Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Palliative Medicine (SB) > 12.1 () Fatigue > Flashcards

12.1 () Fatigue Flashcards

(58 cards)

Start Studying
1
Q

List 3 key features of fatigue

A

Easy tiring - physical
Generalized weakness - emotional
Mental fatigue - cognitive

FS: TWM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q
  1. What is the prevalence of fatigue in cancer patients?
  2. List 3 domains of QOL that may be impacted by fatigue
A
  1. Most frequent and debilitating symptom in ADVANCED stage cancer (60-90%)
  2. physical
    functional - social, work
    psychological - mood
    AND
    decision making capabilities, may lead to refusal of potentially curative Rx

FS:
Physical, emotional, functional, social

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Define “generalized weakness”

A

The anticipatory sensation of DIFFICULTY in initiating a certain activity.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Define “mental fatigue”

A

Defined as the presence of impaired mental concentration, loss of memory, and emotional lability.

Memory
Emotional lability
Concentration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Define cancer-related fatigue

A

A distressing persistent, SUBJECTIVE sense of
- physical, emotional and/or cognitive tiredness or exhaustion
- related to cancer or cancer treatment
- that is not proportional to recent activity and interferes with usual functioning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

List 4 conditions that fatigue should be distinguished from

A

Depression
Delirium (fluctuating LOC)
Drowsiness
Weakness (lack of physical/muscle/motor strength)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

List 2 ways in which tumours can directly cause fatigue

A
  1. Lipolytic factors*
  2. Proteolytic factors*
  3. Pro inflammatory Cytokines* (!)
  4. Tumour degredation products
  5. Invasion of brain or pituitary gland (!)

* = tumour produced by products

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

List 3 pro-inflammatory cytokines implicated in cancer-related fatigue.

A
  1. TNF-alpha
  2. IL-1
  3. IL-6
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How can cancer-related treatments like radiation/chemo induce fatigue?

A

dysregulation of proinflammatory cytokines implicated in fatigue (TNF-a, IL-1, IL-6)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What body systems do pro-inflammatory cytokines act on to induce fatigue? (4)

A
  1. Brain (HPA axis, sleep, psych, dopamine changes)
  2. Muscles (decrease mass/strength)
  3. Metabolism
  4. Immune system (cellular & humoral)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What 3 host factors regulate pro-inflammatory cytokines implicated in fatigue?*

A
  1. Genetic factors
  2. Immune factors
  3. HPA axis alterations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What could be one of the main underlying mechanisms of fatigue?

A

Impaired muscle function

Unclear if fatigue related to muscle loss/altered muscle contraction VS. a central mechanism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Contributors to Fatigue (14)

A
  1. Cachexia (E)
  2. Mood disorders (P)
  3. Inflammation (I)
  4. Neuroendocrine alterations (E)
  5. Poly pharmacy (Iatrogenic)
  6. Cancer-related symptoms (N)
  7. Anemia (V)
  8. Tumour by-products (N)
  9. Infections (I)
  10. Dehydration (D)
  11. Anti cancer treatments (Iatrogenic)
  12. Comorbidities (renal, hepatic, heart disease). (D)
  13. Autonomic dysfunction (V)
  14. Deconditioning (D)
  15. Genetics (SNPs of proinflammatory cytokine genes)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

List 2 causes of muscle abnormalities due to cancer or it’s treatment.

A
  1. Abnormalities in cytokine (pro-inflammatory) production*
  2. Cachexia*
  3. Increased lactate in muscle tissues
  4. Atrophy* if type II muscle fibres
  5. Myopathies* from anti cancer treatments
  6. Loss of muscle mass* from corticosteroids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q
  1. What is the mechanism by which deconditioning leads to fatigue?
  2. What is one treatment for this?
A
  1. Prolonged bed rest + immobility = loss of muscle mass and reduced cardiac output

Deconditioning results in reduced endurance for exercise/ADLs
(may be compounded by muscle abnormalities)

  1. Endurance exercise training can reduce fatigue and improve physical performance in cancer pts undergoing treatment/survivors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

List 4 proposed mechanisms by which fatigue is perceived/induced in the CNS*

A
  1. Primary or secondary CNS tumours
    -invasion of pituitary gland –> endocrine abnormalities
  2. Cognitive dysfunction (from brain tumour/ n.t. &hormones from other primaries/cancer treatments) can be caused by or contribute to fatigue
  3. Dysregulation of serotonin/its receptors in the brain due to cancer/treatments
  4. circadian rhythm disruptions
  5. dysregulation of HPA

n.t. = neurotransmitters

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q
  1. When can fatigue occur with infections
  2. What is the underlying mechanism
A
  1. As a prodrome or may outlast infection by weeks/even months esp with recurrent or protracted infections
  2. Thought to share the same mediators for fatigue as cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

6 causes of anemia in cancer pts

A
  1. Myelosuppression by chemotherapeutic agents
  2. Iron deficiency
  3. Bleeding
  4. Haemolysis
  5. Nutritional deficiencies
  6. Anemia of chronic disease

Microcytic: TAILS

Normocytic - high retic: bleeding or hemolysis

Normocytic - low retic: bone marrow suppression, renal disease, anemia of chronic disease

Macrocytic: liver disease, ETOH, B12/folate deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

List 7 physical effects of autonomic dysfunction.

A

GI:
Malnutrition
Anorexia
Delayed gastric emptying
Chronic nausea

General:
Poor performance status
Fatigue

Vascular:
Orthostatic hypotension

feeling hot or cold in some parts of or all over your body, due to issues that cause the blood vessels to narrow or widen;

Skin:
excessive or decreased sweating, salivating, or eye-tearing;

bladder:
such as being unable to empty one’s bladder fully;

sexual problems:
such as vaginal dryness and difficulty maintaining an erection;

FS:
Vascular, GI, bladder, sexual
General
Skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

List 3 psychological issues that can cause fatigue.

A

Depression
Anxiety
Adjustment reaction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

List 3 endocrine disorders that could be a cause of fatigue

A
  1. Diabetes mellitus
  2. Addison’s disease
  3. Hypothyroidism
  4. Testosterone/androgen insufficiency/hypogonadism
  5. HPA axis abnormalities of corticotropin releasing factor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q
  1. List 4 signs/symptoms of testosterone deficiency
  2. List 4 causes of testoterone deficieny in cancer patients
  3. In cancer treatment-related testosterone deficiency, list 1 possible intervention and 4 of its benefits
A
  1. loss of muscle mass
    fatigue
    reduced libido
    anemia
  2. anorexia/cachexia sydrome
    chemotherapy
    radiation
    hormone ablative therapy
  3. Androgenic anabolic steroids (i.e. testosterone + its derivatives)
    benefits: increase muscle mass/energy/libido/Hb
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

List 4 electrolyte abnormalities that can cause fatigue.

A

Hyponatremia
Hypokalemia
Hypomagnesemia
Hypercalcemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

List 6 cancer-related symptoms that can cause fatigue.

Study These Flashcards
A

Pain
Psychological symptoms
Dyspnea
Sleep disturbances
Anorexia
Constipation

25
List 9 paraneoplastic neurological syndromes associated with fatigue*
Progressive multifocal leucoencephalopathy Paraneoplastic encephalomyelitis Amyotrophic lateral sclerosis Subacute motor neuropathy Peripheral paraneoplastic neurological syndrome Ascending acute polyneuropathy Dermatomyositis polymyositis (neuromuscular) Eaton-lambert syndrome (neuromuscular) Myasthenia Gravis (neuromuscular) ## Footnote PML - usually with leukemia & lymphoma Paraneoplastic encephalomyelitis - 70% cases in lung cancer
26
List 4 anti cancer therapies that commonly contribute to fatigue.
Cytotoxic therapeutic agents Radiotherapy Biological response modifiers (i.e interferon) Targeted therapy (I.e tyrosine kinase inhibitor) (but rule out endocrinopathies from immunotherapy PD-1 inhibitors)
27
List 11 medication classes commonly used in palliative care that can cause fatigue.
Opioids Anxiolytics Anticholinergics Antiepileptics Neuroleptics Alpha-adrenergic blocking agents Diuretics SSRIs TCAs Benzos ## Footnote compounded by polypharmacy!
28
6 components to assessment of fatigue
Severity Duration Onset Level of interference with ever day life Associated psychological or social problems Possible underlying causes FS: OPQRSTUV - DIMS
29
Name 3 clinical assessment tools for fatigue.
Visual analogue scale* ! Numerical rating scales* ! Functional assessment of cancer therapy-fatigue* Brief Fatigue Inventory* ! Piper Fatigue Scale* Fatigue Questionnaire** Multidimensional Fatigue Inventory** Pearson and Byars Fatigue Feeling Checklist ## Footnote * = subjective tools ** = multidimensional tools
30
List 3 specific assessments for fatigue in the clinical setting.
Subjective assessment tools (VAS, NRS, FACT-F, Piper, BFI) Performance status Functional capacity (assess task: walking, driving, cycling) Task-related fatigue (VAS, NRS, Pearson&Byars) ## Footnote VAS= visual analogue scale NRS = numerical rating scale
31
List 3 "dimensions" of fatigue that can be assessed
1. Physical 2. Cognitive 3. Emotional
32
List 3 tools to assess performance status
Karnofsky performance status European Cooperative Oncology Group score (ECOG) Edmonton functional assessment test
33
3 questions to consider in the assessment of fatigue*
1. Is fatigue a symptom of primary concern to the patient? 2. What are the major, probable causes? 3. Are there therapeutic measures available that have reasonable cost/benefit ratio?
34
List 5 non-pharm measures to manage fatigue.
PT OT Acupuncture Exercise if deconditioning (early cancer and cancer survivors… not so much late stage)… best evidence. CBT Education about fatigue + instruction in self-care, coping techniques, activity management
35
List 3 classes of medications that can help manage fatigue.
1. Corticosteroids (dex) 2. Progestational agents (megastrol acetate)/ other anti-cachexia agents 3. Psychostimulants (methylphenidate) (Lack of compelling data to support any of these other than very short term corticosteroids)
36
List 10 specific measures to address in the evaluation and management of fatigue.*
Psychological issues Cachexia Anemia Infection Autonomic failure Metabolic and endocrine disorders Opioid induced sedation Hypoxia Dehydration Deconditioning
37
List 3 ways corticosteroids are thought to help combat fatigue.
Inhibition of tumour induced substances Central euphoriant effects Improvement of physical symptoms | *probably not through appetite stimulation as steroids not shown to impr
38
List 8 potentially reversible causes of fatigue in palliative care patients.*
Infection Anemia Autonomic factors Psychological factors Sleep disturbances (daytime sleepiness and/or insomnia) Metabolic disorders Drug induced Nutritional deficiency Dehydration Hypoxia optimize underlying cardio-resp conditions
39
List 5 ways to manage fatigue caused by autonomic dysfunction. (Name 2 drug names)
Midodrine (alpha-1 sympathomimetic agent) Consider mineralocortocoid if indicated (fludrocortisone) Adjust doses of meds contributing to fatigue Decrease poly pharmacy Encourage exercise Increase salt intake Avoid triggers of autonomic insufficiency.
40
List 4 triggers of autonomic insufficiency
Heat Motionless standing Large morning meals Etoh
41
What is one common nutritional deficiency in patients with advanced cancer?
Carnitine (but in RCT, supplementation did not improve fatigue)
42
List 2 nutritional supplements that may help combat cancer-related fatigue.
L-carnitine Ginseng Co-Enzyme Q-10 Guarana | *more studies needed re: efficacy & safety
43
What are common changes associated with cancer related fatigue? (6)
Decreased cognitive function Decreased muscle endurance Decreased sleep quality Decreased control over body processes Increased social withdrawal Increased emotional reactivity
44
What is the pathophysiology of cancer related fatigue?
Proposed mechanisms include energy imbalance caused by a variety of mechanisms including: Pro-inflammatory cytokines HPA axis dysregulation Circadian rhythms desynchronization Persistent immune system activation Establishment of a chronic inflammatory state.
45
Describe the brief fatigue inventory?
0-10 numeric scale rating fatigue over designated time period. 0-3 mild 4-7 moderate 8-10 severe
46
List 4 psychosocial interventions to manage cancer related fatigue.
CBT Behavioural therapy Psychotherapy Support groups Changing coping strategies Relaxation Energy conservation Stress management
47
What are 4 considerations when prescribing/recommending exercise to patients?
Frequency Intensity Time Type (FITT)
48
What advice would you give a patient to manage fatigue in advanced cancer? (6)
1. Plan activities during times in the day when pt is least tired. 2. Integrate regular, gentle activities into the day (stretching, sitting at table for meals). 3. Avoid stress and include relaxation/meditation techniques throughout the day. 4. Suggest multiple short naps throughout the day. 5. Limit visiting hrs for family and friends. 6. Look into home meal delivery options. FS Physical fatigue - Physical activity (pacing) - Nutrition Mental fatigue - Relaxation - Meditation Emotional fatigue - Social - Avoid stress
49
What are the five elements of the definition of fatigue according to the NCCN?*
Distressing Persistent Physical tiredness Emotional tiredness Cognitive tiredness
50
List 4 CNS abnormalities that may contribute to fatigue
Primary and secondary tumours* Anti neoplastic tx Drugs used to treat complications of cancer (ie opioids) Dis regulation of seretonin and or its receptors in the brain due to cancer tx.* Circadian rhythm disruption* Dysregulation of the HPA axis*
51
What is the relationship between fatigue and cachexia?
Fatigue can be caused by muscle weakness and malnutrition which are characteristic of cachexia. But profound fatigue can exist in the absence of cachexia.
52
On a numerical rating scale what value has been shown to suggest clinically relevant fatigue?
> 5
53
3 benefits of exercising to manage fatigue.
Maintain muscle mass Improved self-reported physical functioning Improved sense of wellbeing Improved self esteem Improved outcomes (ie maintaining independence)
54
List 4 lifestyle modifications that can be undertaken for management if fatigue and which can be explored in counseling.
Adapting activities Spending more time in bed or exercise if deconditioned. Rearranging schedules with respect to fatigue patterns. Change causative medications
55
Treatment for what level of anemia is associated with improved fatigue in palliative care?
<80
56
List 4 disadvantages of epo for treatment of fatigue.
1. Increased thrombotic events* 2. It may decrease survival time 3. 4-8 weeks before hgb increases* 4. Tumour growth (via angiogenesis)* 5. High cost*
57
What is the typical dose of corticosteroids for fatigue?
Prednisone 40mg daily (about Dex 6 mg) *corticosteroid effects usually only last 2-4 weeks * long term risk of osteoporosis, myopathies, infections
58
You have a patient with major depression and cancer-related fatigue. List 1 pharmacological treatment option for both issues
Major depression could be treated with anti-depressant but this has not been found to be effective for cancer-related fatigue Consider psychostimulant for rapid anti-depressant effect + helpful with fatigue, opioid-induced sedation

Palliative Medicine (SB) (145 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions