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Supportive Care: ESO-EONS Joint MasterclassClinical Oncology and Oncology Nursing Managing Fatigue,[object Object],Agnes Glaus, RN, PhD, MSc,[object Object],St. Gallen, Switzerland,[object Object],St. Gallen,[object Object],Geneva,[object Object]
Gruetzi,[object Object],mitenand,[object Object]
Cancer – Related – Fatigue,[object Object],Sign o f human vulnerability,[object Object],Relevant in modernoncology,[object Object],Complex aetiology and impact,[object Object],Challengingfor research,[object Object],Multidimensionality,[object Object],Anaemia,[object Object],Fragments of discovery,[object Object]
0%,[object Object],50%,[object Object],10%,[object Object],20%,[object Object],30%,[object Object],40%,[object Object],60%,[object Object],70%,[object Object],80%,[object Object],90%,[object Object],100%,[object Object],Percent of Citizens with Fatigue in 12 Countries v. Percent of Cancer Patients with Fatigue in 6 Studies,[object Object],N,[object Object],A,[object Object],C,[object Object],C,[object Object],E,[object Object],R,[object Object],Aren’t all individuals tired ? (Morrow 2007),[object Object]
Fatigue in patients with cancer (CRF),[object Object],What is it and how is it called by patients in your language?,[object Object]
Multidimensional FATIGUE: Umbrella-Term,[object Object],Affective ,[object Object],fatigue 29%,[object Object],Physical fatigue 59%,[object Object],Cognitive fatigue 12%,[object Object],[object Object]
No Energy
Sadness
Anxiety
No fighting spirit
Reduced physical performance
No strength, weakness
Unusual need to sleep
Unusual tiredness
Unusual need to rest
Concentration  diffic.
Problems with thinking
„tired head-feeling“
Sleep difficultiesGlaus A, Crow R, Hammond S. Supportive Care in Cancer, 1996, 4:82-96,[object Object]
Fatigue: Key Theoretical Causative Issues,[object Object],Energy supply and energy transformation,[object Object],Muscle-metabolism, muscle endurance ,[object Object],Cytokines,[object Object],Metabolic, biochemical changes,[object Object],Symptoms, Symptom-clusters,[object Object],Treatment induced side effects,[object Object],Cognitive responses,[object Object],Psychosocial, spiritual issues,[object Object]
Addressing Fatigue: Overcoming Barriers ,[object Object],The first steps of fatigue management are awareness, communication and assessment,[object Object],Patient barriers:,[object Object],	- reluctant to report, is inevitable, unimportant, untreatable,[object Object],	Patients speak about fatigue in routine practice only if  subject is addressed by professionals – they belief that professionals would introduce it if important ,[object Object],Professional barriers:,[object Object],	Lack of fatigue documentation , reimbursement issues,[object Object],System barriers:,[object Object],	Lack of supportive care referrals , specialist consult.,[object Object],Borneman T, Piper B et al. J Nat Canc Netw. 2007, 5 (10):1092-101,[object Object]
Fatigue: Awareness, Screening, Assessment ,[object Object],[object Object]
Explain StrategyLittle Fatigue,[object Object],Likert ≤ 4,[object Object],[object Object]
Screening
Open question
LASA, Likert ScaleRe-Evaluation,[object Object],Intensity / Relevance,[object Object],Middle, ,[object Object],Severe ,[object Object],Fatigue ,[object Object],Likert ≥ 4,[object Object],[object Object]
Diagnostics

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MCO 2011 - Slide 10 - A. Glaus - Fatigue management