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Professional Management
Reviewed: December 2006
Managing Your Cancer Treatment-Related Fatigue
Fatigue is a feeling of tiredness that can keep you from doing the things you normally do or want to do. Fatigue is very common among people receiving cancer treatments. Factors such as cancer itself, low blood counts, nutritional problems, and sleep problems contribute to fatigue, but the exact cause is not known.
Signs of Fatigue:
- You feel weary or exhausted. It may be physical, emotional, and/or mental exhaustion.
- Your body, especially your arms and legs, may feel heavy.
- You have less desire to do normal activities like eating or shopping.
- You may find it hard to concentrate or think clearly
How Do We Treat It?
Studies have shown that fatigue can be managed and the first step in management is education. Studies also show that those who learn about fatigue before they experience it have lower incidences of fatigue and are able to manage it better.
Memory and Concentration
A decreased attention span and difficulty understanding and thinking are often associated with fatigue. Attention problems are common during and after cancer treatments.
- Plan activities that require a clear head or concentration when most rested
- Learn new information in small amounts
- Write down or tape-record important information (e.g. at a doctor's appointment) or bring someone to help remember things
- Ask for written material, videos, or audiocassettes when information you need information regarding your condition
- Make reminder lists and/or keep a diary or daytimer to keep track of appointments and to plan activity schedules
- Take regular refreshment breaks, e.g. short walks
Nutrition
Participate in mild or moderate exercise before eating because it can stimulate the appetite. Consume alcohol in moderation, since alcohol is a depressant and will increase fatigue
- Rather than having three large meals a day, try to have many small meals instead. Dried fruits and nuts are great snacks
- Eat whenever you start to feel hungry. Those who are on tamoxifen, dexamethasone, or other corticosteroid treatment should discuss nutrition with their nurse or doctor because these medications can increase the appetite
- Do not diet
- Make mealtimes pleasant and as stress free as possible
- Cook and eat foods that are appealing
Exercise
It is hard for patients to exercise when they feel tired. With chronic fatigue, however, increasing the amount of time one rests ironically contributes to feeling more tired. Regular, moderate exercise can boost energy levels, elevate one's mood, and reduce fatigue.
- Do regular, mild to moderate exercise—not infrequent, intense workout
- Plan exercise during times when energy levels are at their highest
- Start slowly and increase activity level over time as tolerated. For instance, start out walking for 5-10 minutes, 2-3 times a week and increase it slowly to 20-30 minutes, 3-4 times per week.
- If there is bad weather, exercise indoors—(i.e.) walks around the local indoor mall.
- Most important: if feeling unwell or experience a change in heart rate, breathing or pain skip exercise and resume when feeling better
Sleep and Rest
There is a common misconception that resting more will make the feeling of tiredness disappear. This is true for acute fatigue but does not apply to chronic fatigue. This does not mean it is not important to get proper rest, it just means that sleeping most of the day and at night can actually make the fatigue worse.
- Night time should be reserved for the longest sleep of the day
- Nap for only 20 minutes at a time during the day if possible
- Stick to a regular sleep/rest pattern
- Try to keep the bedroom free from activities such as reading or watching T.V.
- New sleeping positions and/or pillows can provide extra comfort.
- Do not eat before bed. This may cause indigestion. Try to eat lightly in the evening
- Avoid smoking, alcohol and/or caffeinated drinks before bedtime.
- Do not do strenuous activities before bedtime. Relax before bedtime. Sometimes drinking warm decaffeinated beverages, and/or relaxation techniques such as meditation, warm baths, or music can help
Medications
Management of fatigue may be due to anemia which can be related to vitamin and dietary deficiencies. With cancer and cancer-treatment related anemia, the cause can be over or under-functioning bone marrow. Our blood cells generally begin from what is known as a stem cell produced by our bone marrow, that then grows to become the type of blood cell we most need. Feedback mechanisms within our bodies tell the bone marrow, that produces the stem cell, whether it should become a red cell, a white cell or a platelet.
Transfusions (intravenous delivery of blood) of packed red blood cells have been the primary treatment for anemia.
Whole blood is rarely given, because only a part of whole blood (red cells, white cells and platelets) is specifically needed; therefore to treat anemia, patients will often receive only red blood cells.
Although red blood cells are typed and matched (tested to be the same blood type as yours) in a laboratory, repeated exposure to blood other than your own can cause you to develop antibodies to blood. Sometimes your body doesn't like the blood it receives, and your body will react with chills or fevers or pain and aches. Over time, these reactions may become more common.
A blood transfusion is not unsafe, when needed, as blood is checked for communicable diseases and can be tested and treated for antibodies to red blood cells, but there are still some risks associated with receiving someone else's blood. Recent guidelines for blood transfusions may dictate that blood is available only when you have symptoms requiring it (like being short of breath) or when your hemoglobin and hematocrit levels are very low. Fatigue related to anemia often occurs when hemoglobin levels are between 8 and 12; therefore other options may be needed.
Recent medical advances, because of two decades of intense interest by researchers, have produced substances that can mimic our body's feedback mechanisms, to help regulate and direct the production of specific types of blood cells. Erythropoietin is the name of a hormone that naturally occurs in our bodies. It is secreted by our kidneys and helps to increase production of red blood cells. Cancer or cancer related treatments may overwork or override this process, allowing anemia to develop or continue or worsen.
Erythropoietin does not immediately begin to correct anemia by regulating production of red blood cells. This process may take a week or two. Blood tests will be done over this time to continue to evaluate your anemia. Your healthcare team may ask you to take an iron replacement, as iron is needed to produce red blood cells. Although generally mild, the following side effects have been reported from using erythropoietin therapy: dizziness, headaches, joint aches, nausea, and diarrhea. Be sure to talk with your healthcare provider if you are experiencing these side effects, as many can be managed and controlled.
Emotional Stress
Cancer is stressful and your mood, beliefs, attitudes, and reactions to stress can result in the development of fatigue. It is "normal" to feel anxious and upset about having cancer and cancer treatment. Emotions can be draining. By understanding or coming up with ways to deal with your emotions creatively, you can save energy for other things, thereby preventing fatigue.
- Remember that feeling emotional is "normal" and it is OK to be upset or angry about this
- Remind them they are not alone in feeling this way
- Talk to someone they trust about their feelings
- Join a support group
- Learn about meditation, deep breathing, or relaxation techniques
- Journal about feelings (even if it is only a few lines)
Social Supports
Social supports are more valuable than ever for someone with cancer related fatigue. Family members, friends and community groups can help manage fatigue. Here are some ways they can help:
- Accept offers of help and don't be afraid to ask for help. Learn to delegate tasks. Ask someone to accompany them to appointments too
- Make a list of people who are willing to help out and what they are willing to do
- Hire someone to do yard work or other chores that require a lot of energy - students are great for this!
- Inquire about getting home care services - people who can help you bathe and attend to other needs
Talk to Your Nurse:
- If you have been too tired to get out of bed for the past 24 hours.
- If you feel confused or cannot think clearly.
- If your fatigue becomes worse.
The BC Cancer Agency maintains a database on commonly used unconventional therapies available to cancer patients.
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