Fatigue

Fatigue is a general feeling of lack of energy, tiredness or feeling exhausted. It is different from the tiredness a person usually experiences at the end of the day. Fatigue is not necessarily related to activity and may not go away with additional rest or sleep. It is the most common symptom reported by cancer patients, especially during treatment. Fatigue can have a great impact on day-to-day functioning and quality of life.

Causes

Fatigue in people with cancer can have many different causes. It can be caused by:

• the underlying cancer
• cancer treatments
  • surgery
  • chemotherapy
  • radiation therapy
  • biological therapy
  • stem cell transplant
• other conditions
  • anemia
  • infection
  • problems with lung, liver, heart or kidney function
  • electrolyte imbalances
• poor appetite
• lack of exercise or mobility
• pain
• drugs (such as anti-nausea or pain relieving medications)
• the stress of coping with cancer
• anxiety or depression

Often more than one of these factors is present. Although these factors can cause fatigue, the exact process of fatigue in people with cancer is not known.

Symptoms

Symptoms of fatigue can vary in severity. Fatigue may be worst at the beginning and end of a chemotherapy treatment cycle or increase as radiation treatment continues.

Fatigue includes physical and mental symptoms such as:

• tiredness
• feeling exhausted
• feeling too weak to carry out normal activities
• feeling drowsy
• having trouble concentrating or remembering

Diagnosis

An assessment is done to find out the cause of fatigue and how it is affecting the person. This may include:

• obtaining information about the pattern of fatigue and symptoms, such as:
  • when fatigue started
  • how long fatigue lasted
  • how severe fatigue is
  • what makes fatigue worse
  • what effect fatigue has had on normal activities
  • sleep and rest habits or changes
• taking a history of medications and treatments
• doing a physical and psychological examination
• doing blood tests to check the level of red blood cells, hemoglobin or iron

Management

Once the extent and cause of fatigue is known, a treatment plan can be developed. The following tips may be helpful for coping with fatigue:

• Try to get an adequate amount of sleep during the night.
• Keep a regular sleep routine.
• Make sure the bed, pillows and sheets are comfortable.
• Schedule short rest periods throughout the day or when feeling tired, but save the longest sleep for night. Too much rest can make a person feel more tired.
• Plan rest periods before activities.
• Schedule appointments or activities for times when energy level is high.
• Organize and prioritize activities. Do things that mean the most first and leave less important activities further down the list.
• Keep in touch with friends and loved ones by phone or e-mail if you don’t have the energy to meet in person.
• Limit visitors and ask them to call before they visit.
• Take advantage of friends' and relatives' offers to help. Allow them to help prepare meals, do chores, drive or babysit.
• Do gentle exercise, such as walking, and ask the healthcare team for exercise or activity suggestions.
• Ask about a flexible work schedule or reduced hours if continuing to work during treatment. Gradually resume a normal work schedule or duties.
• Eat when you have the most energy.
• Eat a well-balanced diet and drink plenty of fluids.
  • Eat green leafy vegetables, liver and cooked red meats that are high in iron.
  • Consult a registered dietitian if necessary.

Medications

The doctor may order certain medications to help with fatigue. Take medications as ordered, such as:

• iron pills – to treat anemia
• pain relievers – if pain is a cause
• psychostimulants – can give a sense of well-being, decrease fatigue, increase appetite and can reverse the sedating effects of drugs such as morphine
• antidepressants – if depression is a cause
• sleeping medications – if necessary for improved sleep

Fatigue can be a short-term temporary problem (acute) or it can also be a longer-lasting (chronic) one that continues long after the person has finished their cancer treatment. Follow-up after cancer treatment includes checking for fatigue, so steps can be taken to help deal with it.