OA08.06 How Complex is Fatigue? Occupational Therapy Playing a Lead Role in Fatigue Management

Abstract

Cancer related fatigue (CRF) is the most commonly reported and debilitatng symptoms reported by individuals with a lung cancer diagnosis. It is strongly associated with reduced qualitiy of life, adhearance to treatment regimes, and functional independence. CRF impactfs on the individual across all domains of the individual, physically, emotionally and cognitively, and therefore holistic fatigue management should address all these areas. Whilst the exact cause of CRF reamins unclear, Mustian et al (2017) determined that first line intervention for the management of this symptom should consist of physical activity and psychological interventions. Occupational Therapists are currently well estabilshed in the role of fatigue management. Through dual training in both the physical and pscyhological health settings they are well placed to provide interventions that encompass both these fields and ensure holistic managment of the symptom. At present fatigue managment is limited in many settings with patient being provided with generalist information, rather than tailored, speicialist intervention which is required in order to ensure the symptom if addressed appropriately. A retrospective analysis was carried out of patients receiving an OT fatigue management intervention over the 3-month period of October to December 2019, at Guy’s Cancer Centre. The interventions were divided into three categories: Basic: Consisting of the provision of generalist fatigue management education, including the causes of CRF, CRF domains and the four Ps (planning, prioritising, pacing and positioning) Medium: Consisting of generalist education and a tailored fatigue management intervention plan Complex: Consisting of generalist education, a tailored fatigue management intervention plan and onwards referral for either equipment provision, care or home based rehabilitation. Over this 3-month period 224 Occupational Therapy specific interventions were completed of which 37% (n=83) were for fatigue management. 24% (n=20) of interventions were for basic fatigue education, 63% (n=52) of interventions were for medium intervention and 13% (n=11) were complex interventions. CRF is the most widely reported symptom by patients with a thoracic oncology diagnosis, however despite this it is poorly managed and continues to impact on an individuals QoL. In many centres fatigue management is limited and often consists of generalist information provision, rather than tailored fatigue management intervention. Whilst this may be effective for individuals with low-level CRF, those presenting with more complex needs require specialist intervention. Due to the multifactorial nature of CRF, OTs are well placed to lead on fatigue management, by providing holistic intervention to address both the physical and mental needs of this patient group. Through this retrospective analysis we have determined that the majority of thoracic oncology patients present with more complex fatigue symptoms and therefore require intervention from a specialist clinician in order to effectively manage this symptom and ensure the best outcomes.