Fatigue is one of the most common problems for cancer patients. Fatigue is complex, and has biological, psychological, and behavioral causes. Fatigue is difficult to describe and people with cancer may express it in different ways, describing this symptom as feeling tired, weak, sad, bored, exhausted, depressed, having no energy, or being unable to concentrate. Health professionals may use terms such as asthenia, fatigue, lassitude, prostration, exercise intolerance, lack of energy, and weakness to describe fatigue. Fatigue can last a few weeks or even for several months
Fatigue can become a very important issue in the life of a person with cancer. It may affect how you feel about yourself, your daily activities, your relationships with others, and whether you can continue with your cancer treatment. People receiving some types of cancer treatments may miss work, withdraw from friends, need more sleep, and, in some cases, may not be able to perform any physical activities because of fatigue. Understanding fatigue and its causes is important in determining effective treatment and in helping you cope.
Who Gets Fatigue?
Fatigue is a common problem in people who:
- have cancer. Fatigue may be one of the cancer symptoms that brings people to the doctor
- have had surgery. Almost everyone has some fatigue after surgery. Many things can cause this: blood loss, bed rest or decreased activity, medicines, and sadness due to diagnosis of cancer.
- are being treated with chemotherapy
- are being treated with radiation therapy
- are being treated with biological therapy (immunotherapy)
- have anemia. Anemia is a low number of red blood cells available to carry oxygen to our tissues and cells.
- have weight loss and/or loss of appetite
- have had their normal metabolism and/or hormone levels disrupted
- emotional distress
- are not getting enough sleep or whose quality of sleep has been reduced
- have pain
- have an infection
- have poor nutrition. Fatigue often occurs when the body needs more energy than the amount being supplied from your diet. In people with cancer, 3 major factors may be involved: a change in the body's ability to process food normally, an increased need by the body for energy (due to tumor growth, infection, fever, or problems with breathing), and a decrease in the amount of food eaten (due to lack of appetite, nausea, vomiting, diarrhea, or bowel obstruction).
- are having extreme emotions, beliefs, attitudes, and reactions to stress
- are taking certain medications
Most of the treatments for fatigue in cancer patients are for treating symptoms and providing emotional support because the causes of fatigue that are specifically related to cancer have not been determined. Some of these symptom-related treatments may include adjusting the dosages of pain medications, administering red blood cell transfusions or blood cell growth factors, diet supplementation with iron and vitamins, and antidepressant or psychostimulant medications.
Although fatigue is one of the most common symptoms of cancer treatments, few medications are effective in treating it. Your health care provider may prescribe medication in low doses that may help you if you are depressed, unresponsive, tired, distracted, or weak. These drugs (psychostimulants) can give a sense of well-being, decrease fatigue, and increase appetite. They are also helpful in reversing the sedating effects of morphine, and they work quickly. However, these drugs can also cause sleeplessness, euphoria, and mood changes. High doses and long-term use may cause loss of appetite, nightmares, sleeplessness, euphoria, paranoid behavior, and possible heart problems.
Your treatment team will monitor your blood counts by taking blood samples when you return to clinic. If anemia is contributing to your fatigue, a transfusion or medication may help.
What Else Can I Do?
Sometimes fatigue cannot be treated. Being flexible, planning, and understanding what is happening to you may make it easier for you to deal with your fatigue. There are things you can do to make it more tolerable:
- Keep a journal or log of your daily activities, noting when your fatigue is less and when it is greatest. This way you can adjust your time and plan for activities when you know you can better tolerate them.
- Use your energy for the things that are most important to you. To schedule important daily activities during times of less fatigue, and cancel unimportant activities that cause stress.
- Balance rest periods with activity through the day.
- Get some exercise - stretch, walk, do yoga, swim. A few minutes of exercise several times a day will help you maintain your muscle strength and feel more alert. People with cancer who exercise may have more physical energy, improved appetite, improved ability to function, improved quality of life, improved outlook, improved sense of well being, enhanced sense of commitment, and improved ability to meet the challenges of cancer and cancer treatment.
- Practicing good sleep habits such as not lying down at times other than for sleep, taking short naps for no longer than one hour, and limiting distracting noise (TV, radio) during sleep. These actions may improve sleep and allow more activity during the day.
- Share household and family activities. Your responsibility is to ask for help.
- Join a support group. Somehow it makes things better to hear that others have the same problem with fatigue. Talking with others can help you cope with your feelings; family members may also benefit from joining a group.