(Music)
Narrator:
It is the most common and debilitating symptom a cancer patient can have. It even surpasses pain.
Title:
Cancer-Related Fatigue
Tom Cassell, Cancer Survivor:
Fatigue is very strange. It's hard to describe to somebody else, but it really slows you down. What you can accomplish and what you can do.
Eva Vega, Cancer Survivor:
I feel no energy, I feel like when you squeezing an orange and you take all the juice in your body. I feel like that.
Narrator:
Most people have experienced fatigue at some point in their lives. But for as many as six to nine out of every ten M.D. Anderson cancer patients, it's much different.
Dr. Carmen Escalante, Medical Director, M. D. Anderson Fatigue Clinic
It's different in the sense of patients without cancer having fatigue is that most of us that have fatigue, rest and we feel better and we're able to do things. Typically that doesn't happen with cancer-related fatigue.
Narrator:
Fatigue cannot only leave patients constantly feeling tired and lacking energy, but with leg pain and shortness of breath. It could even prolong recovery time. It can lead to difficulty walking short distances and performing daily tasks. Cancer-related fatigue cannot only be brought on by cancer itself and cancer treatment, but emotional stress or depression, persistent pain, the side-effects of medications, anemia, poor nutrition, little rest or just lack of good sound sleep. There are warning signs.
Eva Vega:
I was doing some cooking and I have to stop and go sitting and resting.
Narrator:
A weak feeling over the entire body, like Eva felt, is just one of them. A lack of energy, difficulty concentrating, waking up tired after sleeping, a lack of motivation to be physically active and increased irritability, nervousness, anxiety or impatience are others. But through education, a patient could learn how to alleviate the fatigue they're feeling and keep it from getting worse.
Desiree Gonzales Phillips, Patient Education:
We decided to offer a class that on a monthly basis, so that patients could come and learn about fatigue, and learn about how to manage fatigue, have an opportunity to talk with other patients and just be able to see what they could do to help, you know battle fatigue and the side-effects.
Narrator:
The class is facilitated by a nurse practitioner and features guest speakers who can answer questions. Patients interested in a plan to manage their fatigue can ask their oncologist or doctor to refer them to M.D. Anderson's Fatigue Clinic.
Dr. Carmen Escalante:
Our objective is hopefully to either lessen the fatigue or hopefully at some point, potentially do away with the fatigue, so that they can be more productive in whatever aspects of life they choose.
Dr. Ellen Manzullo, Professor, General Internal Medicine:
We do a complete medical evaluation. Get a complete history, do a complete physical exam, check labs on them.
Narrator:
Part of the evaluation process also includes filling out questionnaires.
Rosalie Valdres, Nurse Practitioner:
The questionnaires consist of assessing the fatigue level, their pain level, nutritional status, functional status, their mood and depression, anxiety, as well as multiple other symptoms.
Narrator:
The questionnaires along with lab tests are then reviewed by a nurse practitioner. And with the doctors help a plan to manage the fatigue is developed and treatment begins. The plan can include recommendations for exercise, nutrition, medications, sleep hygiene, education, and stress management and relaxation.
Title:
Exercise
Eva Vega:
But in the first you say, we want to do an exercise. I look at them and I told myself I feel so tired and they want me do an exercise.
Dr. Carmen Escalante:
It almost sounds contradictory, you know to fatigue and I want you to exercise. However, if we can get patients engaged in getting them to start, most of them really start feeling better.
Narrator:
Eva started out just walking ten minutes a day.
Rosalie Valdres:
Walking with a purpose, you know is one of the cheapest exercise that you can advice your patients and she just keep on walking, you know, not just walking under the moonlight, but you know walking for a purpose.
Eva Vega:
I was feeling really sick. I told myself I don't think so, I can able to do it, but I start a walking you build an energy. In six months I was a different person. I was happy, I was a smile.
Narrator:
Exercise has been a key for Tom's treatment of fatigue as well.
Rosalie Valdres:
We sent him for a water exercise therapy, a very comprehensive one.
Robin Cassell, Tom's wife:
The water therapy was wonderful because it took away the gravity issue, which was so fatiguing.
Narrator:
Tom also spends an hour a week with a physical therapist doing exercises involving coordination, balance, equilibrium and endurance training. Specifically the two work on developing a normal walking pattern by using a cane.
Tom Cassell:
I just like walking with a cane, sounds easy though it's hard.
Narrator:
But all that hard work and exercise has paid off in a big way.
Kathleen Stross, Tom's physical therapist:
It is notable to say that we've trained him regularly to have the endurance and have the confidence that he took a trip to Israel and walk through the desert and over the mountains and through the ruins that he couldn't have done before.
Title:
Conserving Energy
Narrator:
In order to lessen the fatigue patients like Tom can also look for ways to conserve energy in some of their daily and weekly activities.
Lauro Munoz, Senior Occupational Therapist:
One of the biggest aspects, ideas that I teach energy conservation is planning your day, prioritizing your day.
Narrator:
Senior occupational therapist Lauro Munoz suggests keeping it low and writing down activities.
Lauro Munoz:
And I want them to tell me two things: How much energy it takes and how much of a priority is it to them.
Narrator:
This way a patient can learn to plan and prioritize the activities that are important to them at times during the day when they have the most energy. Don't forget to schedule rest and pace yourself.
Lauro Munoz:
Be moderate. Take a moderate pace of what you do. Don't try to do everything at once.
Narrator:
This includes alternating tasks that take lots of energy with those that take less. Then look at your body's positioning.
Lauro Munoz:
It is important for the patient to cook or to do laundry, keep everything at chest level, you know, don't spend a lot of time and energy reaching up or reaching down.
Narrator:
A gadget like this Reacher is one of several accessories that can help conserve energy.
Lauro Munoz:
If you're gonna wear clothing that has small buttons or a zipper and you really don't want assistance, we have something called the button-hook.
You just take it through and pick the button through, it's a small button, put it through and voila, it's done.
And for people who have problems bending over and putting their socks on, we have a device called the socket that will make things easier. Another thing we use is this piece of rubber with a hole in it and to hold on to utensils, that requires a lot of strength and a lot of energy.
Title:
Nutrition
Tom Cassell:
You have to make yourself eat. You force yourself, you've realize it gives you nourishment.
Narrator:
Better food choices and eating five or six small meals a day can help.
Dena Reagan, Clinical Dietician:
So, it's not just about the quantity, getting enough, it's about the quality, so most people need to eliminate some things from their diet, as well as to include other healthy things. Mainly fruits and vegetables, other plant foods like beans or nuts, energy bars, granola bars, yoghurt, fish. Healthy sources of carbohydrate, healthy fat, as well as protein.
Narrator:
It's also important to stay hydrated. Dieticians recommend drinking eight to twelve 8-ounce glasses of water or non-alcoholic, non-caffeinated fluids each day. There are several ways a patient can conserve energy when planning or preparing a meal. They can ask a spouse or family member to help bring or prepare food or even make extra to freeze. Patients can pick healthy frozen foods that are microwavable. Order food for delivery or carry-out or use disposable products or let dishes air-dry.
Title:
Medications
Narrator:
Several types of medications can cause fatigue. Chemotherapy is at the top of the list.
Ali Zalpour, Clinical Pharmacist Specialist:
Chemotherapy by itself, drugs that or involved or they use for treatment of depression can cause fatigue. Drugs that for they use to treat sleeping disorders certainly can cause fatigue. Drugs to treat hypertension or blood pressure, high blood pressure certainly can cause fatigue. These are well-known drugs that can cause fatigue.
Narrator:
Drugs used to treat depression can create an additional problem because they cause drowsiness throughout the day.
Ali Zalpour:
It's a catch-22, you know, you know at the same time you're treating depression and the same time you're causing additional fatigue and additional problems for these patients.
Narrator:
But there are medications to counteract this type of fatigue. Patients are encouraged to ask their doctor about them.
Title:
Relationships
Narrator:
Fatigue drains the patient's energy and that can change the role a patient has in the family because they're no longer able to do what they once did. Sometimes it can be misinterpreted as being lazy.
Mary K. Hughes, Advanced Practice Nurse, Psychiatry:
So, I'll ask the person, do you think, do you think your wife is lazy? Well, no. Oh, so, when confronted with that thought, oh they're not lazy because that's what it seems like. That's what they're accusing them of without using the word lazy. Then they realize this is something that the person can't help.
Narrator:
The role change can trigger loss and grief.
Mary K. Hughes:
They just think about grief when somebody dies, but when you grieve because of things you can't do, the person that has fatigue is grieving because they are not able to do what they used to. The family is grieving too.
Narrator:
Patients and caregivers are urged to communicate their feelings.
Mary K. Hughes:
They could say, you know, I really miss your coming to the movies with me. I really miss us going out to eat or whatever it is that they did together, they missed.
Narrator:
Since fatigue can drain a person's energy, it can also affect sexual relationships.
Mary K. Hughes:
You've gotta have some energy for desire. Patients tell me they may have some desire, but they're too tired to think about doing it. One of the things is notice the time of day that you have energy and so, if the energy is in the morning, then especially for sexual relationships if that's the time you have energy, then try to schedule. It's not anything spontaneous as more try to schedule a sexual encounter in the morning when you do have energy.
Title:
Depression
Eva Vega:
You'll feel miserable and you feel like you're nobody.
Narrator:
Sometimes medications can help. Eva also found that volunteering her time at the Place...of Wellness help tremendously.
Eva Vega:
I'm so happy to be volunteering in M.D. Anderson. I enjoy to be helping another patient to be give my experience another patient and then when you there, when I did is my housing, my other house.
Title:
Additional Resources
Narrator:
If you feel you or a loved one is experiencing cancer-related fatigue ask a doctor for referral to M.D. Anderson's Fatigue Clinic. M.D. Anderson offers other resources as well. Visit the Learning Center for additional hand-outs and brochures about fatigue and how to manage it. In the Place...of Wellness, sign-up for yoga, Tai-chi, or learn meditation and relaxation techniques. M.D. Anderson is here to help you learn as much as you can.
Mary K. Hughes:
The very important thing is learning to live today with whatever you have. If it's fatigue, there's ways to manage fatigue. You might not be at the same level you were before you had cancer, but you're alive.
Eva Vega:
Doing something for you. You like I need you back, your self-esteem.
Tom Cassell:
Force yourself, make yourself do this. Then it'll come naturally.
(Music)
©2008 The University of Texas M. D. Anderson Cancer Center
1515 Holcombe Blvd, Houston, TX 77030
1-800-392-1611 (USA) / 1-713-792-6161