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 for cancer treatment. It has been described as a feeling of exhaustion, feeling completely worn out, feeling that your body is "heavy" and hard to move, or an being unable to focus. Fatigue can cause physical, emotional, and mental exhaustion.

This fatigue is not caused by too much activity and often does not go away with rest. Many people still suggest rest as a way to decrease fatigue. People going through cancer treatment can have ups and downs, good days and bad days in terms of energy levels.

What causes cancer-related fatigue and how is it treated?

Healthcare providers do not know exactly what causes fatigue. Fatigue most likely has a few different causes, which makes it hard to treat. There are two ways to treat fatigue that have been effective in studies: 

• Exercise.
• Treatment of anemia.

Exercise

• Exercise has 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 add time or distance slowly over time. Having a buddy to exercise with can help motivate and make it more enjoyable.
• Work towards an exercise program you can stick with that includes endurance (walking, jogging, swimming) and resistance (weights, Pilates) exercises.
• A cancer rehabilitation program or physical therapist may be able to help you make an exercise plan that works for you.

Treatment of Anemia

• Anemia happens when the level of red blood cells (hemoglobin) in your body is too low. 
• Anemia is a hemoglobin level <12 g/dL. Hemoglobin helps carry 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 on the cause and how you are affected by the low hemoglobin level. Possible treatments are iron pills, red blood cell transfusion, or growth factors to help make red blood cells. 
• Your healthcare provider can talk with you about which treatment, if any, is right for you.

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 nap to affect your nighttime sleep.
• Save up 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). Avoid tasks that are not necessary.
• 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 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 up.
• Friends and family need to 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 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 provider about a sleep aid if you are having trouble.
• Not eating a balanced diet can make fatigue worse. 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, talk with your employer about your fatigue. Refer them to websites about fatigue. You may be able to change your schedule to work around your energy 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 take time for themselves. They also become fatigued and need to be at their best to help you.
• If you are having pain, proper pain management can also help relieve fatigue. 

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