Nursing Measures to Alleviate Cancer-Related Fatigue

Nursing treatments for cancer-related fatigue depend on the patient’s complaints and symptoms. These may either be expressions of the illness itself – such as physical weakness due to weight loss – or side effects of oncological therapies. On a deeper level, symptoms and complaints of cancer-related fatigue can be understood as an expression of the relationship patients establish with their illness, with themselves, and with their environment, on the level of soul and spirit. This may manifest itself in withdrawal, exhaustion or depression.

Patients with cool extremities

Cool extremities at room temperature are an expression of a lack of peripheral blood circulation, often associated with a lack of physical exercise. Anxiety or eating disorders can also be the cause. In any case, they signify a withdrawal of the ‘I’-organization. We can counteract this by applying warmth-stimulating substances locally.

• Footbaths, with Rosemary Invigorating Bath Milk WELEDA (also available as Rosmarin Aktivierungsbad)
  stimulate the patient’s peripheral circulation and warm the limbs. 
  For instructions, see http://www.pflege-vademecum.de/rosmarinbad_fussbad.php
  
  
• Rhythmical embrocation of the patient’s hands, arms, legs and feet with Rosemary oil WALA, WELEDA or DR. HEBERER.
  Best used in the morning and at midday.
  
  
• Rhythmical embrocation with Red Copper Ointment WALA (also available as Kupfer Salbe rot), or Cuprum metallicum praeparatum 0.4% WELEDA 
  Best used in the evening.
  
  
• Footbaths with mustard powder
  stimulate the patient’s metabolic processes through rapid warmth stimulation. Mustard powder can be used in the morning, at noon and in some cases also in the evening.
  For instructions, see https://www.pflege-vademecum.de/senffussbad.php

Patients carry out these applications themselves after being given a motivating introduction. Taking regular care of one’s hands and feet can stimulate warmth development. Patients can better perceive themselves and their warmth and take on more individual responsibility.

CAUTION: On the day of the administration of cytostatics, no warmth applications should be given together with the following groups of drugs, since some research has shown that they may promote polyneuropathy: taxanes (paclitaxel, docetaxel), vinca alkaloids and platinum derivatives (1). Warmth applications administered in combination with oxaliplatin, in contrast, were shown to have a positive effect, according to a Chinese study (2).

Chilled patients who appear to be lacking an enveloping layer of protection (e.g., during or after chemotherapy)

Exhausted people or those suffering from pain generally cannot react on their own to warmth-stimulating substances (as was described above), or take on their own treatment. In this case we help relieve their burden by taking over the process and providing them with enveloping, warmth-maintaining applications.

• Rhythmical embrocation of the extremities or full-body rhythmical embrocation with Solum oil WALA.
  The composition of moor extract, chestnut, horsetail and lavender, all brought together, creates an oil with gentle enveloping and warming properties (“like a mantel wrapped around me”).

Patients with pronounced feelings of weakness and heaviness in their extremities

Just as cold extremities are an expression of a weakened warmth organism, so are heaviness and weakness expressions of a fluid organism that has become inert. Congestion and edema in the limbs, as well as anasarca, show that the person’s bodily fluids can no longer be kept flowing and light but have instead become subject to gravity. The person’s fluid organism can be strengthened with substances related to light and water, such as spring-flowering blackthorn and citrus fruits, along with walking on morning dew and Kneipp water treatments.

• Rhythmical embrocation of the extremities with Blackthorn oil WALA (available as Schlehenblüten Pflegeöl)
  has a nourishing, uplifting effect and strengthens the life organization. Can be given morning and evening.
  
  
• Footbath with Citrus Refreshing Bath Milk WELEDA (also available as Citrus Erfrischungsbad).
  For instructions, see http://www.pflege-vademecum.de/zfb.php
  
  
• or Rhythmical embrocation with Citrus Refreshing Body Oil WELEDA (also available as Citrus Erfrischungs-Öl) or Citrus oil WALA.  
  Lemon has a stimulating, invigorating and toning effect. Do not use when the feet are cold! Should generally be applied in the morning or at midday. 

Patients with “cool” edema or anasarca who have a weakened life organization

Some edemas, such as lymphedema after radiation or lymph node removal, are the result of scarring and thus are primarily physical blockages. It is difficult to invigorate such tissue. The following applications may provide temporary relief.

• White cabbage compresses
  have an invigorating and decongestive effect.
  For instructions, see https://www.pflege-vademecum.de/weisskohlauflage.php
  
  
• Rhythmical embrocation with 5% olive juniper oil DR. HEBERER (available as Oliven-Wacholder-Öl)
  Juniper has an organizing and structuring effect on the fluid metabolism, has an ordering effect on solid, cool edemas and reintegrates the fluid from the tissue into the vascular system.

Patients who are cold in the low back and kidney region, who are emotionally and affectively cramped/cool

Tiredness is an expression of the fact that the alert soul and spirit want to detach themselves from the body. This tendency to retreat from the body can be counteracted by stimulating the person’s sensory organization (soul body), as long as the problem is not caused by an exhaustion of the patient’s forces for that day. According to anthroposophic thinking, the kidney is the organ through which the soul organization works.

• Ginger kidney compress.
  Use in the mornings or by midday at the latest. This has a centering and warming effect on the soul from within.
  For instructions, see http://www.pflege-vademecum.de/ingwer-nierenkataplasma.php
  
  
• Equisetum kidney compress.
  Horsetail helps the kidney to excrete.
  For instructions, see http://www.pflege-vademecum.de/equisetum-nierenwickel.php
  
  
• Apply Red Copper Ointment WALA (also available as Kupfer Salbe rot) as a rhythmical embrocation of the kidneys  
  or apply a compress with copper massage oil LICHTERDE (available as Kupfer Massageöl) or Red Copper Ointment WALA (also available as Kupfer Salbe rot) to the kidney region.
  Copper has an antispasmodic effect, is relaxing and warms through. May be used in the morning or evening.

Patients with no appetite, resulting in weakness, and who lack a sense of rhythm

The withdrawal of the soul organization from the metabolic system leads to a lack of appetite, as well as constipation and flatulence. This is why stimulation of digestive activity is recommended in the treatment of cancer fatigue. Incidentally, warm, moist compresses wrapped around the body, applied after the main meal, have a rhythm-encouraging and upbuilding effect on the entire organism.

• Yarrow compress on the liver region (yarrow tea)
  
• or a yarrow oil compress. 

Use at midday after eating. To support the sleep rhythm, this compress can also be used in the evening to fall asleep.

This treatment strengthens the liver’s metabolic processes, supports the transformation and detoxification of cytostatic substances, and has warming, metabolism-stimulating properties.
For instructions, see http://www.pflege-vademecum.de/schafgarben_leberwickel.php

Patients with sleep disturbances

Patients with cancer-related fatigue crave rest and sleep. When they manage to fall asleep, they often do not experience the quality of sleep as being refreshing. We can distinguish 4 kinds of sleep disorders:

1. Difficulty falling asleep: This is usually caused by inner unrest, fears and worries. The soul and spirit cannot let go of the sensory world.

• Heart ointment compress with Aurum/Lavandula comp. ointment WELEDA (also sold as Oleum aethereum Lavandulae 10%, Lavender massage oil) before going to sleep.
  For instructions, see https://www.pflege-vademecum.de/aurum-lavandula-herzauflage.php
  
  
• Rhythmical embrocation of the feet with Lavender oil WALA, or as needed with Red Copper Ointment WALA (also available as Kupfer Salbe rot) if the person has cold feet
  
  
• Lavender Relaxing Bath Milk WELEDA (also available as Lavendel Entspannungsbad) or Moor Lavender Calming Bath Essence DR. HAUSCHKA (available as Moor Lavendel Bad)
  
  
• Drink Melissa tea, 1 cup before going to bed
  
  
• Always ensure the patient has warm feet (provide wool socks)

2. Difficulty sleeping through the night: This is often the result of nocturnal disturbances due to pain or not getting enough movement during the day. Cultivate the person’s day-night rhythm with:

• Rosemary oil footbaths each morning,
  to stimulate and awaken
  
  
• Lavender oil footbaths each evening,
  to soothe and relax
  
  
• Yarrow liver compresses

3. Waking up disorders: Many people take a long time, often several hours, to make the transition from sleeping to waking. This time is often experienced as torturous.

• Rosemary footbaths in the morning
  
  
• Rosemary washes in the morning
  

4. Poor quality of sleep: Even when the person sleeps long enough, their sleep can be perceived as not refreshing. This is due on the one hand to problems sleeping through the night, and on the other to a lack of sleep hygiene – such as no review of the day, noisy surroundings, running TV, a bedroom that is too warm, etc.