Fatigue- did you miss it?

It was great to see so many colleagues at the regional audit meeting today- we think it was one of the best attended meetings for some time.

The GDG had done a great job with their in depth review of how best to assess and manage fatigue in patients with life limiting illness.

Their literature review had been a little daunting to start with when the search came back with over 13000 articles. That must have give the lead some sleepless nights!. Fortunately they managed to whittle it down to a manageable 30 full text reviews although even that is a significant piece of work. Well done to everyone who contributed- we think you did a great job!

Over 75% of patients with cancer experience significant fatigue. This figure increases even further if we include patients who are post cancer treatment.We heard the latest updates on how best to assess this challenging symptom, which non pharmacological measures have the best evidence and a review of which drugs we should and shouldn’t be using.

It was interesting to hear about the evidence for acupuncture and acupressure. Often we don’t think about it as an option and even if we do many services don’t have access to this intervention. It was also good to be reminded about some of the drugs that we don’t consider as potentially exacerbating this symptom such as calcium channel antagonists and ACE inhibitors.

One thing was very clear- we need to be better about providing patients and those important to them with written information about fatigue. The Macmillan booklet “Coping with fatigue” is recommended although it is fairly lengthy.

You can see the slides from the literature review here. Please feel free to share within your team, organisation and locality.

Results from the HCP survey and the case note review showed us what we say we are doing and what actually happens in clinical practice. Thank you to everyone who took the time to complete the surveys and enter data. We will get the localised and network audit results out to you as soon as we possibly can. Any team who submitted 10 or more cases will get a bench marked localised report. Where that wasn’t possible, teams will receive a global network report.

And then there was plenty of time for discussion where we thought about how we develop evidence for the essential multiprofessional input, and the huge research gaps that exist around optimum doses of corticosteroids. We were also reminded about focusing on patient goals when we talk with patients about fatigue management strategies.

The GDG will now crack on and start finalising the guideline and standards so that we can get them out for external review and hopefully publish on the website later this year.

If you were able to join us today we hope it was both enjoyable and stimulating. If you had to miss it, we hope the slides give you some more information and we really hope that you will be able to join us at our next meeting in September when we delve into some of the tricky questions about the use of anticoagulation at the end of life

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