In conversation with patients about the potential side effects of chemotherapy, two concerns are often expressed: coping with nausea and hair loss. “Although concerns about fatigue are not mentioned at the beginning of treatment, research has shown that fatigue is experienced by 78 per cent of patients undergoing chemotherapy.” (Ashbury et al, 1998) This incidence is higher than hair loss or nausea.
What is cancer-related fatigue? It is a subjective symptom – meaning that people experiencing it say what it is, and how it affects them. It “incorporates total body feelings, ranging from tiredness to exhaustion”, and it “interferes with individuals’ ability to function to their normal capacity.” (Ream & Richardson, 1997) However, cancer-related fatigue is unique in that it doesn’t often present until well into the course of treatment, as late as four or five months after the start of chemotherapy.
Hence in October 2000, a pilot project on fatigue or symptom management, sponsored by a grant from Ortho Biotech, was implemented in hospitals across Canada. As a result of the project, a new role called Symptom Management Coordinator (SMC) was implemented in 12 Regional Cancer Centres across the country. At Lakeridge Health Oshawa, this role was called Fatigue Management Coordinator (FMC). The main focus of the FMC is fatigue and anemia management for the oncology population. What’s unique about the role at Lakeridge Health is that it deals with fatigue in a proactive fashion.
Many nurses in the FMC or SMC roles rely on a referral mechanism to identify patients with fatigue therefore dealing with fatigue in a reactive fashion. However, at Lakeridge Health Oshawa’s Chemotherapy Clinic, patients are taught about the potential for fatigue at the beginning of their treatment. The FMC meets with all new patients during the first or second cycle of treatment to explain the potential for both physical and cognitive fatigue during treatment. Patients are told that fatigue often does not surface until later in treatment, and can exist beyond the end of the formal treatment time. Patients and the FMC also discuss the importance of healthy lifestyle during treatment, and if necessary the FMC will help develop strategies with the patients to support lifestyle changes.
In February 2002, Lakeridge Health’s Oncology Clinic staff and the Fatigue Management Coordinator, Fran Konorowski worked closely to identify opportunities for patient and staff education. As a result of teamwork and initiative, the “Chemo Olympics” were held at the same time as the Olympic Games in Salt Lake City.
The “Chemo Olympics” rewarded all patients undergoing treatment in the clinic for regular involvement in physical activities such as walking, stretching, swimming or gentle weight training exercises. It also encouraged and rewarded those activities that promoted emotional and spiritual wellness such as doing crafts, caring for a pet, going to the theatre or a movie, or socializing with friends and family. All activities counted and a scorecard was developed to allow patients to keep track of their success. After completing their scorecard, patients were awarded with a ‘chocolate covered’ gold medal to demonstrate their first place efforts.
Although we cannot prevent fatigue, we can educate patients and their families about it. Where possible, we can be proactive in our approach, so that people are aware of the potential for fatigue and are not frightened if it occurs.
At Lakeridge Health, every attempt is made to follow-up with patients before the end of their treatment to confirm the information that was previously given to them. Reassurance is given that a certain level of fatigue is not unexpected and hopefully will prevent feelings that something is “wrong”.
Nevertheless, when patients do experience fatigue that impacts their abilities to function, the FMC is contacted by the Oncology Clinic staff and asked to assess the situation. Fatigue Management Coordinator, Fran Konorowski, RN works closely with the physicians and other health-care providers to develop and implement a plan of care. Anemia, depression, chronic pain, difficulty breathing and changes in sleeping patterns can all impact on the levels of fatigue and an in-depth assessment is done if required. Konorowski reassures patients that the end of treatment does not mean access to her is stopped. If patients have a question or concern they can call her anytime.
In dealing with fatigue at Lakeridge Health Oshawa, we believe that an “ounce of prevention is worth a pound of cure.”