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Fighting Fatigue

by Ellen Manzullo MD, FACP

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Plan to do your most important activities during periods of the day when you have the most energy.

Fatigue is the most common and often most distressing symptom in cancer survivors. Cancer-related fatigue is different from the fatigue we all experience in daily living. Cancer-related fatigue can occur suddenly and can be overwhelming. You may experience weakness over the entire body or lack the energy to perform normal activities of daily living. Some people wake up tired after a normal night of sleep.

Cancer-related fatigue can also be mental, as well as emotional. At times, fatigue may cause you to have trouble concentrating and can make performing daily tasks difficult. A person who is emotionally fatigued might experience difficulty in relationships with family and friends. It is important to note that some people may experience cancer-related fatigue even years after completing cancer treatment.

There are many possible causes for cancer-related fatigue. It can be caused by cancer and by cancer treatments. It can also be a sign of an undiagnosed medical condition, or one that is being inadequately treated. For example, heart disease, hypothyroidism, and anemia can all result in the sensation of fatigue. Individuals with depression, uncontrolled pain, and insomnia can also experience fatigue. Fatigue has many possible causes, and there is often more than one cause in an individual. Although cancer-related fatigue can be overwhelming, several strategies can be used to fight fatigue.

It is important to pace yourself and avoid becoming overtired.

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Dr. Ellen Manzullo

Energy Conservation Measures
If you are experiencing cancer-related fatigue, there are many things you can do to conserve your energy. First, prioritize your most important activities and plan to do them during periods of the day when you have the most energy. Routine tasks can be scheduled throughout the week. It is important to pace yourself and avoid becoming overtired. When possible, delegate chores such as strenuous housework, shopping, and laundry to others. In the workplace, try to arrange your environment to conserve your energy, and plan your most strenuous tasks during times of peak energy. Talking with your employer and coworkers about cancer-related fatigue can help them understand this symptom.

Good Sleep Hygiene
Some simple measures can be taken to help you sleep at night. During the day, try to limit naps. If you do nap, try not to sleep for longer than 30 minutes. In the late afternoon and evening, avoid caffeine, chocolate, and alcohol. Also, limit liquid intake in the evening. Try to go to bed and wake up at the same time every day, including weekends. Spouses should try to go to bed at the same time as well. Use your bedroom for sleep and intimacy only. If you cannot fall asleep within 15 minutes, then it is fine to get up, go to another room, try listening to quiet music, and then go back to bed when you feel sleepy.

Exercise and Nutrition
Although it might seem difficult, it is important to remain active. Cancer survivors should try to exercise on a daily basis if possible. Before beginning an exercise regimen, you should discuss an appropriate program with a healthcare professional. In some cases, it might be advisable to be assessed by a physical therapist. The eventual goal would be to obtain 30 minutes of exercise per day if possible.

Occasionally, you may also experience mental fatigue. If this is the case, try working crossword puzzles or engaging in other activities where you are required to focus your concentration. Finally, it is important to eat a well balanced diet that includes foods containing protein, such as meat, eggs, milk, and legumes. You should also remain well hydrated by drinking eight 8-ounce glasses of non-alcoholic, noncaffeinated fluids each day.

Restorative Therapy
It is beneficial to engage in activities that you enjoy and that help you feel relaxed. Try to set aside time at least three times a week for an activity that you enjoy, such as listening to music, gardening, walking through a park, bird watching, or visiting with friends and family. You might also want to try relaxation exercises. These activities can be both mentally and physically restorative.

Although cancer-related fatigue is the most common and distressing symptom in cancer survivors, there are many measures that can be taken to help manage this symptom. If the fatigue persists and significantly interferes with your daily life, you should discuss this symptom with a healthcare professional.

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Dr. Ellen Manzullo is a professor of Medicine at the University of Texas M. D. Anderson Cancer Center. She is the deputy chair (clinical) of the department of General Internal Medicine, Ambulatory Treatment, and Emergency Care and chief of the section of General Internal Medicine. Dr. Manzullo also evaluates and treats cancer survivors in the fatigue clinic.

This article was published in Coping® with Cancer magazine, September/October 2009.

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