Managing Fatigue

What is fatigue?

Fatigue is one of the most common side effects of cancer treatment. It can be caused by surgery, chemotherapy, radiation therapy, or other medications used to treat your cancer. It is a feeling of exhaustion, feeling completely worn out, feeling that your body is "heavy" and hard to move, or being unable to focus. Fatigue can cause physical, emotional, and mental exhaustion.

Cancer-related fatigue is not usual tiredness, and often does not go away with rest. Healthcare providers do not know exactly what causes cancer-related fatigue. Some conditions that may make fatigue worse include anemia, pain, insomnia, depression, anxiety, nutrition-related problems, and infection.

There are many ways to treat or manage symptoms of fatigue, including treating anemia and exercising.

Exercise

Exercise has been shown to improve fatigue and quality of life.

• Start slow if needed, maybe with a walk around the block, then add time or distance as you feel more comfortable.
• Having a buddy to exercise with can help motivate you and make it more enjoyable.
• Try to include endurance (walking, jogging, swimming) and resistance (weights, Pilates) exercises.
• A cancer rehabilitation program or a physical therapist can help you make a plan that works for you.

Treatment of Anemia

Anemia happens when the level of red blood cells (hemoglobin) in your body is too low. Hemoglobin helps carry oxygen throughout the body. This oxygen is the fuel for muscles, and low levels of it can lead to fatigue.

• Treatment for anemia depends on the cause and your symptoms. Possible treatments are iron pills, red blood cell transfusions, or growth factors to help make red blood cells.
• Your provider can talk with you about which treatment is right for you.

Rest & Routine

• Allow yourself to rest and create a sleep schedule. Too much rest can make fatigue worse, so keep your rest times to 45-60 minutes. Try to keep a normal sleep schedule (go to bed and wake up at the same time), limit naps to 45-60 minutes, avoid caffeine, and talk to your provider about a sleep aid if you are having trouble.
• Save up energy for when you need or want it most. If there is something you want to do in the afternoon, make sure you take time to rest in the morning and evening. Avoid tasks that you do not have to do.
• Keep track of your bad days. If you know the day after treatment is a bad day, don't make plans for that day. If you work every day, schedule treatment on Friday afternoon to give you the weekend to rest.
• Let friends and family know that even if you make plans, there will be some days when you just can't do it and may have to cancel or change plans.
• You may be able to change your work schedule while you are receiving treatment. Talk to human resources about job accommodations under the  Americans with Disabilities Act or the Family Medical Leave Act (FMLA), sick time, and healthcare coverage.

Other Tips for Managing Fatigue

• Ask for help! People want to help, they just don't always know what to do. Ask a friend to clean, prepare a meal, run an errand, or just sit and talk. Think about the person's personality and strengths when asking for help, and accept that they may do it differently from you.
• Be sure to eat a balanced diet with carbohydrates and proteins for energy, avoid heavy fatty meals, and try 4 or 5 smaller meals as opposed to 3 larger ones.
• Make time for activities that energize you, like visiting with friends, having a meal out, listening to music, or doing a hobby you enjoy.
• Integrative therapies such as massage, relaxation techniques, meditation, and yoga can help relieve fatigue.
• If you are having pain, proper pain management can help with fatigue.
• Ask how to manage other side effects of treatment that are affecting your sleep, like nausea, vomiting, diarrhea, mucositis, and skin issues.

Be sure to let your provider know if you are not getting any relief from fatigue or if you begin to feel depressed, feel a loss of interest, or have increased anxiety, as these could be signs of other issues.