The reasons for fatigue in patients go beyond treatment.
Cancer treatments are unlike any other medical procedures. For many, they can cause an overwhelming sense of drowsiness, exhaustion and weakness — despite plenty of rest. Cancer treatment-related fatigue is unlike normal, everyday fatigue, the wear and tear that comes after a long day at the office or a hard workout at the gym. Cancer-related fatigue can feel like being stuck in a car that won’t shift out of first gear. Patients with cancer are likely all too familiar with this. Estimates suggest that nearly 90 percent of patients undergoing radiation therapy and 80 percent treated with chemotherapy experience cancer-related fatigue.
For more than 20 years, the Oncology Nursing Society (ONS) Foundation has worked to provide nurse scientists with funding and support as they conduct research related to fatigue symptoms. Through this area of study, new, evidence-based practices are being incorporated into treatment plans throughout the country.
Pursuing Fatigue Management Research
Cancer-related fatigue symptoms are often pervasive, disruptive and difficult to understand, which is why, in 1995, the ONS Foundation created the Fatigue Initiative through Research and Education® program, awarding grants to oncology nurse scientists seeking ways to treat these symptoms. From 1995—2000, the Foundation awarded more than $1 million to help understand, investigate and ameliorate symptoms associated with cancer-related fatigue.
ONS member Anna Schwartz, Ph.D., FNP, FAAN, was one of the recipients of an early FIRE grant. Her focus was to create a clinically effective scale to assess and monitor fatigue associated with cancer treatment, since previous measurements of fatigue were not designed specifically for people with cancer. She developed the Schwartz Cancer Fatigue Scale, a validated questionnaire that measures fatigue based on physical and perceptual dimensions. In another Foundation-funded study from 2013, ONS member Margaret McCabe, Ph.D., R.N., PNP, studied fatigue in pediatric patients and its association with their hospital environments, accounting for light, sound, temperature, humidity and room entries.
“We documented that reduced sleep impacts fatigue in less well-functioning patients,” McCabe said. “We were able to see that patients who were more ill were more impacted by less sleep — they reported higher levels of fatigue.” McCabe and her colleagues also noticed a relationship between fatigue and factors that can affect sleep quality. “Less fatigue and better sleep quality were associated with less light in the environment,” McCabe said. “We also noticed that elevated sound levels, despite efforts to keep noise at a low level in the hospital, was impacting sleep quality, too.”
For many patients, cancer-related fatigue is thought to stem solely from treatment regimens such as radiation and chemotherapy. However, McCabe was quick to note that the reasons for fatigue in patients go beyond treatment.
“What we’re learning in the science of fatigue is that there are so many variables that have the potential to impact symptoms,” McCabe noted. “We have the environment, everything related to the disease process itself, treatment, and there may be underlying genetic implications for how you experience symptoms, as well.”
Challenging Fatigue Symptoms Through Physical Activity
In the past, most oncology professionals would recommend extended rest for patients with cancer suffering from fatigue. However, evidence and ongoing research show the importance of physical activity to help with managing fatigue.
Through an intense review of the research and associated literature, ONS has developed recommendations for practice that incorporate physical activity into treatment, as tolerated by the patient and approved by the physician. ONS champions this through its Get Up, Get Moving campaign, which encourages oncology nurses to work with their patients and oncologists to create individualized physical activity plans.
For some patients, physical activity may mean simply walking to the mailbox at the end of the driveway or taking a stroll outside. For other patients, jogging, biking and weight training may be encouraged. The most important thing is to consult with nurses and physicians first.
The Future of Fatigue Management
Exciting possibilities are on the horizon for fatigue management. From the incorporation of physical activity into treatment plans to digital monitoring devices to computer-aided programs that track fatigue levels in relation to activity, future strategies could provide great relief to patients suffering from cancer-related fatigue.
In 2017 and beyond, the ONS Foundation has committed to funding several fatigue-related research projects. By supporting oncology nurse scientists, the ONS Foundation hopes to discover novel, evidence-based interventions that decrease symptoms, lessen the negative impacts of treatment and increase quality of life for all patients with cancer.
The ONS Foundation (onsfoundation.org) is the only entity in the world that directly supports the projects of oncology nurses like Anna Schwartz and Margaret McCabe. Gifts to the foundation provide these nurses with access to education, research and professional development, ultimately improving patient care and advancing the oncology nursing profession.