Managing Cancer-Related Fatigue

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What is cancer-related fatigue?

Fatigue is described differently by different people. It can include feeling:

  • tired
  • exhausted
  • washed out
  • lacking energy
  • wiped out
  • weak
  • less able to concentrate

It can make it hard for you to feel like doing things or to have a positive outlook. Unlike day-to-day feelings of tiredness, cancer-related fatigue doesn't get better with rest and sleep.

Who gets cancer-related fatigue?

Most patients with cancer experience fatigue. How much fatigue you have, and how long it lasts, may be related to your type of cancer, what treatments you are getting, and your general health. Approximately one-third of cancer survivors report that fatigue can last months or even years after treatment ends.

There Are Many Causes of Cancer-Related Fatigue

  • Surgery.
  • Chemotherapy treatment — in some cases, fatigue may be worse just after a round of chemo but improve before your next treatment.
  • Radiation treatment can cause an increase in fatigue that may last for three to 12 months after treatment.
  • Medications can cause fatigue but this improves when the medications are stopped.
  • Conditions like low thyroid function and low blood pressure are causes of fatigue that can be medically treated.
  • Anemia is a common problem in patients with cancer. Anemia is when your red blood cell counts are low. Red blood cells carry oxygen throughout your body. Because oxygen is necessary for your body to produce energy and function, anemia can cause fatigue. If you have anemia, you and your doctor will decide if you need medication and/or blood transfusions as treatment.
  • Poor nutrition, not drinking enough fluids, not sleeping enough, and not being active enough are other causes of fatigue that can be corrected.

What can you do about fatigue?

It's important to tell your doctor or nurse if you think you have cancer-related fatigue.

  • Be prepared to tell them how badly you are fatigued. Using a 0 – 10 scale, 0 for no fatigue and a 10 for worst fatigue, rate your fatigue.
  • Keep track of your fatigue from day to day. Writing in a diary or journal can help.
  • What activities does fatigue make it difficult for you to do?
  • Is there a pattern to your fatigue during the day? Around your treatments?
  • Are you having other symptoms? Pain? Nausea? Sleeplessness? Shortness of breath? Headaches? Lack of appetite? Difficulty concentrating?
  • Do you feel sad, anxious, stressed?
  • If you are not interested or taking pleasure in usual activities, tell your doctor or nurse.

Balance, Rest, and Activity

While it may seem logical to rest more if you feel tired, inactivity can cause de-conditioning and decrease your ability to be active. Studies show that low to moderate amounts of exercise actually help people feel less fatigue. Exercise that makes you more fatigued is too much. You may need to take frequent rest breaks, but staying as active as you can is important.

How to Manage Sleep and Rest

If you have symptoms like pain, nausea, diarrhea, urinary frequency, or anxiety that disturbs your sleep or rest, talk to your doctor or nurse about how to better control these symptoms.

  • Plan your rest periods: limit naps to 15-20 minutes in late morning or early afternoon to avoid interfering with nighttime sleep.
  • Have a bedtime routine and follow it. Going to bed at the same time and waking at the same time helps establish a sleep habit.
  • If you have trouble going to sleep, get up and do something.
  • Remember that alcohol and stimulants like coffee, tea, and sugary or caffeinated soft drinks can keep you from sleeping.
  • Use sleeping medications cautiously and under the direction of your doctor.

Keep an Adequate Food and Fluid Intake

The body needs energy to heal and to function. Food provides that energy. If you are having trouble eating, try small, frequent meals. Concentrate on foods that provide protein and calories. Drinking enough fluids is also important for the body to heal and to function. On average, you need to drink about 1 1/2 to 2 quarts (6-8 glasses) of fluid each day. Learn more about planning meals and managing cancer treatment side effects.

Tips to Conserve Energy

  • Plan ahead and organize what you need to do.
  • Schedule what you need to do according to your energy pattern. For example, if you feel best in the morning, plan activities for that time.
  • Place things that you use often with easy reach.
  • Try to be organized: avoid multiple trips up and down stairs, in and out of rooms.
  • Use tools to conserve your energy when possible (answering machines, remote control, elevators).
  • Prioritize so you can use your energy on the things that are most important to you. Include some fun activities as priorities.
  • Pace yourself. A slow to moderate pace uses less energy than hurrying. Frequent rest periods may allow you to complete a task that you could not do all at once.
  • Delegate to others when they ask to help you, ask for help doing things that you cannot.
  • Do activities that you enjoy doing.
  • Do something that catches your attention, allows you to forget your worries, and renews your sense of hope and satisfaction with life.

Deal With Emotions

Feeling stressed, worried, angry, or sad can contribute to fatigue. Relaxation, meditation, prayer, humor, counseling, and support groups are ways of helping you deal with emotions. Journal writing can release emotions. You may talk with your doctor or nurse to arrange to meet with a social worker, or psychiatrist. Having the support of family and friends also helps.

Could complementary therapies help cancer-related fatigue?

There are many different types of integrative or complementary therapies. Some patients find them helpful. While some therapies (like relaxation, Reiki, therapeutic touch) are considered to be low risk for most people, others may be dangerous depending on your particular condition. If you decide to use a complementary therapy, it is important to discuss it with your doctor or nurse.

Complementary therapies that may counter fatigue include acupuncture, massage, yoga, chi kung, Reiki, therapeutic touch, and stress-reduction strategies.