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Cancer-Related Fatigue

Find Out What’s Causing It and What Can Help

by Yesne Alici, MD

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Cancer-related fatigue is a distress­ing, persistent, and subjective sense of physical or emotional tiredness that is caused by cancer or its treatment and that interferes with day-to-day functioning. Fatigue is one of the most prevalent and troubling side effects cancer survivors experience both during treatment and after treatment ends. It can significantly diminish a survivor’s quality of life.

What’s Causing Your Fatigue?
By reviewing a detailed history of the onset, pattern, and duration of your fatigue, as well as its triggers and alleviating fac­tors, your doctor will determine what is causing your fatigue. Your doctor may also request tests to look at your blood counts, electrolytes, and liver, kidney, and thyroid gland functioning. Medical conditions, medication side effects, alcohol or substance abuse, poor nutri­tion, pain, depression, anxiety, sleep disturbances, and poor physical fitness are the most common causes of fatigue. The good news is these problems are often treatable. Your oncologist may recommend that you consult with an internist, an endocrinologist, a psycholo­gist, or a psychiatrist, depending on the factors that play a role in your fatigue.

What Can You Do about It?
Physi­cal activity, psychosocial interventions, mindfulness-based therapies, and med- ication are all effective ways to manage cancer-related fatigue. Your fatigue-management plan can incorporate any number of these strategies. Work with your doctor to come up with a plan that is tailored to your specific needs and that applies the strategies that work best for you.

Physical Activity
Engaging in physical activity can help reduce cancer-related fatigue. Moderate levels of physical activity (such as two to three hours per week of brisk walking, cycling, or swimming), in addition to strength training exercises, are generally recom­mended for cancer survivors, unless your doctor advises otherwise. You might consider working with a physi­cal therapist or an exercise specialist to help tailor an exercise program based on your specific needs and physical capabilities.

Many survivors buy in to the misconception that fatigue is an inevitable consequence of cancer and its treatment.

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Dr. Yesne Alici

Maintaining a long-term fitness routine might be challenging for some cancer survivors because of time con­straints, limited access to exercise facilities, inadequate instruction on appropriate exercises, and physical limi­tations. However, most survivors should regularly engage in some form of basic exercise, such as walking or using a stationary bike. Walking is generally considered a safe physical activity for everyone, but you should always con­sult with your doctor before starting any exercise program.

Psychosocial Interventions
A num­ber of psychosocial interventions are effective in managing cancer-related fatigue. Cognitive behavioral therapy is a form of psychotherapy that focuses on examining the relationships among a person’s thoughts, feelings, and behav­iors. Cognitive behavioral interventions targeting dysfunctional thoughts about fatigue, sleep disturbances, and lack of activity can help you put your cancer-related fatigue in perspective.

Educational programs, such as pam­phlets or online courses that provide information on physical activity, distress management, sleep hygiene, energy res­toration and conservation, and fatigue management, are helpful tools for cancer survivors. Practicing energy restoration and conservation strategies is an espe­cially helpful way to reduce fatigue. Some examples include setting priori­ties, pacing your energy-consuming activities, allowing time for adequate rest, delegating tasks, using energy-saving devices, and participating in enjoyable, restorative activities.

Mindfulness-Based Therapies
Research has shown yoga, acupuncture, and other mindfulness-based therapies to be effective in relieving cancer-related fatigue. Massage therapy, music therapy, and other methods of relaxation also can be helpful. Ask your doctor if he or she knows of any mindfulness-based pro­grams in your community.

Medication
Psychostimulants, such as methylphenidate and dextroamphet­amine, are medications that have been tested and effectively used to reduce fatigue. Talk with your doctor to deter­mine whether you could benefit from this type of medication.

Although fatigue is one of the most distressing side effects of cancer treat­ment, this debilitating condition is often under-recognized and undertreated. Many survivors buy in to the miscon­ception that fatigue is an inevitable consequence of cancer and its treatment; they choose not to report their symptoms to avoid seeming like complainers. On the contrary, cancer survivors should seek relief from cancer-related fatigue. By reporting your symptoms of fatigue to your doctor, you can then work together to devise a plan to reduce your fatigue.

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Dr. Yesne Alici is a psychiatrist at Memorial Sloan-Kettering Cancer Center in New York, NY. She is board certified in psychia­try, geriatric psychiatry, and psychosomatic medicine. She primarily works with people with brain tumors and with older individu­als with cancer.

This article was published in Coping® with Cancer magazine, May/June 2014.

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