OncoTalk: Improving Oncologists' Communications
A multimedia resource
from the University of Washington. "The way you communicate is part of your work as a healer. You weren't born with communication
skills-you learn them," Anthony
Learn More >>
In the April 2010 issue we discussed opioid Risk
Evaluation and Mitigation Strategies (REMS). The latest edition of the PainEDU newsletter
has a summary of REMS history and current directions. A new industry-sponsored website, Ready for REMS, also explains the history, process, and issues.
Learn More >>
Schwartz Rounds will
resume on September 16 at noon in a new location:
the new Smilow Cancer Hospital at Yale-New Haven in the Park Street
A Disconnect Between the Family and Medical
- October 14
What to do with a Hard-Charging Husband in Patient Care
Yale Bioethics Center End of Life Issues Group
Theme for 2010-2011: "Ethical Aspects of the Advances in Modern
Medicine." (CME) Tuesdays
5:30pm - 7:00pm.Learn More >>
A Mother Should Never be Asked to Pull the Plug: Aversive
Choices in Modern Medicine. Kristina Orfali, PhD. Child Study Center's
Cohen Auditorium, 230 South Frontage Road.
- October 5
Health-Centered Cancer Care Across the Lifespan. Andres Martin, MD,MPH. 77 Prospect St, Room A002.
9th Annual Oncology Nursing Symposium
in Oncology Nursing Practice. Smilow Cancer Hospital. Contact: Lisa Barbarotta, MSN. (CNE)
Symposium on Palliative and End-of-Life Care. (CME)
Learn More >>
Comfort in Pediatric Palliative Care
8:30am - 1:00pm. Fairfield University. Contact: Cathy Tuttle
Registration deadline: Sepember 15.October 8 & 15ONS Chemotherapy & Biotherapy Course
Hospital of St. Raphael, New Haven. Contact: Susan Fisher at (203)
789-3391. Deadline: September 16. (CNE)
September 17-19First Annual Navigation & Survivorship Conference
Academy of Oncology Nurse Navigators. Baltimore. (CNE)Learn More >>October 8 - 10Practical Aspects of
Palliative Care: Integrating
Palliative Care into Clinical Practice
HMS Center for Palliative Care. Cambridge, MA. (CME)Learn More >>
November 5 - 6Quality of life for the Children
4th Annual Pediatric
Palliative Care Conference. Washington, DC.Learn More >>November 5 - 7
Survivorship for Clinicians:
Helping Survivors Live Well Beyond Cancer
Dana-Farber Cancer Institute. Boston. CME, CNE, SWCE, Psych CE.
Learn More >>
|September 2010 Volume 4 · No 8|
Survivorship Themes: Fatigue
As we continue to review the common themes seen in survivors
at the Connecticut Challenge Survivorship Clinic at Yale Cancer Center, this
issue will review the second most common theme (and perhaps the most common
symptom), fatigue. As with other
themes, it is reported in varying ways:
Will I ever have energy again?
I'm so tired that I can't think straight.
I feel like an old lady.
Preparing a meal is exhausting.
Where will I get the energy to exercise? I have to take a nap after I shower!
Our specialists address this concern in a hypothetical
APRN: A very
common physical response to insult (infection, injury, surgery, chemotherapy,
radiation therapy, etc.) is fatigue.
Although it is known that certain cytokines may be involved in
development of fatigue, we do not have a clear medical picture of the sometimes
profound or prolonged fatigue that may be experienced by people recovering from
cancer and its treatment. It is a
very frustrating symptom that may contribute to or be exacerbated by
depression, anxiety, and cognitive changes. The only known intervention for cancer-related fatigue is
regular exercise. Good nutrition,
changes in routine to optimize energy use, and adoption of coping mechanisms
may also contribute to successfully addressing this symptom. As with other aspects of recovery, we
cannot predict the course of fatigue for any one person. For some it may be short-lived or of
marginal concern, for others it may have a serious or prolonged impact. Enlisting the help of family, friends,
or professionals (yoga instructor, personal trainer, therapist) may be
beneficial in a new lifestyle that accommodates and transcends fatigue.
Physical Therapist: During and following surgery, radiation therapy, and chemotherapy, your
body may feel fatigued as it is healing from these treatments, and thus you may
not feel like exercising. A
vicious circle can be created: you
feel tired, so you don't exercise, and then you become more fatigued because
you have not been able to increase your energy level by exercising, and so
on. "The journey of 1,000 miles
begins with a single step." Begin
slowly and keep things in perspective.
Aim for 30 minutes a day, 5 times a week as your long-term goal. If this is too much to start with,
begin with 15 minutes, 3 times a week (a day on, a day off for rest) and
increase each session gradually to 30 minutes. Then you can add in another day, (starting at 15 minutes and
working up to 30). Set a specific
goal. For example: 'I want to be
able to do a 3 mile walk for breast cancer by May.' Write your routine and goals for the week on the calendar. Having concrete, but realistic and
adjustable, plans and goals is a good strategy to keep you motivated.
Social Worker: First
of all, please know most cancer survivors feel your concern. Many medical
professionals want to reassure cancer survivors and tend to underestimate the
amount of time it takes to return to a previous level of energy. I
believe this is so because the doctors (and other medical professionals) hope
that their patients will have an optimistic attitude, and the optimism will
assist in recovery. My suggestion is to trust your body and attune to
what you can do. In yoga, it is called "the edge," meaning go
to the edge of what you can do, without pushing so hard that you go over (the
edge). The key is self acceptance and patience; it is important to trust
your body and allow the necessary healing to take place as you return to
Nutritionist: "I am too tired to food shop, cook, even at times to
eat." As explained above with exercise, the same vicious circle can be
created: you feel tired so you
skip meals, then you become more fatigued because you are not giving your body
enough fuel and nutrients. Eating 5-6 smaller meals throughout the day helps to
sustain your blood glucose levels, which makes you feel more energized. It is important to have a source
of protein at every meal (cheese, skim milk, nuts, peanut butter, eggs, fish,
or lean meat). Also have two types
of high fiber foods at every meal (whole grain breads, crackers, cereals, any
fruit, or any vegetable). This
combination of protein and fiber helps raise and sustain your blood glucose
levels, which gives your body a steady source of fuel. Even if your appetite is
low, it is better to have a few bites of each of the protein and high fiber
foods then trying to eat all of only one food item.
Be careful to avoid falling into
the trap of eating sweets for quick energy. This in fact creates more fatigue and sets you up to crave
more sugar and another vicious circle of fatigue continues. Be willing to ask for and accept help
from your family, neighbors, and friends with food shopping and meal
preparation. Take advantage of home delivery services offered by supermarkets.
Having healthy food stocked and readily available in your home and work
environment will make eating well throughout the day easier.
In the News
Cancer Survivorship Events
Challenge bicycle ride to raise money for survivorship programs throughout
Connecticut was held on July 24th in Fairfield. There is still time to donate in the name
of a specific team or individual.
The Challenge helps to support the adult and pediatric
survivorship clinics at Yale Cancer Center.
Learn More >>
A special benefit
concert by Band Together CT,
featuring rock legend John Oates, will be held on December 1st at the Fairfield
Theatre Company. Proceeds will
support the new Connecticut Challenge Survivorship Center in Fairfield.
Learn More >>
Valley-Shore YMCA in Westbrook is offering a free individualized exercise
program for cancer survivors, Hope is Power (HIP), starting on September 28th. A benefit bike tour and walk to benefit
HIP and the Lance Armstrong Foundation will be held on Saturday, October 2. Contact: Stacy McGee, 860-399-9622
Learn More >>
National Take-Back DayLearn More >>
25, 2010, the Drug Enforcement Administration (DEA) will coordinate a collaborative effort with state and
local law enforcement agencies to remove potentially dangerous controlled
substances from our nation's medicine cabinets. Collection activities will take
place from 10:00 AM through 2:00 PM at sites established throughout the country. The
National Take-Back Day provides an opportunity for the public to surrender
expired, unwanted, or unused pharmaceutical controlled substances and other
medications for destruction. These drugs are a potential source of supply
for illegal use and an unacceptable risk to public health and safety.
in Elders: Three recent special
issues address this population:
Pain Management Nursing,
2010;11(2 Supp 1).
Oncology Nursing Forum,
When Will "Usual Care" in Advanced Illness Be "Palliative Care"? Journal of Palliative Medicine.
2010;13(8):934-935.Read More >>
Coyne P, Lyckholm L.
Artificial nutrition for cognitively impaired
individuals: Strategies to promote
appropriate care. Journal of Hospice and Palliative Nursing.
2010;12(4):263-267. Read More >>
Davis MP, Walsh D.
of fatigue. Journal of Supportive Oncology.
2010;8(4):164-174. (Free full text)Read More >>
Related commentary: Bruera E. Cancer-related
fatigue: A multidimensional
syndrome. pp 175-176.Read More >>
Related commentary: Ng A. The
underrecognized role of impaired muscle function in cancer-related fatigue. pp 177-178.Read More >>
Ettinger DS, et
Non-small cell lung
cancer. J Natl Compr Canc Netw
. 2010 Jul;8(7):740-801. (This is the 2010 NCCN NSCLC clinical
guideline)Read More >>
Grunfeld E, et al.
Population-based longitudinal study of follow-up care for
breast cancer survivors. Journal of Oncology Practice
2010;6(4):174-181. Read More >>
Manitta VJ, et al.
Palliative Care and the Hemato-Oncological Patient: Can We
Live Together? A Review of the Literature. Journal
of Palliative Medicine.
2010;13(8):1021-1025. Read More >>
McCullough L, et al.
survivors of Hodgkin lymphoma treated with chest radiotherapy. Cancer
. 2010 Jul 13. Read More >>
Mercadante S, Et
Sexual issues in early and
late stage cancer. Supportive Care and Cancer.
2010;18(6):659-65. Read More >>
Nevidjon B, Chaudhary R.
Controlling Emesis: Evolving Challenges, Novel Strategies. Journal
of Supportive Oncology.
2010;8(4 Supp2):1-10.Read More >>
Redig AJ, Munshi HG.
Syndrome After Hormone-Modifying Therapy: Risks Associated With Antineoplastic
2010;24(9):839-847. (Free full text)Read More >>
Related commentary: Van Londen GJ. Metabolic
Effects of Hormone Deprivation Therapy: Weighing the Evidence.Read More >>
Related commentary: Ligibel JA. Considering
Metabolic Effects When Making Breast Cancer Treatment Decisions.
Read More >>
Ridner SH, et al.
Breast cancer treatment-related lymphedema self-care:
Education, practices, symptoms, and quality of life. Supportive Care in
Cancer. 2010 Apr 15. Read More >>
Bell CJ, et al.
End-of-life experiences in adolescents dying with cancer. Support
2010;18(7):827-35. Read More >>