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Fatigue is a condition marked by extreme tiredness and decreased ability to function due to an overwhelming lack of energy. Unlike typical, expected tiredness which happens to everyone, fatigue is an unusual, excessive whole-body tiredness that is not relieved by sleep.
There are two main types of fatigue. Acute fatigue is a feeling of tiredness that lasts for a short time (e.g., a month or less). Chronic fatigue is a debilitating, long-lasting fatigue that comes and goes, but never ceases completely.
If you are fighting cancer, chances are you have experienced fatigue at some point. Cancer-related fatigue (CRF) is a very real and prevalent medical condition. At the same time, it is one of the least understood symptoms of cancer and its treatment.
Cancer-related fatigue is an unusual and persistent lack of energy or sense of tiredness and exhaustion related to cancer or its treatment. It is different from fatigue of everyday life, which is often temporary and relieved by rest. CRF typically comes on unexpectedly, is not related to an excessive amount of activity, and usually does not improve with rest or sleep.
As each person experiences cancer differently, the same goes for cancer-related fatigue, which can vary in its unpleasantness, severity and the amount of time it is present. For some, the fatigue is mild and brief. Others experience chronic fatigue that lasts for months, or even years, after active treatment is complete.
If you are suffering from cancer-related fatigue, even simple activities, such as talking on the telephone, shopping for groceries, or walking across a room can seem like too much. Cancer-related fatigue can make you feel:
Cancer-related fatigue can be challenging to treat. It requires understanding the underlying cause(s) of the condition and learning ways to manage it. Unfortunately, it is not always possible to determine the exact cause of cancer-related fatigue. Most likely, it is a combination of factors which vary from person to person.
The following are some biological, psychological and behavioral factors that may contribute to fatigue:
To evaluate your fatigue, your doctor may ask the following questions:
Your doctor may ask you to describe your fatigue on 0-10 scale. You may also receive a physical examination and additional tests, such as blood work. Your doctor will likely consider other factors, including the type and stage of cancer, your treatment history, current medications, sleep and/or rest patterns, psychological profile, general health, and other factors (e.g., anemia, breathing problems, decreased muscle strength, etc.).
Anemia is a common problem for people fighting cancer, particularly blood cancers like lymphoma or leukemia. Anemia results from a low red blood cell count. Red blood cells contain a substance called hemoglobin, which carries oxygen throughout the body. Fewer red blood cells (a hemoglobin count of less than 12 g/dl) mean your body is getting less oxygen for energy and function, which can result in fatigue.
Cancer and its treatment can interfere with the supply of red blood cells in the body and cause anemia. If your red blood cell counts become dangerously low, you may require a transfusion (intravenous delivery of blood) to raise red blood cell levels and help restore energy. Also, certain medications can stimulate red blood cell production, such as erythropoietin. These growth factors (e.g., Aranesp, Procrit, Epogen) are generally given by subcutaneous injection (a shot under the skin). If poor diet is the cause of anemia, eating a balanced diet and taking iron and folic acid supplements may help.
It’s no wonder you feel tired during this time. Your body uses a lot of energy to deal with the physical and emotional stresses of an illness like cancer. Your body also needs energy to heal itself in response to cancer treatments. The type of cancer treatment you receive can determine the pattern of fatigue you experience. Cancer treatments commonly associated with fatigue include chemotherapy, radiation therapy, surgery, immunotherapy, bone marrow/stem cell transplant, and/or a combination of treatments.
With radiation therapy, your body needs extra energy to repair damaged skin tissue. Radiation therapy can cause cumulative fatigue (fatigue that increases over the course of treatment). Fatigue brought on by radiation therapy usually lasts from three to four weeks (but can persist for months) after treatment ends. With chemotherapy, as anti-cancer drugs work to destroy cancer cells, they can also harm healthy red blood cells and decrease new red blood cell production. Chemotherapy can also disrupt your eating and/or sleeping habits. In general, chemotherapy-related fatigue usually peaks at the time when blood counts are low (nadir), which is generally a few days after treatment.
Some fatigue during cancer treatment is to be expected. However, it is important to notify your doctor if your fatigue is persistent, interferes with your ability to perform everyday tasks, and/or becomes progressively worse. Warning signs to look out for including the following: If you feel confused, dizzy, lightheaded, too tired to get out of bed for more than 24 hours, or if you have a sudden and dramatic decrease in your energy level, problems waking up, an increased shortness of breath with minimal exertion, loss of balance, uncontrolled pain, anxiety or nervousness, and/or ongoing depression.
Coping with a serious illness like cancer requires a tremendous amount of energy and effort. Cancer-related fatigue can impact your physical, psychological and emotional well-being. You may feel like you don’t have enough energy to keep up with your usual daily routine, including work and social activities, and even your cancer treatment plan. In addition, fatigue can affect your mood, emotions and concentration, how you feel about yourself, and your relationships with others.
Despite its prevalence, cancer-related fatigue is often over-looked, under-recognized and under-treated.
Talking about cancer-related fatigue and understanding its causes can help you and your healthcare team identify ways to successfully cope with and manage it.
In addition to the help your doctor provides, there are things you can do to take charge of your life and help alleviate your fatigue.
NOTE: YOU SHOULD ALWAYS REPORT ANY FATIGUE YOU MAY BE EXPERIENCING TO YOUR PHYSICIAN.
NOTE: THIS INFORMATION IS NOT INTENDED TO BE A SUBSTITUTE FOR PROFESSIONAL MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF YOUR PHYSICIAN OR OTHER QUALIFIED HEALTHCARE PROVIDER REGARDING YOUR FATIGUE.
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