Intervention of the Occupational Therapist in the Oncological Patient with Cancer-Related Fatigue

Main Objectives of the Occupational Therapist in Oncology

1. Promote the recovery, maintenance and compensation of functions and performance skills.
2. Sustain and promote the restoration and continuity of performance in occupational areas.
3. Promote the functional recovery of the individual.
4. Provide the adaptations and/or modifications necessary for the maintenance of the person’s performance in their daily life.
5. Contribute to the improvement of the quality of life related to the health of the cancer patient through the correct control of present symptoms.

Next, we will analyze more deeply one of the symptoms, tumor asthenia, understanding its clinical characteristics, its form of evaluation, emphasizing the most appropriate measures or instruments from the perspective of the occupational therapist, and addressing it from a theoretical point of view, what would be the principles that would support their intervention [15].

Icd-10 Criteria for Cancer-Related Astenia

A. The following symptoms have been present every day or almost every day during the same two-week period in the last month: Significant chronic fatigue, decreased energy, or increased need to lie down, out of proportion to any recent changes in activity level; in addition to five or more of the following:

1. Complaints of general weakness, heavy limbs.
2. Decreased concentration or attention.
3. Decreased motivation or interest in participating in regular activities.
4. Insomnia or hypersomnia.
5. Dream that does not refresh or restore.
6. Perception that you need to fight to overcome inactivity.
7. Marked emotional reactivity (for example, sadness, frustration, or irritability) in the face of chronic tiredness.
8. The difficulty of carrying out daily tasks is attributed to the feeling of tiredness.
9. Perception that there are problems with short-term memory.

Ethiopathogeny of Cancer-Related Fatigue

10. Tiredness after strenuous exercise lasts for several hours. B. Symptoms cause clinically significant impairment, or weakness, or impairment in social, professional, or other important behavioral areas. C. There are signs in the medical history, medical examination, or test result that symptoms arise as a result of cancer or cancer treatment. D. Symptoms do not arise primarily as a consequence of simultaneous psychiatric disorders, such as severe depression, somatization disorder, or delirium. Cancer-Related fatigue is the most common symptom associated with cancer and its treatment. The estimated prevalence varies between 60-90%, depending on the diagnostic criteria used. Asthenia is considered the most durable and disruptive symptom of cancer patients and has the greatest impact on quality of life parameters (Table 1).

Evaluation instruments Most used tumor asthenia evaluation instruments:

• PERFORM questionnaire.
• Piper Fatigue Scale (PFS).
• Visual Analog Scale (EVA).
• Functional Assessment of Cancer Therapy-Fatigue (FACT-F). Perform Questionnaire We consider this to be the ideal instrument to evaluate this symptomatic group. Until the elaboration of the PERFORM questionnaire, “Perceptions of Fatigue in Cancer Patients”, there was no known instrument for evaluating Cancer-Related asthenia that had been developed and fully validated in Spain, which meant that certain aspects, relevant to our oncologic patients would not be being measured at the questionnaires from other contexts so cioculturales. These questionnaires reflect and evaluate a certain concept of quality of life related to health (HRQOL) that may not fit with the reality of Spanish patients, because the concept of HRQOL may differ depending on the cultural environment.

Questionnaire PERFORMS us to good viability: the average number of lost items per patient was less than 1 and 80% of patients completed to thickness of the questionnaire. The average time required for administration of the cues tionnaire was less than 9 minutes. Over 80% of patients considered the question easy or very easy to complete. The extreme scores were very Infer count (<5%), this being an indication that the cues tionnaire covers well the intensity range of the symptom of the sample.

The internal consistency of me did was very satisfactory, both globally and by dimensions with an overall Cronbach alpha value of 0.935.

The test-retest reliability in group of patients defined as stable was also very satisfactory, both overall dimensions as an intraclass correlation coefficient 0.832 overall.

In addition, the questionnaire present ta solid evidence of validity so that correlates consistently with health measures duly sarrolladas and validated, as the questions also relational consistently with variables related to the health, as Karnofsky index, the in density asthenia measured by visual analog scale or level of care required. Additionally it was significantly associated with levels have myoglobin of the patient (P = 0.0163).

Finally, both the overall score and the scores of the di mansions of the questionnaire were PERFORM sensitive to changes in self-perceived health status by pa enough, especially when this change meant a worsening.

It is a tool that has proven to be feasible, reliable, valid and sensitive to change, and whose extension short (s or the 12 items) makes it very adequate for use in clinical practice is specialized, one of the variables that had us Keep in mind when choosing a measuring instrument, in order to avoid that the patient feels “assaulted” before so much evaluation.

The items of the questionnaire are distributed in 3 dimensions: habitual activities (4 items), attitudes and beliefs (4 items) and physical limitations (4 items). What makes the questionnaire show us values not only on the incidence of the symptoms of asthenia itself, but also establishes parameters of functionality of the patients. This last piece of information is of great value to us as occupational therapists, which makes this instrument the ideal one to later elaborate our therapeutic performance.

Occupational therapist intervention The intervention will consist of the following:

• Progressive mobilization of the patient: In the bedridden cancer patient based on the capacities present in the individual, the objective will be to begin mobilization focusing on restoring lost autonomy. Progressively and taking into account all the health problems present in it.
• Reeducation in activities of daily living (ADL): Based on the present symptoms, the patient must adapt their daily routines, their activities, to their capacity for effort. In that case, we as occupational therapists must carry out a specific re-education program for their daily activities.
• Individualized education: Energy saving techniques (APR).
• Restructuring of rest periods: Hygienic measures for sleep disorders in cancer patients.
• Use of the activity as a rehabilitation tool.
• Muscle toning program.
• Assess the need for a support product that facilitates patient mobilization.

Hygienic Measures for Sleep Disorders in Cancer Patients

• Maintain a sleep-wake rhythm as regular as possible, especially when waking up.
• Avoid stimulating medication and other substances before sleeping.
• Maintain good pain control at night, preferably with long-life pain relievers.
• Avoid spending unnecessary time in bed during the day; for bedridden patients, providing physical and cognitive stimuli throughout the day.
• Minimize nighttime interruptions due to noise, medication administration or other environmental conditions.
• Remove unpleasant stimuli, such as clocks, from the room.
• Avoid being in bed during the night awake, trying to sleep; Do some relaxing activity (reading), preferably out of bed, until drowsiness appears.
• Avoid naps in the late afternoon.
• Use hypnotic medication after a correct evaluation of the sleep disorder and avoid its overuse.