1.
Cancer Related Fatigue

2.
TODAY’S WEBINAR
 SPEAKER(S)
 Bram Kuiper, Michael Mancini, Amy Rosenblum
 QUESTIONS
 Ask a question in the panel on the RIGHT SIDE of your
screen
 WEBINAR ARCHIVE
 FightCRC.org/webinar
 TWEET ALONG
 Follow along via Twitter – use the hashtag #CRCWebinar

3.
RESOURCES

4.
FIGHTCOLORECTALCANCERDISCLAIMER
The information and services provided
by Fight Colorectal Cancer are for
general informational purposes only.
The information and services are not
intended to be substitutes for
professional medical advice,
diagnoses or treatment.
If you are ill, or suspect that you are ill,
see a doctor immediately. In an
emergency, call 911 or go to the
nearest emergency room.
Fight Colorectal Cancer never
recommends or endorses any specific
physicians, products or treatments for
any condition.

5.
Dr. Bram Kuiper is a clinical psychologist, scientific entrepreneur and CEO of Tired of
Cancer. Up until July 2017, Bram was the CEO of the Helen Dowling Institute for psycho-
oncology and research. With over thirty years of experience in the field of psycho-oncology
and in co-writing treatment protocols, he has now devoted his career to seeing the Tired of
Cancer App help as many people as possible who suffer from cancer-related fatigue.
Mike Mancini is a Stage IV colon cancer survivor diagnosed in June of 2017 at age 42. He
is currently pursuing his MBA through Southern New Hampshire University while working full
time managing a a team of small commercial insurance customer service reps. He is a 2019-
2020 Fight Colorectal Cancer Ambassador living in Wolcott, CT.
Amy Rosenblum has spent over 10 years in the U.S. healthcare industry with a background
in marketing strategy, development, and execution of healthcare initiatives. She currently
works for the company Tired of Cancer as their Director of Partnerships.

6.
Understanding Cancer-Related Fatigue
This project has received funding from the European Union’s Horizon
2020 research and innovation programme under Grant agreement
No. 756641

7.
• Can cer - Relat ed - F at ig u e – t h e p ro b lem
• Possible int ervent ions
• Q u est io n an d An sw er Sessio n
The Agenda

8.
T H E P R O B L E M
Cancer-Related
Fatigue
Nr. 1 side-effect of
cancer and its
treatments

9.
D E F I N I T I O NT H E P R O B L E M
Can cer - Relat ed F at ig u e may b e d ef in ed as* :
“A distressing, persistent, subjective sense of tiredness or exhaustion related to
cancer or cancer treatment that is not proportional to recent activity and interferes
with usual functioning“
* NCCN (National Comprehensive Cancer Network)

10.
C H A R A C T E R I S T I C ST H E P R O B L E M
Characteristics CRF
(Different from Chronic Fatigue Syndrome!)
 It comes sudden, without warning and usually not
as a result of exertion
 The fatigue is often an extreme experience and
seems like exhaustion
 The recovery period lasts longer than after a
‘normal’ fatigue

11.
I M P A C TT H E P R O B L E M

12.
I M P A C TT H E P R O B L E M
Huge impact of CRF
 Physical limitations
(e.g. limited radius of action)
 Social invalidation
(e.g. cannot/less work, different role in the family, withdraw from
activities)
 Psychological problems
(e.g. anxiety, depression, poor sleep, cognitive disorders)

13.
F A T I G U E S C O R ET H E P R O B L E M
Fatigue Score (0-10)
(Or Fatigue Symptom Inventory - FSI)
› CRF can’t be measured ‘objectively’, it’s always the unique experience of the individual person.
Incidence (score 4 - 10: moderate to severe fatigue) (American Cancer Society)
Initial (first year after diagnosis) 70 - 100%
Long term (often many years) 30 - 50%
0 1 2 3 4 5 6 7 8 9 10
0 – 4
mild fatigue
4 – 7
moderate fatigue
7 – 10
severe fatigue

14.
P R E V A L E N C E
16.000.000 CRF
24.000.000 no CRF
Europe and USA
40.000.000 Cancer Patients and Survivors
40% With CRF (score 4 -10)
T H E P R O B L E M

15.
Psychological/Social/
Behavioral factors
• Anxiety (for recurrence)
• Depression
• Distress
• Sleep disorder
• Decreased physical
activity
Co-morbid conditions
• Hypothyroidism
• COPD
• Diabetes mellitus
• Cardiovasculair disease
• Infections
Side effects of other
medications
• Opioids
• Psychiatric drugs
• Antihistamines
• Beta blockers
• Corticosteroids
Latrogenic factors related
to
• Chemotherapy
• Immunotherapy
• Radiotherapy
• Surgery
• Hormonal therapies
• Small-molecule targeted
therapies
Physical symptoms
associated with the
underlying tumor or its
treatment
• Pain
• Dyspnoea
• Difficulty swallowing
• Appetite loss
Tumor-related factors and
complications
• Anaemia
• Dehydration
• Anorexia
• Thrombosis/pulmonary
embolism
• Renal, liver or heart failure
• Neurological deficit
• Fever
CRFKoornstra e.a., 2014
I N F L U E N C I N G F A C T O R S C A U S I N G A N D M A I N T A I N I N G T H E P R O B L E MT H E P R O B L E M

16.
DEPRESSIONFEAR
LIMITED PHYSICAL ACTIVITY
PAIN STRESS
COGNITIVE DYSFUNCTIONS Disruptive thoughts
Social isolationNo return to work
SLEEP DISORDERMalnutrition
Feelings of despairFinancial problems
Too high expectationsAnger
V I C I O U S C I R C L E ( w i t h o u t i n d i c a t i o n s f o r s o m a t i c c a u s e s )T H E P R O B L E M

17.
P O T E N T I A L T R E A T M E N T SC R F
National Comprehensive Cancer Network (NCCN)
Intervensions for CRF
Pharmacologic interventions
- Psychostimulants (methylphenidate)
- Antidepressants
- Steroids
- Supplements (Ginseng, vitamin D)
 Limited evidence for patients in advanced disease
or active treatment
 No evidence for cancer survivors
Non-pharmacologic
- Psycho-education
- Cognitive Behavior Therapy (CBT)
- Mindfulness Based Cognitive Therapy (MBCT)
- Exercise programs (strength training, walking,
swimming, cycling etc.)
- Mind-body interventions: yoga, reiki etc.
 Positive and promising results (in combination!)
21

18.
P O T E N T I A L T R E A T M E N T ST H E S O L U T I O N
NCCN
• There’s no Magic Pill
• Cancer-Related Fatigue is a complex problem
that requires a multimodal approach

19.
Weekly measurements
Buddy
Private Facebook Community
Library
Personal notes
T H E U N T I R E P R O G R A MC R F

20.
1. You’re not alone
R E V I E WS U M M A R Y
3. Take small steps,
every little bit can help!
2. There are ways to cope

21.
Q&A

22.
This project has received funding from the European Union’s Horizon
2020 research and innovation programme under Grant agreement
No. 756641
THANK YOU!
Feedback or Suggestions - info@untire.com

23.
Q
&
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24.
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