Fatigue in People With Cancer

Understanding cancer-related fatigue

Cancer-related fatigue, a common and upsetting problem that can occur during and after cancer treatment, can have physical, mental, and emotional aspects. It can occur months or even years after cancer treatment ends and is typically more severe than fatigue experienced by people without cancer.

The important thing to know is that you do not have to “just live with” fatigue. If you are experiencing fatigue, tell your doctors and nurses about it. Many factors can contribute to fatigue, and some of them can be changed. Your health care providers can work with you to reduce fatigue and its effects.

Symptoms of Cancer-Related Fatigue

• Lack of energy
• Extreme tiredness
• Difficulty walking short distances or climbing stairs
• Difficulty making decisions and concentrating
• Difficulty doing ordinary daily tasks

What causes cancer-related fatigue?

Many cancer medications and treatments, including chemotherapy and radiation as well as bone marrow transplant and some types of immunotherapy, can cause fatigue. Another common cause of fatigue is anemia, or low levels of oxygen-carrying red blood cells. In certain circumstances, this side effect of cancer therapy may be treated with medication such as erythropoietin-stimulating agents (ESAs) or transfusions. (For announcements on ESA use in cancer, go to http://www.fda.gov/cder/drug/infopage/RHE/default.htm.) Sleeping problems common among cancer patients can also make fatigue worse. Other causes of fatigue include nausea and vomiting from cancer therapy and drugs used to treat those side effects; interactions among medications you may be taking; your body using more energy to recover from cancer; health conditions that reduce energy levels (eg, thyroid or other metabolic problems, respiratory problems); poor diet and nutrition; depression, stress, and anxiety; and not getting enough exercise.

Practical Tips for Patients

• “Manage” your energy. Start by keeping a diary to track your own fatigue and energy patterns. Then you can plan the best times to perform activities as well as the times to conserve your energy. Ask loved ones to help with difficult activities.

• Exercise. Exercise (especially aerobic exercise) has been shown to help control cancer-related fatigue. In addition to its many health benefits, exercise helps to fight depression and improve feelings of wellness. Talk to your practitioner before starting an exercise program.

• Make a healthy diet a priority. Recovering from cancer requires increased attention to a healthy balance of fluids, protein, fat, and fiber. Ask for a referral to a dietician for advice about nutrition that can help you to feel more energetic and maintain a healthy weight.

• Get rest when you need it. Take short naps-no longer than 45 minutes-not long ones, which can actually lower your energy level. Talk to your practitioner about steps you can take to promote better sleep.

• Engage in “attention-restoring activities.” Activities like walking, gardening, birdwatching, and arts and crafts can improve concentration and problem-solving skills.

• Talk to a professional counselor or therapist about stress and depression. Depression and fatigue are often related, so reducing depression may alleviate fatigue.

This article is also available in Spanish.