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Self-Care Strategies to Relieve Fatigue in Patients Receiving Radiation Therapy

Jeanne M. Erickson
Laura Kim Spurlock
Jenna Centini Kramer
Mary Ann Davis
CJON 2013, 17(3), 319-324 DOI: 10.1188/13.CJON.319-324

Despite advances in symptom management, patients commonly experience fatigue during radiation therapy (RT). Minimal research has been conducted to determine how evidence-based recommendations are put into clinical practice and used by patients to manage fatigue. The aims of the current study were to identify the self-care strategies used by patients receiving RT, explore the effectiveness of those strategies, and identify how patients learned about fatigue management. Participants reported using multiple recommended interventions to relieve fatigue. The majority of participants reported they primarily rested or slept to improve fatigue. They also reported decreasing their activity level, exercising, using stimulants and complementary therapies, and eating and drinking nutritious items. More than half of the participants reported some relief of fatigue regardless of the intervention used. The majority of participants reported that they learned how to manage their fatigue mostly through experience and trial and error. Nurses need to explore the complex dynamics of each patient's fatigue and tailor multiple evidence-based interventions to maximize each patient's functional status and quality of life. When assessing and teaching about fatigue, nurses need to explore patients' daytime activity level and daytime sleep to be sure that excessive inactivity is not contributing to fatigue.

References 

American Cancer Society. (2010). Seven ways to manage cancer-related fatigue. Retrieved from <a target="_blank" href='http://www.cancer.org/Treatment/TreatmentsandSideEffects/PhysicalSideEff...

Bennett, S., Purcell, A., Meredith, P., Beller, E., Haines, T., & Fleming, J. (2010). Educational interventions for the management of cancer-related fatigue in adults. <i>Cochrane Database of Systematic Review, 4</i>, CD008144. doi:10.1002/14651858.CD008144

Borthwick, D., Knowles, G., McNamara, S., O'Dea, R., & Stroner, P. (2003). Assessing fatigue and self-care strategies in patients receiving radiotherapy for non-small cell lung cancer. <i>European Journal of Oncology Nursing, 7</i>, 231-241.

Campos, M. P., Hassan, B. J., Riechelmann, R., & Del Giglio, A. (2010). Cancer-related fatigue: A practical review. <i>Annals of Oncology, 22</i>, 1273-1279. doi:10.1093/annonc/mdq458

Dhruva, A., Dodd, M., Paul, S. M., Cooper, B. A., Lee, K., West, C., … Miaskowski, C. (2010). Trajectories of fatigue in patients with breast cancer before, during, and after radiation therapy. <i>Cancer Nursing, 33</i>, 201-211. doi:10.1097/NCC.0b013e3181c75f2a

Fagundes, C. P., Murray, D. M., Hwang, B. S., Gouin, J., Thayer, J. F., Sollers, J. J., … Kiecolt-Glaser, J. K. (2011). Sympathetic and parasympathetic activity in cancer-related fatigue: More evidence for a physiological substrate in cancer survivors. <i>Psychoneuroendocrinology, 36</i>, 1137-1147. doi:10.1016/j.psyneuen.2011.02.005

Ganz, P. A., & Bower, J. E. (2007). Cancer related fatigue: A focus on breast cancer and Hodgkin disease survivors. <i>Acta Oncologica, 46</i>, 474-479. doi:10.1080/02841860701367845

Haas, B. K., (2011). Fatigue, self-efficacy, physical activity, and quality of life in women with breast cancer. <i>Cancer Nursing, 34</i>, 322-334.

Kim, H., Barsevick, A. M., & Tulman, L. (2009). Predictors of intensity of symptoms in patients with breast cancer. <i>Journal of Nursing Scholarship, 41</i>, 158-165.

Knobf, M. T., & Sun, Y. (2005). A longitudinal study of symptoms and self-care activities in women treated with primary radiotherapy for breast cancer. <i>Cancer Nursing, 28</i>, 210-218.

Jean-Pierre, P., Morrow, G. R., Roscoe, J. A., Heckler, C., Mohile, S., Janelsins, M., … Hopkins, J. O. (2010). A phase 3 randomized, placebo-controlled trial of modafinil on cancer-related fatigue among 631 patients receiving chemotherapy: A University of Rochester Cancer Center Community Clinical Oncology Program Research base study. <i>Cancer, 116</i>, 3513-3520.

Jereczek-Fossa, B. A., Marsiglia, H. R., & Orecchia, R. (2002). Radiotherapy-related fatigue. <i>Critical Reviews in Oncology and Hematology, 41</i>, 317-325.

John, L. D. (2009). Self-care strategies used by patients with lung cancer to promote quality of life. <i>Oncology Nursing Forum, 37</i>, 339-347.

Lowe, S. S., Watanabe, S. M., Baracos, V. E., & Courneya, K. S. (2009). Associations between physical activity and quality of life in cancer patients receiving palliative care: A pilot study. <i>Journal of Pain and Symptom Management, 38</i>, 785-796.

Lundberg, P. C., & Rattanasuwan, O. (2007). Experiences of fatigue and self-management of Thai Buddhist cancer patients undergoing radiation therapy. <i>Cancer Nursing, 30</i>, 146-155.

Lundh Hagelin, C., Wengström, Y., & Fürst, C. J. (2009). Patterns of fatigue related to advanced disease and radiotherapy in patients with cancer—A comparative cross-sectional study of fatigue intensity and characteristics. <i>Supportive Care in Cancer, 17</i>, 519-526.

Matthews, E. E., Schmiege, S. J., Cook, P. F., & Sousa, K. H. (2012). Breast cancer and symptom clusters during radiotherapy. <i>Cancer Nursing, 35</i>(2), E1-E11. doi:10.1097/NCC.0b013e3182277222

Mendoza, T. R., Wang., X. S., Cleeland, C. S., Morrissey, M., Johnson, B. A., Wendt, J. K., & Huber, S. L. (1999). The rapid assessment of fatigue severity in cancer patients: Use of the Brief Fatigue Inventory. <i>Cancer, 85</i>, 1186-1196.

Merriman, J. D., Dodd, M., Lee, K., Paul, S. M., Cooper, B. A., Aouizerat, B. E., … Miaskowski, C. (2011). Differences in self-reported attentional fatigue between patients with breast and prostate cancer at the initiation of radiation therapy. <i>Cancer Nursing, 34</i>, 345-353.

Miles, M. B., & Huberman, A. M. (1994). <i>Qualitative data analysis: An expanded sourcebook</i> (2nd ed.) Thousand Oaks, CA: Sage.

Minton, O., Richardson, A., Sharpe, M., Hotopf, M., & Stone, P. C. (2011). Psychostimulants for the management of cancer-related fatigue: A systematic review and meta-analysis. <i>Journal of Pain and Symptom Management, 41</i>, 761-767.

Mitchell, S. A., Beck, S. L., & Eaton, L. H. (2009). Fatigue. In L. H. Eaton & J. M. Tipton (Eds.), <i>Putting evidence into practice: Improving oncology patient outcomes</i> (pp. 149-174). Pittsburgh, PA: Oncology Nursing Society.

Nail, L. M. (2004). My get up and go got up and went: Fatigue in people with cancer. <i>Journal of the National Cancer Institute, 32</i>, 72-75.

Pertl, M. M., Hevey, D., Donohoe, G., & Collier, S. (2012). Assessing patients' beliefs about their cancer-related fatigue: Validation of an adapted version of the illness perception questionnaire. <i>Journal of Clinical Psychology in Medical Settings, 19</i>, 293-307.

Poirier, P. (2006). The relationship of sick leave benefits, employment patterns, and individual characterstics to radiation therapy-related fatigue. <i>Oncology Nursing Forum, 33</i>, 593-601.

Poirier, P. (2011). The impact of fatigue on role functioning during radiation therapy. <i>Oncology Nursing Forum, 38</i>, 457-465.

Ryan, J. L., Carroll, J. K., Ryan, E. P., Mustian, K. M., Fiscella, K., & Morrow, G. R. (2007). Mechanisms of cancer-related fatigue. <i>Oncologist, 12</i>(Suppl.), 22-34. doi:10.1634/theoncologist.12-S1-22

Schmitz, K. H., Courneya, K. S., Matthews, C., Demark-Wahnefried, W., Galvão, D. A., Pinto, B. M., … Schwartz, A. L. (2010). American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. <i>Medicine and Science in Sports and Exercise, 42</i>, 1409-1426.

Sood, A., & Moynihan, T. J. (2005). Cancer-related fatigue: An update. <i>Current Oncology Reports, 7</i>, 277-282.

Stricker, C. T., Drake, D., Hoyer, K. A., & Mock, V. (2004). Evidence-based practice for fatigue management in adults with cancer: Exercise as an intervention. <i>Oncology Nursing Forum, 31</i>, 963-974.

Wanchai, A., Armer, J., & Stewart, B. (2011). Nonpharmacologic supportive strategies to promote quality of life in patients experiencing cancer-related fatigue: A systematic review. <i>Clinical Journal of Oncology Nursing, 15</i>, 203-214.

Wang, X. S. (2008). Pathophysiology of cancer-related fatigue. <i>Clinical Journal of Oncology Nursing, 12</i>(Suppl.), 11-20.

Wilkins, K., & Woodgate, R. (2008). Designing a mixed methods study in pediatric oncology nursing research. <i>Journal of Pediatric Oncology Nursing, 25</i>, 24-33. doi:10.1177/1043454207311914

Williams, S. A., & Schreier, A. M. (2004). The effect of education in managing side effects in women receiving chemotherapy for breast cancer [Online exclusive]. <i>Oncology Nursing Forum, 31</i>, E16-E23.

Wu, H. S., & McSweeney, M. (2007). Cancer-related fatigue: "It's so much more than just being tired." <i>European Journal of Oncology Nursing, 11</i>, 117-125. doi:10.1016/j.ejon.2006.04.037

Yates, P., Aranda, S., Hargraves, M., Mirolo, B., Clalvarino, A., McLachlan, S., & Skerman, H. (2005). Randomized controlled trial of an educational intervention for managing fatigue in women receving adjuvant chemotherapy for early-stage breast cancer. <i>Journal of Clinical Oncology, 23</i>, 6027-6036.