Fatigue
z Section Two:
Findings From Recent Study: Physiological
Correlates in Cancer-Related Fatigue
z Section Three:
Practical Considerations Related to Exercise
in Cancer Patients
Section One:
Overview of Cancer-Related Fatigue
WHY FATIGUE
z Affective Dimension
(irritability, anxiety, depression)
z Cognitive Dimension
(poor concentration & memory)
z Physical Dimension
(muscle fatigue & weakness, breathlessness)
MEASUREMENT of CRF
VARIABLE TOOL
Cancer-Related Fatigue Brief Fatigue Inventory (BFI)
Mendoza et al. Cancer (1999)
Mendoza et al. Cancer (1999)
MEASUREMENT
VARIABLE TOOL
Exercise Capacity 2-Minute Walk Test (2MWT)
O2 Saturation with Activity Pulse Oxymeter
Muscular Strength 30 second Chair Rise (CR)
Hand Grip Dynamometer
Muscular Endurance Hand Grip Dynamometer
Hemoglobin & C-Reactive Routine Blood Testing
Protein (CRP) Levels
MEASUREMENT
VARIABLE TOOL
Overall Breathlessness Visual Analogue Scale (0-10)
Weakness Visual Analogue Scale (0-10)
Sleep Visual Analogue Scale (0-10)
Pain Visual Analogue Scale (0-10)
STATISTICAL ANALYSIS
z INCLUDED
– Stage III or IV non small cell lung cancer
– Referred to McGill Cancer Nutrition and Rehabilitation
Program
z EXCLUDED
– Unable to complete questionnaires
– Unable to complete the assessment tasks due to pain
or safety reasons
PATIENT CHARACTERISTICS (n=58)
40
30
20
10
100
% Respondents
80
60
40
20
DIMENSION OF FUNCTIONING
50
% Respondents
40
30
20
10
FACTOR R2
Weakness (VAS) 0.45**
Overall Breathlessness (VAS) 0.30**
Pain (VAS) 0.29**
Lower Limb Strength (CR) 0.21**
Exercise Capacity (2MWT) 0.18**
** p<0.01 level
FACTORS UNRELATED TO CRF:
UNIVARIATE ANALYSIS
FACTOR R2
Upper Limb Strength 0.07
Upper Limb Endurance 0.04
O2 Saturation - Exercise 0.03
Hemoglobin 0.07
C-Reactive Protein (CRP) 0.02
Sleep (VAS) 0.03
MODEL BY
MULTIPLE REGRESSION
z Weakness (VAS)
z Overall breathlessness (VAS)
z Measurement of lower limb strength
(CR performance):
z Why exercise?
z Practical considerations related to exercise in
cancer patients
z Motivation and resources
Why Exercise
z Treatment Side-effects
– Chemo-induced
– Radiation-induced
– Surgical
– Other treatments: eg: Stem-Cell Transplant, steroids
z Disease-Related
– Site of tumor
– Metastases
– Nutritional status
– Psychosocial impact
Chemo-Induced
z Fatigue
z Thrombocytopenia
z Anemia
z Neutropenia
z Loss of hair
Chemo-Induced
z Decreased appetite
z Nausea and vomiting
z Changes in bowel function
z Neuropathy
z Altered mentation, “Chemo-brain”
z Cardiotoxicity
Radiation-Induced
z Burns
z Fibrosis
z Fatigue
Surgical
z Pain
z Anatomical changes
z Scar mobility
z Added management difficulties if followed
closely by radiation
z Foot drop
z Post-op restrictions due to type of surgery
z Post-op restrictions suggested by surgeon
Other Treatments
z Corticosteroids:
– Used in many treatment regimens
Site of Tumor
z Gastroesophageal
z Breast
z Prostate
z Hepatobiliary
z Lung
z Hematologic
z Other
Metastases
z Liver
z Lung
z Brain
z Bone
Nutritional Status
Psychosocial Impact
Coping
Coping
Cognitive
Cognitive Emotional
Emotional
Spiritual
Spiritual
Occupational
Occupational Person
Person Religious
Religious
Financial
Financial Relationships
Relationships
Physical
Physical
Some Guidelines from Cancer Exercise
Specialist Training Course
z Individualize
z Moderate intensity activity level
z Full body exercise at each session 3x/wk
z Monitor blood counts
z Progress slowly and vary workout with treatment
effects
Some Guidelines from Cancer Exercise
Specialist Training Course
z Some ideas….
– Patients have control: CHOICE
– Prevention of complications or secondary
problems
– Potential benefits
– Sense of achievement
– Goal setting
– New habit: can take 30-60 times to develop
– Exercise can be FUN, really…
Take-Home Message
marta.jelowicki@muhc.mcgill.ca