Tips in a Minute: Fatigue

What is fatigue?

• Fatigue is one of the most common side effects reported by people receiving cancer treatments (surgery, chemotherapy, radiation therapy, or other drug therapy).
• It has been described as a feeling of exhaustion, feeling completely worn out, feeling that their body is "heavy" and difficult to move, or an inability to concentrate. Fatigue can cause physical, emotional, and mental exhaustion.
• This fatigue is not caused by overactivity and is not usually relieved by rest, yet many people will suggest rest as a way to decrease the fatigue.
• People undergoing cancer therapy can have ups and downs, good days and bad days in the energy department.

What causes cancer related fatigue and how is it treated?

Unfortunately, doctors do not know exactly what causes fatigue, and think it probably has several different causes, which makes finding effective treatments difficult. There are two ways to treat fatigue that have proven effective in studies: exercise and treatment of anemia.

Exercise

• Exercise has consistently been shown to improve fatigue levels and quality of life.
• This does not mean running a marathon – something as simple as a walk can be very helpful.
• Start off with what you feel comfortable doing – perhaps a walk around the block – and increase the amount slowly over time. Having a buddy to exercise with can help motivate and make it more enjoyable.
• Work towards a consistent exercise program that includes endurance (walking, jogging, swimming) and resistance (weights, Pilates) exercises.
• A cancer rehabilitation program or physical therapist may be able to help you plan a health-appropriate regimen.

Treatment of Anemia

• Anemia is defined as a hemoglobin level <12 g/dL. Hemoglobin is responsible for carrying oxygen throughout the body. This oxygen is the fuel for muscles, and low levels of it can lead to fatigue.
• The treatment for anemia depends upon the cause. Possible treatments include: iron pills, red blood cell transfusion or growth factors to stimulate red blood cell production.
• Your healthcare provider can discuss if any of these treatments are appropriate for your situation.

Other Tips for Managing Fatigue

• Allow yourself to rest, but do not overdo it as too much rest can make fatigue worse. A nap during the day should not be longer than 45 minutes to an hour, and you do not want this to interfere with nighttime sleep.
• Conserve energy for when you need or want it most (take it easy in the morning so you can make it to the grandkid's soccer game in the afternoon). Eliminate tasks that are unnecessary (do you really need to make the bed every day?).
• Ask for help!! People want to help; they just don't know what to do. Ask a friend to clean, prepare a meal, run an errand, pick up the kids, or just sit and talk. Consider the person's own personality and strengths when assigning a task, and accept that they may do it differently than you. Consider who likes to cook, who is good with the kids, or who doesn't mind cleaning?
• Know your bad days. If you know the day after therapy is a bad day, don't make plans for that day. If you work every day, schedule treatment on Friday afternoon to allow the weekend to recover.
• Friends and family need to know that even if you make plans, there will be some days were you just can't do it and may have to cancel or adjust the plan.
• Sleep problems can add to fatigue. Try to keep a normal sleep schedule (go to bed and wake at the same time), avoid caffeine and talk to your doctor about a sleep aid if you are having trouble.
• Poor nutrition can worsen fatigue. Carbohydrates and proteins provide the most energy, avoid heavy fatty meals, and try 4 or 5 smaller meals as opposed to 3 larger ones.
• Take time to re-energize with enjoyable activities such as visiting with friends, a meal out with your significant other, listening to music, or doing a hobby you enjoy.
• If you work, talking with your employer about fatigue is crucial. Refer them to websites about fatigue. You may be able to adjust your schedule to work around your energy, or adjust your responsibilities while you are receiving treatment. Talk to your human resources representative about the Americans with Disabilities or Family Medical Leave Acts, sick time and healthcare coverage.
• Complementary therapies such as massage, relaxation techniques, meditation, and yoga have been shown to help relieve fatigue.
• Make sure your caregivers takes time for themselves. They also become fatigued and need to be at their best in order to help you.

Be sure to let your doctor or nurse know if you are not seeing any relief of fatigue or if you begin to feel depressed, feel a loss of interest, or experience increased anxiety as these could be a sign of other issues.