The Fatigue Experience

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:

• Overly tired, shaky, exhausted, and weary
• Worn out, wiped out, listless, drained, weak all over
• Unable to concentrate, think clearly, or remember things
• Heavy in your body, especially your arms and legs
• Short of breath after light activity
• A need to stop in the middle of activities to rest
• Muscle weakness, leg pain (including difficulty climbing stairs or walking short distances)
• Depressed, emotional, impatient, irritable, bored, and/or anxious
• Disinterested in normal day-to-day activities
• Not like your “old self”

Understanding Cancer-Related Fatigue

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:

• Chronic pain
• Psychological factors (e.g., depression, anxiety, emotional distress, frustration, fear)
• Anemia*
• Sleep problems (e.g., insomnia)
• Hypothyroidism (i.e., inactive thyroid gland)
• Medications
• Hormonal changes/changes in metabolism
• Infection
• Pulmonary or renal dysfunction
• Oxygen level in the body
• Nutritional deficiencies (e.g., weight loss, dehydration, loss of appetite)
• Inactivity, lack of exercise, muscle wasting, loss of muscle coordination
• Co-morbidities (i.e., having other medical conditions in addition to cancer)
• Mental ability factors (i.e., difficulty understanding and thinking)
• Cancer treatments and their side effects*

Assessing Fatigue

To evaluate your fatigue, your doctor may ask the following questions:

• When did your fatigue first begin?
• How severe is it?
• How long does it last?
• How has it progressed since your diagnosis and/or over the course of your treatment?
• What helps ease your fatigue and what makes it worse?
• How does fatigue affect your daily life?
• Do you experience shortness of breath or chest discomfort?
• How are well you sleeping?
• How and what are you eating?
• How are you feeling emotionally?

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.).

*Fatigue and Anemia

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.

*Fatigue and Cancer Treatment

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.

When to Notify Your Doctor

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.

Fatigue and Quality of Life

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.

Tips for Managing Cancer-Related Fatigue

• Keep a regular and reasonable daily routine. You may feel extra tired because you are still trying to keep up with your former routine. It helps to prioritize your activities so you use your energy on the activities most important to you. Try easier, shorter versions of the activities you enjoy, spread your activities throughout the day during times when you feel best, and take rest breaks in between activities.
• Plan rest periods throughout the day. Set aside time to rest and take short, frequent naps throughout the day (rather than one long nap). Limit naps to about 30 minutes each and try not to nap too late in the afternoon. If you can, rest before you become fatigued and follow a nap with an activity or light exercise. Keep in mind that too much rest can actually decrease your energy level and make you feel more tired.
• Maintain proper nutrition. Cancer and cancer treatment often puts extra demands on your body for calories, nutrients and fluids. A well-balanced diet provides the energy your body needs to heal and function, and can also help you feel more energized. Your diet should include the right amounts of fruits, vegetables, protein, carbohydrates, and fat, as well as plenty of fluids (e.g., 8-10 glasses of water a day) to prevent dehydration. If you are having trouble eating, try frequent, small meals rather than large meals. A dietitian can help you develop a meal plan that is right for you.
• Stay as active as you can. Lack of physical activity, which can result from the illness and/or its treatment, can lead to tiredness and lack of energy. Regular, light exercise (e.g., a 15-minute walk three times a week) can help you stay active, increase your energy and strength, and provide an overall sense of well-being. Start slowly (before fatigue sets in if possible) and work up to the level that best suits you, but don’t overdo it. A physical therapist can help develop a personalized exercise plan for you.
• Establish a regular sleeping routine. Sleep problems can contribute to fatigue. Try to maintain regular bedtimes (go to sleep and wake up at the same time), take consistent, short naps during the day, and avoid heavy meals, alcohol or caffeine late in the day. Also, try to improve the quality of your sleep by wearing comfortable clothes and sleeping in a comfortable bed in a cool, dark, quiet room. You can also read a book or listen to music to relax before going to bed.
• Communicate with your healthcare team. Although cancer-related fatigue is common and often expected, you should still share your concerns with your doctor. You are the only one who knows just how tired you feel, so it’s important to be as specific as possible about your fatigue. The more your doctor knows about the possible causes of your fatigue, the better he or she will be able to help treat it.
• Keep track of your fatigue from day to day. As you undergo cancer therapy, you may have some days when you feel more energy than others. To better understand your fatigue, it helps to keep a diary. When did you first start feeling fatigued? Is there a pattern to your fatigue (e.g., time of day it occurs)? What makes your fatigue better or worse? How has your fatigue changed since you were diagnosed? How is your fatigue affected by your treatments? What situations make you feel more tired?
• Conserve your energy. A slow to moderate pace uses less energy than a hurried one. There are many techniques you can use to pace yourself and conserve your energy. You can modify your home environment by placing items within easy reach to avoid multiple trips up and down stairs or in and out of rooms. Also, you can shop at quiet times, get easy-to-prepare meals, and plan activities that involve sitting down. Another way to conserve energy is to delegate household chores and tasks to others.
• Consider complementary medicine therapies. Various complementary medicine therapies may help relieve fatigue. For instance, rehabilitation therapy (e.g., physical therapy) may help with nerve or muscle weakness, proper body mechanics, and energy-saving techniques. Mind-body medicine can help with techniques like distraction, deep breathing, guided imagery and relaxation techniques, cognitive behavior therapy, stress management, humor therapy, massage, Reiki therapy, acupuncture, etc. A naturopathic medicine provider can recommend vitamins and mineral supplements to use alongside your cancer treatments to combat fatigue.
• Deal with your emotions. Fatigue can be a constant reminder of cancer. And, it is distressing to feel so tired all the time. Feeling stressed, worried, angry, or sad, can make fatigue worse. It may help to express your feelings in a journal. A professional counselor/therapist can also provide emotional support and practical advice.
• Adjust your work schedule. Some people feel well enough to work, while others need to cut back. If you are working, discuss your treatment schedule with your supervisor prior to starting therapy. You may be able to adjust your schedule to take advantage of your peak energy times, limit work that increases muscle tension, or adjust your responsibilities while you are receiving treatment. Check with your Human Resources Department to see if you are eligible for time off through the Family and Medical Leave Act and/or other types of leave.
• Find support with others. Lack of understanding about cancer fatigue can lead to communication problems, resentment and guilt among family and friends. Share your feelings and don’t be afraid to cancel plans if you are too tired. Support groups can also help you share experiences and coping tips with others who are dealing with cancer-related fatigue. These groups can also help you realize that you are not going through cancer and fatigue alone.

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.

At Cancer Treatment Centers of America (CTCA), we help you fight cancer by treating the whole-person, not just the disease. We understand cancer-related fatigue can affect your sleeping, eating, mood, concentration, relationships, and quality of life. Our integrative care model ensures that as you receive advanced conventional cancer treatments, you also receive supportive therapies to help relieve your fatigue.

At CTCA, your multidisciplinary care team will work closely with you throughout your care to deliver a personalized, comprehensive treatment plan. Your plan will include the following complementary medicine therapies to help ease side effects like fatigue:

• Pain management: Our pain management team will use various pain management techniques to help control your pain which can, in turn, help relieve your fatigue.
• Nutrition therapy: Our nutrition team will work closely with you to develop an individualized nutrition plan to fortify your body and combat fatigue.
• Naturopathic medicine: Our naturopathic medicine team will recommend specific vitamins and mineral supplements to strengthen your immune system and ease fatigue.
• Oncology rehabilitation: Our oncology rehabilitation team will provide a personalized exercise program, including energy-saving techniques, to help you build strength and endurance.
• Mind-body medicine: Our mind-body medicine team will provide techniques like guided imagery, stress management, and humor therapy to promote your emotional well-being and restore your energy.
• Spiritual support: Our pastoral care team will help nurture your spiritual well-being so that you may find hope and strength throughout your journey.

We understand cancer-related fatigue is a very real and prevalent condition. Throughout your care, CTCA cancer experts will help relieve your fatigue so you feel strong, optimistic and empowered as you heal from cancer.

At CTCA, we’re in this fight together every step of the way.

I hope this information has helped you in some way. I will check in with you again next month. In the meantime, stay strong and hopeful.