Managing Cancer-Related Fatigue

Barbara Sadick

Fatigue is the most common side effect of cancer and its treatment, and it varies in degree from patient to patient.

It can be sporadic or constant, and, in some cases, is more intense and debilitating than "normal" fatigue. At its most intense, it can’t be relieved by sleep and is often described as "paralyzing." It affects physical, emotional and social quality of life and is characterized by a lack of energy and motivation, total body exhaustion, a feeling of heaviness, an inability to concentrate or remember, and anxiety. Patients should discuss fatigue with their healthcare providers, who can suggest coping mechanisms and solutions, and can help them understand that such exhaustion doesn’t necessarily mean the cancer has worsened or recurred.

Causes

Fatigue is experienced by up to 90 percent of cancer patients and is caused by side effects of cancer treatments or by the cancer itself. Like the fatigue, causes vary from person to person and are often due to metabolic changes.

Some cancers increase the body’s need for energy, weaken muscles and alter hormone levels.Others release proteins called cytokines, which appear to increase fatigue.

Little is known about cancer-related fatigue, but one cause may be the destruction of healthy cells in addition to those targeted for treatment and the amount of energy needed to repair and heal damaged tissues. Anemia, nausea, vomiting, pain, insomnia and mood change often occur during and after treatment and can lead to extreme fatigue.

The following are common causes of fatigue:

  • Chemotherapy, radiation, bone marrow transplantation and surgery, particularly chemotherapies that stop bone marrow from making enough red blood cells to carry oxygen to the body;

  • Biologic therapies that use the body’s immune system to fight cancer;

  • Treatment-related hormonal changes to thyroid and adrenal glands, testes and ovaries;

  • Treatment-related nutrient deficiencies;

  • Sleep disorders, anxiety, depression and difficulty learning and remembering (attention fatigue); and

  • Medication to treat other conditions and side effects, especially pain.

Management

Following cancer treatment, most survivors want to resume a lifestyle free from cancer-related fatigue. The American Cancer Society estimates, though, that 30 to 50 percent of cancer survivors experience persistent fatigue for months and, sometimes years. It’s important to continue to consult with physicians, as underlying medical conditions that exacerbate the problem can often be treated. While more research is needed in this area, the following are some ways in which symptoms of fatigue can be managed:

  • Medications. Stimulants, such as Ritalin (methylphenidate) and modafinil, might help but must be prescribed and monitored by a physician.

  • Diet and Nutrition. Small, well-balanced, highprotein meals can provide energy. Ample fluid and limited caffeine and alcohol intake may prevent dehydration.

  • Exercise. Regular exercise routines can increase energy levels, lower blood pressure, improve the ability of the heart to pump blood and increase endurance. Evidence indicates that aerobic exercise, such as walking, cycling or swimming, can help alleviate fatigue.

  • Sleep and Relaxation. Sleep quality can be improved by practicing relaxation exercises before sleep, avoiding long afternoon naps and setting (and keeping) a sleep schedule.

  • Complementary Therapies. Acupuncture can reduce pain and nausea by increasing the body’s blood flow and natural painkillers. Practicing visual guided imagery, meditation and mind/body exercises, such as qigong, tai chi and yoga, can also help.