Effective Fatigue Management Begins With Good Communication

NEW YORK—Management of anemia-related fatigue begins with good communication, said Patricia Ann Kramer, RN, MSN, AOCN, a San Francisco-based oncology nurse educator and consultant. Speaking at a Cancer Care teleconference, she urged patients to report their fatigue to doctors, describe it on a scale of 0 to 10, and not to feel they are taking up their doctor’s valuable time talking about it. "The squeaky wheel," Ms. Kramer observed, "gets the grease."

Ms. Kramer said patients should inform themselves about the meaning of hematocrit and hemoglobin levels so that they can ask questions about their blood work. "The more knowledge you have, the more empowered you can be when you talk to your provider," she said.

Fatigue is an individual experience, she said, one affected by age and by cancer diagnosis and treatment. And there are individual energy patterns that lead some to feel more energetic in the morning and others to feel more so in the afternoon or evening, patterns that patients have to recognize to help manage their fatigue, she said.

Minimizing abnormalities and maximizing positives like nutrition, exercise, and sleep are the essence of management, Ms. Kramer explained. Physicians minimize the abnormalities by stimulating red blood cell growth; correcting electrolyte imbalances, thyroid abnormalities and dehydration; or, in the most severe cases, treating with blood transfusions.

Patients can maximize the positives by taking other steps to increase energy and quality of life, Ms. Kramer said. She recommended that patients pace their activities and lighten their schedules; take short naps, but not long ones that may interfere with sleep at night.

Pharmacologic intervention can be appropriate for sleep difficulties, but relaxation techniques and a regular sleep schedule may also overcome sleep problems. Beverages after 7 pm should be avoided to prevent sleep interruption. An exercise regimen, no matter how slight, should be followed, as long as it is approved by a physician. "I don’t mean jumping jacks," Ms. Kramer said. "I mean regular, consistent, physical activity in moderation. Start small."

The diet should include good amounts of complex carbohydrates and proteins, she said. Meals should be small and frequent to sustain energy levels throughout the day, and pantries should be stocked with foods that are both nutritious and easy to prepare.

Stress and depression are often connected with fatigue. Doing enjoyable activities each day can help, Ms. Kramer said. "Give high priority to activities that lift your spirits. Be good to yourself. It’s therapeutic and not just frivolous." Relaxation techniques, meditation, and support groups combat stress and depression as well.