Cancer Related Fatigue (CRF) can be one of the most limiting factors for your patients – but how, as clinicians, can we help to manage- or even improve- this issue? Here, we delve into understanding CRF, how prevalent it is, and our three top ways to assist with this challenging and debilitating problem.
Understanding CRF
What is cancer-related fatigue, or CRF? CRF is a term used to describe symptoms of fatigue associated with active cancer or cancer treatment, and is relatively common in cancer patients. Your patient may report symptoms that are both physical and cognitive in nature, feel persistent and are not reasonable for the amount of activity they engage in on a daily basis. They may tell you that rest and sleep haven’t been adequate enough for the level of fatigue they are experiencing. Physical symptoms of CRF may include feeling weak, weighed down, slower than typical, exhausted after minimal activity and persistently tired. Cognitive symptoms of CRF may include disinterest or difficulty focusing on typical or previously enjoyed activities, irritability and forgetfulness. CRF at a glance may appear very similar to symptoms associated with depression, but is considered a primary symptom associated with cancer and treatment for cancer.
What causes CRF?
The exact mechanism of CRF is not well understood, but can potentially be caused by several things ranging from the cancer itself to the cancer treatment. Cancer treatment may consist of modalities including chemotherapy, radiation therapy, hormonal therapies, immunotherapy and surgeries. Your patient may be experiencing CRF as a result of hormonal and protein imbalances, residual toxins from chemotherapy, and healing or infection from surgical procedures among other things. The cancer itself may be placing additional strain on the body’s ability to perform natural functions like breathing, pumping blood and filtering waste causing fatigue as a secondary response to the increased work required.
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Cancer Related Fatigue is Common
Anywhere from 80-100% of patients report having fatigue that is notably different from fatigue felt in life pre-cancer. Breast cancer patients specifically are at increased risk of experiencing Cancer Related Fatigue well into the survivorship phase, however all cancer patients carry some risk of this.
Despite CRF being fairly common amongst cancer patients in active treatment, it may be underreported. This can be attributed to patient’s misunderstandings of what the symptoms represent, fearing it may be a sign of worsening illness, may be unmanageable and something they should “tough it through,” fear it represents unsuccessful treatment, and fear that it means permanent change to their body and/or lifestyle. It is imperative as practitioners that we are able to recognize the signs and symptoms of CRF, understand the challenge and fear associated with CRF and be prepared to better support our patients through management of CRF symptoms.
Supporting your Patient with CRF: Where to start
Prioritizing and patient-centered approach is key to gaining an understanding of your patient, their unique position and their priorities for care. Discuss with your patient what their goals are, what specifically they want to to be able to do or accomplish that CRF is impacting, what their understanding of Cancer Related Fatigue is. Discussing these points will help you better understand your patient’s lived experience and facilitate treatment.
Plan to Conserve
Once you understand the occupations your patient wishes to prioritize, a good place to start will be with energy conservation and work simplification. Educating your patient on the “four p’s” of energy conservation (plan, prioritize, pace, positioning) will be a great starting point, as it is something that can immediately be implemented into the daily routine. The activity tracking guide will assist you and your patient with identifying which activities are the highest priority for the patient, making it easier to plan a day around ensuring they are able to complete them. Pacing through important tasks will ensure your patient does not run through their limited energy reserves quicker than they are able to recover. Discussing and adjusting positioning during task engagement will assist your patient with identifying which tasks can be completed sitting down or if there is a more ergonomic manner for completion.
Encourage your patient to reduce their daily task list when possible to decrease the amount of energy required to make it through the day. If the patient is able to, encourage them to delegate tasks or portions of tasks that are especially difficult for them to complete. Delegating a portion of a task versus a whole task may allow your patient to feel that they are still able to engage and participate in important activities and not being forced to give up the entire activity.
Important to Move
Moderately intensive exercise has been shown to be helpful in management of symptoms and promoting improved quality of life in cancer patients. Activities including walking, running, resistance exercises, yoga and tai chi chuan may be beneficial to explore with your patient. Exercise may be broken up into thirds (3 sets of 10 minutes) if necessary to allow for breaks and recovery. Activity early in diagnosis has been shown to positively impact symptoms overall and may contribute to reduced fatigue, increased endurance and activity tolerance.
Sleep Hygiene
Patients suffering from CRF may report that it feels like they need thrice the amount of sleep as normal, and that it no longer feels restful or rejuvenating. While naps may seem tempting, it is counterproductive for your patient to take multiple naps per day as it lessens the chance that their evening sleep will be restful. Discourage your patient from taking late evening naps, limiting naps to 15-20 minutes in late morning or early afternoon. This will decrease the likelihood of a non-restful sleep and help ensure they are able to sleep throughout the evening. It may also be beneficial to explore routine modifications with your patient to ensure they are creating an environment conducive to restful sleep. Mindfulness exercises, relaxation exercises, aromatherapy and use of a sleep tracker may assist your patient in getting the restful sleep they need in order to combat effects of CRF.
Spenser Bassett graduated from the University of Findlay with her Doctorate in Occupational Therapy in 2022. She currently works in subacute & LTC, and is ARC Seminars’ Associate & Social Media Developer. Spenser is passionate about promoting diversity in rehab spaces & empowering rehab professionals to succeed beyond classroom walls.
Spenser Bassett graduated from the University of Findlay with her Doctorate in Occupational Therapy in 2022. She currently works in subacute & LTC, and is ARC Seminars’ Associate & Social Media Developer. Spenser is passionate about promoting diversity in rehab spaces & empowering rehab professionals to succeed beyond classroom walls.
To learn more about how to enhance your PT/OT/SLP and RN interventions for people with cancer, check out our comprehensive, 3 CEU webinar, ‘Cancer Care: A Collaborative Approach’. Practical, immediately applicable skills and resources that will make your treatments effective, evidence-based, and empowered!
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