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Fighting Fatigue

by Ellen Manzullo, MD, FACP

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Fatigue is the most common and often most distressing symptom cancer survivors face. Cancer-related fatigue is different from the fatigue we all experience in daily living. Cancer-related fatigue is usually more severe, lasts longer, and can have a significant impact on your daily living. Even simple activities, such as eating, bathing, and grocery shopping, may be hard to do when you are fatigued. In addition, normal rest might not help you feel more energetic. Some people may experience cancer-related fatigue even years after completing cancer treatment.

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.

Prioritize your most important activities, and plan to do them during periods of the day when you have the most energy.

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Dr. Ellen Manzullo

There are many possible causes for cancer-related fatigue. It can be caused by cancer or cancer treatments, such as chemotherapy, radiation treatment, bone marrow transplant, and surgery. It can also be a sign of an undiagnosed medical condition, or one that is being inadequately treated. For example, heart disease, anemia, hypothyroidism, and sleep disorders, such as sleep apnea, can all contribute to fatigue. Pain, depression, and anxiety can also cluster with cancerrelated fatigue. It’s important to have a list of your medications since some can cause fatigue. Your healthcare team can review the list and determine if any adjustments need to be made.

There is usually more than one cause of cancer-related fatigue in an individual. Although this symptom can be overwhelming, several strategies can be used to fight it.

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’s important to pace yourself and 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.

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 longer than 30 minutes. In the late afternoon and evening, avoid caffeine, chocolate, and alcohol. Also, limit liquid intake in the evening. When you exercise, give yourself at least two to four hours before bedtime to recover. Also, try to avoid activities that are mentally stimulating prior to going to bed, such as working on the computer or playing video games. 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. If you cannot fall asleep within 15 minutes, it’s 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 every day if possible. Before beginning an exercise regimen, you should discuss an appropriate program with a healthcare professional. Some people may need to be assessed by a physical therapist. The eventual goal would be to achieve 30 minutes of exercise per day. Studies have shown that people with cancer who exercise have more energy, are better able to perform routine activities, and enjoy an improved sense of well-being.

It is important to eat a well-balanced diet with the right amount of calories. If you cannot eat regular-sized meals, eat small meals more often. Include protein, such as fish and lean meats, in your diet. A dietitian can instruct you on the best sources and amount of protein for you. You should also remain well hydrated by drinking eight 8-ounce glasses of nonalcoholic, non-caffeinated 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 and meditation. These activities can be both mentally and physically restorative.

Although cancer-related fatigue is one of the most common and distressing symptoms for cancer survivors, many measures can be taken to help manage this symptom. If fatigue persists and significantly interferes with your daily life, promptly discuss this symptom with your healthcare provider.

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Dr. Ellen Manzullo is a professor of Medicine at The University of Texas MD Anderson Cancer Center in Houston, TX. She is the deputy division head for the division of Internal Medicine 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, July/August 2012.