Reducing Chemotherapy Induced Fatigue
Chemotherapy has a reputation for a wide variety of unwanted side effects that range from neurological symptoms, such as peripheral neuropathy, to gastrointestinal symptoms, such as nausea, vomiting and diarrhea. Fortunately through science and research there have been many advancements in medicine and the majority of symptoms induced by chemotherpy can be managed by specific medications. The most common side effect of the vast majority of chemotherapy drugs that modern medicine has yet to remedy is chemotherapy-induced fatigue (CIF). Fatigue is a common happening that occurs on a daily basis to even the healthiest of individuals. Unlike with CIF, the healthy individual remedies the fatigue by achieving a full night of sleep. In oncology patients CIF remains despite the fact that the individual obtains an adequate amount of rest and it has the potential to interfere with activities of daily living (Kuchinski, Reading, & Lash, 2009).
For this project I worked closely with Dr. Reece Jones, a board certified oncologist at Southern Cancer Center, and five chemotherapy nurses, whose experience ranges from three years to nearly eighteen years. All of these healthcare professionals agreed that CIF is a continued problem throughout the oncology population. Though the fatigue that these individuals experience can easily be related to the cancer, it’s severity is increased by chemotherapy. With this being the case, before any patient receives chemotherapy at Southern Cancer Center, he or she is required to attend a chemotherapy education course that focuses on side effects of chemo, along with special attention to the specific drugs that the patient is to receive. In the past this class has mainly focused on side effects such as nausea, vomiting, diarrhea, and shortness of breath to name a few. With the guidance of Dr. Jones, I implemented a new portion of this course that was directed at decreasing the effects of CIF.
From past experiences with chemotherapy and the education that patients receive in the days before, it appears that patients have fewer complaints when the side effects are thoroughly discussed in the chemotherapy education course. It is believed that by educating the patient and family members prior to being treated they tend to have a better understanding of how to control these symptoms, which in turn reduces the number of complaints related to these. Knowing this, it stands to reason that if patients receive education related to reducing CIF, they will in turn better cope with the fatigue and manage it much more successfully. The intention of this project is health promotion, from the standpoint of the patient receiving adequate education, which in turn will decrease chemotherapy-induced fatigue by teaching patient proper management.
To deliver a project such as this and ensure that the patients will be receptive it must be presented in a particular manner. From previous experiences I found that if the information is presented and the patient is allowed to draw his or her own conclusion, which is directed by the teaching, they tend to be more willing to make the change. For this project the chemotherapy nurses who provided patient education added a pamphlet to their teaching material that I had designed. This was used as an additional tool to help them to understand why they are fatigued. The pamphlet included information such as the cause of fatigue and every day methods for its remedy. Because of this patient population
I chose to use Orem’s theory of self-care to direct the patients toward caring for themselves from a holistic standpoint throughout their chemotherapy (Hartweg, 1990). The information was presented and then the patients were given an opportunity to give suggestions on how they will try to reduce fatigue during their treatment. From the perspective of the chemotherapy nurse who provided the education, the patients were very involved and enjoyed hearing the suggestions provided by their peers.
When presenting this project to new chemotherapy patients it was delivered as part of their initial teaching and received the same attention as the other portions of the education. The Registered Nurses who taught the chemotherapy course focused on the primary causes of CIF, such as anemia, and why this actually makes the patient feel fatigued. By giving the patients a very brief overview of this it seems that they understand the reason behind the fatigue, therefore they have a better understanding of how to remedy this fatigue.
As a family nurse practitioner, we will come in contact with a wide variety of patients. Although they may or may not be undergoing chemotherapy, much of this information is relevant in the care of patients with other disease processes such as those affecting the cardiovascular and respiratory systems. These individuals chronically suffer from fatigue that is most often caused by poor gas exchange or circulatory problems. The primary concern of the practitioner is this situation is treating the underlying condition, but the information related to CIF can also be applied to reducing fatigue in these patients as well.
The outcome of the project was evaluated two different ways. The first was by Dr. Jones and myself interviewing patients on each visit and determining their overall level of fatigue. The patients were asked to rate their fatigue on a scale of zero to ten, with zero being absolutely no fatigue and ten being so fatigued that it interrupts activity of daily living. Of the twenty-two patients that were new to chemotherapy the average answer was four. Based on his clinical experiences, Dr. Jones felt that this was a significant decrease in the average level of fatigue that patients typically express. The second method for determining the outcome of this project was by talking with the chemotherapy nurses and hearing their accounts of patient reports of fatigue. All but one of the five chemotherapy nurses felt as though the patients had developed their own methods of decreasing fatigue and coping with the fatigue that he or she may endure.
Overall the patients seemed to not only benefit from this health promotion project, but they also enjoyed the opportunity to learn more about what to expect throughout their chemotherapy journey. This portion of the chemotherapy education course has been implemented in one other center and hopefully will be used in all six centers within the next several months. It is important to help these vulnerable individuals feel as though they still have some control over their bodies and health. This project proved to do that and has the opportunity to do that same for many more patients.
References
Kuchinski, A., Reading, M., & Lash, A. (2009). Treatment-related fatigue and exercise in patients with cancer: a systematic review. MEDSURG Nursing, 18(3), 174-180.
Hartweg, D. (1990). Health promotion self-care within Orem's general theory of nursing. Journal Of Advanced Nursing, 15(1), 35-41. doi:10.1111/j.1365-2648.1990.tb01670.x
Chemotherapy has a reputation for a wide variety of unwanted side effects that range from neurological symptoms, such as peripheral neuropathy, to gastrointestinal symptoms, such as nausea, vomiting and diarrhea. Fortunately through science and research there have been many advancements in medicine and the majority of symptoms induced by chemotherpy can be managed by specific medications. The most common side effect of the vast majority of chemotherapy drugs that modern medicine has yet to remedy is chemotherapy-induced fatigue (CIF). Fatigue is a common happening that occurs on a daily basis to even the healthiest of individuals. Unlike with CIF, the healthy individual remedies the fatigue by achieving a full night of sleep. In oncology patients CIF remains despite the fact that the individual obtains an adequate amount of rest and it has the potential to interfere with activities of daily living (Kuchinski, Reading, & Lash, 2009).
For this project I worked closely with Dr. Reece Jones, a board certified oncologist at Southern Cancer Center, and five chemotherapy nurses, whose experience ranges from three years to nearly eighteen years. All of these healthcare professionals agreed that CIF is a continued problem throughout the oncology population. Though the fatigue that these individuals experience can easily be related to the cancer, it’s severity is increased by chemotherapy. With this being the case, before any patient receives chemotherapy at Southern Cancer Center, he or she is required to attend a chemotherapy education course that focuses on side effects of chemo, along with special attention to the specific drugs that the patient is to receive. In the past this class has mainly focused on side effects such as nausea, vomiting, diarrhea, and shortness of breath to name a few. With the guidance of Dr. Jones, I implemented a new portion of this course that was directed at decreasing the effects of CIF.
From past experiences with chemotherapy and the education that patients receive in the days before, it appears that patients have fewer complaints when the side effects are thoroughly discussed in the chemotherapy education course. It is believed that by educating the patient and family members prior to being treated they tend to have a better understanding of how to control these symptoms, which in turn reduces the number of complaints related to these. Knowing this, it stands to reason that if patients receive education related to reducing CIF, they will in turn better cope with the fatigue and manage it much more successfully. The intention of this project is health promotion, from the standpoint of the patient receiving adequate education, which in turn will decrease chemotherapy-induced fatigue by teaching patient proper management.
To deliver a project such as this and ensure that the patients will be receptive it must be presented in a particular manner. From previous experiences I found that if the information is presented and the patient is allowed to draw his or her own conclusion, which is directed by the teaching, they tend to be more willing to make the change. For this project the chemotherapy nurses who provided patient education added a pamphlet to their teaching material that I had designed. This was used as an additional tool to help them to understand why they are fatigued. The pamphlet included information such as the cause of fatigue and every day methods for its remedy. Because of this patient population
I chose to use Orem’s theory of self-care to direct the patients toward caring for themselves from a holistic standpoint throughout their chemotherapy (Hartweg, 1990). The information was presented and then the patients were given an opportunity to give suggestions on how they will try to reduce fatigue during their treatment. From the perspective of the chemotherapy nurse who provided the education, the patients were very involved and enjoyed hearing the suggestions provided by their peers.
When presenting this project to new chemotherapy patients it was delivered as part of their initial teaching and received the same attention as the other portions of the education. The Registered Nurses who taught the chemotherapy course focused on the primary causes of CIF, such as anemia, and why this actually makes the patient feel fatigued. By giving the patients a very brief overview of this it seems that they understand the reason behind the fatigue, therefore they have a better understanding of how to remedy this fatigue.
As a family nurse practitioner, we will come in contact with a wide variety of patients. Although they may or may not be undergoing chemotherapy, much of this information is relevant in the care of patients with other disease processes such as those affecting the cardiovascular and respiratory systems. These individuals chronically suffer from fatigue that is most often caused by poor gas exchange or circulatory problems. The primary concern of the practitioner is this situation is treating the underlying condition, but the information related to CIF can also be applied to reducing fatigue in these patients as well.
The outcome of the project was evaluated two different ways. The first was by Dr. Jones and myself interviewing patients on each visit and determining their overall level of fatigue. The patients were asked to rate their fatigue on a scale of zero to ten, with zero being absolutely no fatigue and ten being so fatigued that it interrupts activity of daily living. Of the twenty-two patients that were new to chemotherapy the average answer was four. Based on his clinical experiences, Dr. Jones felt that this was a significant decrease in the average level of fatigue that patients typically express. The second method for determining the outcome of this project was by talking with the chemotherapy nurses and hearing their accounts of patient reports of fatigue. All but one of the five chemotherapy nurses felt as though the patients had developed their own methods of decreasing fatigue and coping with the fatigue that he or she may endure.
Overall the patients seemed to not only benefit from this health promotion project, but they also enjoyed the opportunity to learn more about what to expect throughout their chemotherapy journey. This portion of the chemotherapy education course has been implemented in one other center and hopefully will be used in all six centers within the next several months. It is important to help these vulnerable individuals feel as though they still have some control over their bodies and health. This project proved to do that and has the opportunity to do that same for many more patients.
References
Kuchinski, A., Reading, M., & Lash, A. (2009). Treatment-related fatigue and exercise in patients with cancer: a systematic review. MEDSURG Nursing, 18(3), 174-180.
Hartweg, D. (1990). Health promotion self-care within Orem's general theory of nursing. Journal Of Advanced Nursing, 15(1), 35-41. doi:10.1111/j.1365-2648.1990.tb01670.x