Walking through cancer fatigue

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Battling cancer fatigue, 78-year-old Christian Mentrup of Kansas City walks as part of work that he does to combat fatigue. The program he's part of at North Kansas City Hospital focuses on working through the fatigue instead of getting too much rest.

Nearly one year ago Northland resident Christian Mentrup, 78, was diagnosed with a form of non-small cell lung cancer.

"It was a grim diagnosis, incurable but treatable...but they told me an 87-year-old had received the same diagnosis and survived and was doing great," Mentrup said.

In January 2005, he began chemotherapies that continued into June. In August, after journeying to M.D. Anderson Cancer Center in Houston for evaluation, Mentrup returned to his hometown oncologist, Kevin P. Hubbard, and began radiation. His 25 radiation treatments ended Sept. 15.

"When I was having the chemo, I was a little tired, but with the radiation I was very, very tired. It was tough, even after it ended," Mentrup said.

He talked about his fatigue with Mary Calys, physical therapist at North Kansas City Hospital, and she introduced him to a new cancer fatigue program, a multi-faceted program launched at the hospital this past July.

Cancer fatigue is the most common side effect from both the disease and the treatments, said Peggy Eldredge, RN, oncology clinical nurse specialist at North Kansas City Hospital.

Eldredge, who started her nursing career on the city's first oncology unit in 1974, works with Calys, cancer specialist Kay Suppes and Jenny Fitzpatrick, manager of the unit, on the cancer fatigue treatment team.

"We became really aware of the problem from a survey we did with breast cancer patients over the last two years. Mary had done her master's work in fatigue management...We talked with her and together developed a program of fatigue management, which we started in July as part of a comprehensive rehabilitation program," Eldredge said.

The fatigue reported by cancer patients, she said, is different from ordinary tiredness: "It's the tiredness that won't go away with rest."

"'Overwhelming' is the most common description," said Lillian Nail, Ph.D., RN, and a cancer survivor studying cancer fatigue at the University of Utah School of Nursing who is quoted on the American Cancer Society Web site.

"When compared with the fatigue experienced by healthy people, cancer-related fatigue is more severe, it lasts longer, and sleep just doesn't bring relief," Nail said.

It can be debilitating exhaustion that affects a patient's emotions, capacity for performing even small tasks, and the ability to concentrate and make decisions.

The causes are multiple, Eldredge said.

"Some of it comes from the disease itself. Chemo can lower red cell count; some fatigue comes from anemia. Radiation and chemo both kill cells, and that can have an effect. So can the stress of coping and all the emotions that go with that...We know that people with all kinds of cancers and all kinds of treatments are affected," Eldredge said.

Fatigue management, however, has not been as widely addressed as pain management for cancer patients. In response to the lack of cancer fatigue research and treatment, The Fatigue Coalition, a multi-disciplinary group of medical practitioners, researchers and patient advocates, was formed in 1996. It is that group's recommendation that cancer patients be assessed at every health care visit not only for pain but also for fatigue. That regular assessment is part of the NKCH program.

"We created our own assessment tool - which we have already changed once," Eldredge said. "We work with newly diagnosed patients and patients well into their treatments and beyond. We've started assessing fatigue right along with pain on the familiar 1-10 scale as soon as patients are diagnosed."

Patients are asked about specific fatigue symptoms as well as their degree of fatigue.

"Whatever the symptoms are, we can provide a referral to a clinical specialist - including the chaplain," she said. "There are certain things we look for: how they manage their daily activities, sleeping problems, ability to get dressed and get the day started, depression that comes with fatigue. We look at potential problems - and then we make up an individualized treatment plan."

The plan may include medication, nutrition and lifestyle adjustments. Almost always it includes exercise.

"Everything, including the exercise component, is very individualized, very tailored to a specific patient," Eldredge said.

For Christian Mentrup, the heart of the program is walking.

"Mary said that when I felt tired, I should try going for a little walk, just an eight-minute walk, rather than going to bed. I'm doing three walks a day," Mentrup said.

The therapy, he said, has worked for him.

"Oh, my goodness, yes...I feel better after I walk - and I can sleep now," Mentrup said.