Patient Education Quarterly
Use pain as model to assess fatigue
There is no formula for treating cancer-related fatigue because there are multiple causes for the symptoms. These include the cancer itself; treatments such as chemotherapy, radiation therapy, and surgery; quality of sleep or nutrition; prescribed medications; and pre-existing conditions such as heart disease or diabetes.
It is important for health care professionals to assess each patient experiencing fatigue to determine a strategy to help combat it and improve the patient’s quality of life. "We have learned a lot about how to manage pain, and we could use pain as the model for tackling this symptom," says Grace Dean, RN, MSN, a research specialist at City of Hope National Medical Center in Duarte, CA. With pain management, patients are asked to rate their pain on a scale of one to 10, and this same method can be used to rate cancer fatigue. If patients are experiencing mild fatigue of three or less, they might be given some energy conservation tips, such as delegating tasks to save energy, and information on balancing rest and activity. If the fatigue were rated at four or higher, patients would receive a complete physical along with a focused history to uncover possible causes.
The history would include such questions as, "When did your fatigue start? Patients might learn that they are fatigued right after chemotherapy, and a week later, they are feeling better and can do more so they can plan for those variances," says Dean.
There are factors that are a direct cause and effect of fatigue, such as anemia. When there is a medical problem, it could be managed properly to increase a patient’s stamina. For emotional distress, patients might be referred to a social worker or counselor.
At the James Cancer Hospital and Solove Research Institute in Columbus, OH, an interdisciplinary group decided to use "PQRST" to assess patients for fatigue, says Molly Moran, MS, RN, CS, a hematology/medical oncology clinical nurse specialist at the medical facility. (See editor’s note at the end of this article regarding the PQRST technique.)
"PQRST" involves asking patients:
- P (provoke). What provokes the symptoms, or makes them better or worse?
- Q (quality). What is the quality or level of the symptoms that you are experiencing?
- R (regional). Is the fatigue regional, general, or mental?
- S (severity). On a scale of zero to 10, how do you rate the fatigue?
- T (timing). When did you first notice the fatigue, and how long have you experienced it?
A good assessment will help health care professionals at the facility determine appropriate interventions, says Moran. These might include a consult with a dietitian; suggested complementary therapies such as guided imagery, biofeedback, or aromatherapy; or restorative activities that revive a person, such as bird-watching or reading books.
[Editor’s note: The PQRST assessment tool selected by the team was adapted from Health Assessment & Physical Examination by Mary Ellen Zator Estes, Delmar Publishers, New York City, which was published in 1998. The publication costs $72.95, and can be ordered by calling: (800) 347-7707.]
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