Fatigue: Management

Fatigue is a feeling of being physically, emotionally, or mentally tired, weak, or exhausted. It is a symptom of cancer itself and also the most common side effect of cancer treatment. Some people with cancer have described fatigue as being “tired to the bones” or “hitting a wall.” Others say it is the most distressing side effect of cancer treatment. Fatigue may cause decreased ability to work or do physical activity, and can affect concentration or attention.

Fatigue can come and go or stay constant for a while. Fatigue from chemotherapy tends to occur a few days after the treatment, peaks, and then gets better before the next treatment. Fatigue from radiation may not happen right away. It develops over the first two to three weeks of treatment and then increases as the treatment continues. It may last three months or more after the treatment is finished. Attentional fatigue can last up until two or three years after treatment is completed. Fatigue is different for everyone, so it is important that the person who is experiencing it describe how he or she feels.

We currently understand some of the causes of fatigue but not all of them. Fatigue may be related to physical changes caused by cancer itself or its treatment (chemotherapy, biotherapy, radiotherapy, or surgery). The fatigue people have when receiving cancer treatment tends to be more severe than for fatigue healthy people. This fatigue lasts longer and is not relieved by sleep. Certain things can make the fatigue worse. For example, if the person with cancer has pain all the time, or pain that is not controlled, then this will cause irritability, prevent sleep, and make the person feel tired. Lack of sleep may also cause irritability. If the person with cancer feels short of breath much of the time (dyspnea), he or she may feel anxious or tired from the work of breathing. Depression, nausea and vomiting, or diarrhea can worsen fatigue. Most of these problems can be relieved to lessen fatigue.

Other things that can worsen fatigue may be harder to treat, like financial worries and fears or concerns related to the cancer or its treatment. It is important to talk about these, and there are members of the healthcare team who can help, like the social worker or counselor. Talking about fears or problems can make a person feel more in control and able to find solutions to the problems. Often, a support group is very helpful to provide ongoing support and also as a forum to share creative solutions to problems encountered with fatigue. Talk to your nurse or doctor for more information.

Low hemoglobin levels are also related to fatigue. Hemoglobin carries oxygen in the blood, so if it is low, the body cells do not get as much oxygen as they need. People receiving chemotherapy often have decreased hemoglobin. Doctors may prescribe medication to boost the body's ability to produce oxygen-carrying red blood cells. Currently there are two drugs, epoetin alfa (Procrit or Epogen) and darbepoetin alfa (Aranesp), that may be prescribed for certain people receiving chemotherapy. Both of these drugs are given as injections on a regular basis. Both drugs can have serious side effects. The most common include fatigue, diarrhea, edema, fever, vomiting, and shortness of breath. These drugs should not be used in people with uncontrolled high blood pressure. Recently, these drugs have been shown to shorten overall survival and may increase the risk of tumor progression or recurrence in some cancer patients. The risks and benefits of both drugs should be carefully considered.

People who are not well nourished, who don't drink enough fluid and are dehydrated, or who are not able to move around much tend to have fatigue more easily. The way a person handles stress, thinks, or behaves can influence fatigue. It is important that a person with cancer learn ways to conserve energy. Energy is like money, and people only have a limited amount of it. Think carefully about how to spend it. What activities are most important? What activities help restore energy? These are the activities that people with cancer should spend their energy on.

The American Cancer Society recommends asking your healthcare provider the following questions about cancer treatment and fatigue:

• Will the cancer therapy I am receiving cause fatigue?

• How severe will my fatigue be?

• Are there effective treatments to control my fatigue or make it better?

• How will you decide which treatment I will receive?

• What can be done if the treatment does not make my fatigue better?

• What are the likely side effects of the proposed treatments?

• What other healthcare professionals can help manage my fatigue?

• Is my fatigue caused by anemia? If so, how will it be treated?

To manage related fatigue or to lessen it, a person on chemotherapy can also:

• Eat a well-balanced diet and talk to the nurse or doctor about taking a multivitamin daily.

• Drink plenty of fluids.

• Regularly do gentle exercise.

• Talk about problems with friends and family or the healthcare team.

• Ask for help with chores or tasks.

Be sure to talk with your healthcare provider about how you can manage or lessen fatigue.