Cancer-Related Fatigue

What is cancer-related fatigue?

Fatigue is more than feeling tired. You may have trouble thinking and moving like your normally do. It affects your quality of life. Rest and sleep do not manage your fatigue. Cancer-related fatigue (CRF) is caused by cancer and its treatments, and it is a very common side effect that you should talk to your provider about. Fatigue can start before a cancer diagnosis, during certain treatments, or even after treatment is complete.

What causes CRF?

There are many things that can cause CRF. Researchers continue to try to figure out the exact reason, but it is likely that your CRF is caused by more than one factor.  Some medical conditions that cause fatigue and can be treated are:

• Anemia which is a low red blood cell count.
• Pain.
• Infection.
• Cardiac (heart) or pulmonary (lung) disease.
• Side effects of medication.
• Thyroid disorders.
• Poor nutrition.
• Renal (kidney) failure.
• Low hormone levels.

Psychosocial conditions that can cause fatigue are:

• Lack of family, friends, and community social support.
• Poor coping skills.
• Anxiety.
• Depression.
• Sleep problems like a lack of sleep or disrupted sleep patterns.

Another potential reason for CRF is a higher than normal level of cytokines. Cytokines are proteins that are released by cells and are messengers for the immune system. These proteins help your immune system work by doing things like managing inflammation, immune function, and making blood cells. Cancer causes your body to release more of certain cytokines.

Another possible cause of CRF is that some cancers cause people to have higher resting energy consumption. This means they burn more calories at rest than someone without cancer and need more energy to do daily activities.

Because there are so many things that can cause CRF, it is important to talk to your provider about how you are feeling and to figure out a plan to treat and manage what might be causing your fatigue.

How can you reduce or prevent fatigue?

Ways to reduce or prevent fatigue will depend on what may be causing it. Some ways to manage fatigue that have been shown to be helpful are:

Treating Anemia

Anemia means you have less red blood cells (RBCs) than you usually do. Most cancer treatments kill cells that grow at a fast rate. RBCs grow at a fast rate so are often affected, which can lead to fatigue.

Treatments for anemia include:

• Iron supplements.
• Blood transfusions.
• Supplements like B12 or folic acid.
• Injections of growth factors which are medications that help you grow more red blood cells.

In most studies, treating anemia led to less fatigue and a better quality of life.,

Exercise

Exercise helps prevent fatigue and has been shown to work best when started before fatigue starts. It can be much harder to start exercising once fatigue has started, but it is not impossible. Exercise can also lead to better mood, more energy, feeling more rested, and a better ability to concentrate.

You should talk to your team before starting an exercise plan because certain exercises may not be ok for you to do if you have bone metastases, low blood counts, or other health conditions. They may suggest cancer rehab, which could include physical therapy. If you are ok to start an exercise plan, you can include light exercises, such as taking a walk, doing simple arm exercises, marching in place, non-strenuous swimming, or pedaling on a stationary bike. The important thing is that you do some activity. You will often feel better once you get started.

Rest and Sleep

Rest is often suggested to treat CRF, but it often does not help. One way rest can help is through energy conservation (saving your energy) and activity planning. This means planning and saving your energy for when you want or need it most. It may also mean asking for help getting tasks done to save energy to do other things.

Sleep problems and not getting enough sleep can add to or cause fatigue. Keep a normal sleep schedule and talk to your provider about options if you are having trouble sleeping at night. Avoid caffeine later in the day so that it is less likely to affect your ability to sleep. Avoid naps or limit them to 20-30 minutes and not too late in the day. See our article on insomnia for more tips.

Nutrition

Eating a balanced diet can help reduce and manage fatigue. Eating a variety of healthy fruits, vegetables, proteins, and carbohydrates can help your body gain the energy it needs to help manage CRF.

Integrative Therapies

Mind-body interventions have been studied in the treatment of fatigue. Acupuncture, healing touch, hypnosis, massage, yoga, guided imagery, and relaxation have been found to be helpful. Managing stress can also help you manage fatigue.

Medications

Some medications may be used to help reduce or prevent fatigue:

• Psychostimulants might increase your energy. There are side effects to these medications such as loss of appetite, sleep problems, dizziness, headache, and nausea. Overall, studies have shown that CRF is best treated with other types of treatments and not medications. But, if other treatments are not helping, your healthcare team may suggest medications.
• Depression and anxiety can make fatigue worse. Studies show that treatment with antidepressants was helpful in patients with clinical depression to help manage their fatigue.
• Managing pain can also help manage fatigue. Talk to your provider about the pain you are having and what medications can be used to help manage it. You may also be given non-medication ways to manage your pain.

Clinical Trials and Specialists

Ask about clinical trials studying fatigue. Some centers have fatigue clinics that deal with this symptom. Find available trials using the OncoLink Clinical Trials Matching System. Your team may also refer you to other specialists to help manage side effects that are causing fatigue.

Fatigue is a very common side effect for those with cancer. Talk to your team about ways to manage your fatigue.