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Are You Tired of Cancer-Related Fatigue?

Here are some steps you can take to fight fatigue and reclaim your energy.

by Carmen P. Escalante, MD

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Cancer-related fatigue is not just a usual state of tiredness. It is more severe and affects your usual daily activities. Often, you do not feel refreshed after a night’s sleep. Cancer-related fatigue is the most common side effect reported by people with cancer. It is usually caused by multiple factors, including the cancer itself, cancer treatment, anemia, nutritional factors, sleep dysfunction, psychological issues (such as depression, anxiety, and other mood disorders), pain, medications, and other chronic illnesses.

The evaluation of cancer-related fatigue requires a thorough history, physical examination, and laboratory testing for anemia and thyroid, liver, kidney, and hormonal dysfunction. In addition, specific survey tools measuring fatigue, pain, depression, anxiety, sleep, nutrition, and general well-being may also be used to identify factors that may contribute to fatigue.

Some interventions commonly utilized for treatment of cancer-related fatigue include exercise, energy conservation, nutritional balance, good sleep hygiene, and relaxation techniques. In addition, medications may be used to treat cancer-related fatigue in some people. Often, a combination of treatment interventions customized to the needs of the individual is necessary.

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Dr. Carmen Escalante

Exercise has been shown to improve fatigue in people with cancer. It may also help increase appetite, improve performance of daily physical activities, and improve quality of life. Be sure to discuss any exercise program with your healthcare provider before starting. You may require physical therapy or rehabilitation, especially if you have limited exercise capabilities.

Exercise can be done during cancer treatment, but modifications may be necessary. For example, if you are receiving chemotherapy and your blood counts are low, it may be more difficult for you to continue your exercise at the same pace. You may need to alter the type or decrease the intensity of the program during those times of your chemotherapy cycle.

When you begin an exercise program, always start slowly and gradually increase exercise time and intensity as your body becomes better conditioned. While exercising, you should stay well hydrated by drinking plenty of fluids and avoiding excessive heat or humidity. You should try to follow a regular exercise schedule. It may be helpful to exercise with a partner, which will help you stick to your exercise plan and adds a social component to your routine.

Walking is an inexpensive way to exercise that does not require additional costly equipment or gym memberships. All you need is a pair of well-fitting, comfortable athletic shoes. If you cannot leave your home, try stretching and toning exercises that can be done at home. There are numerous television programs and exercise videos available for at-home use. Water exercises are another option, especially for those with difficulty in their muscles, joints, and bones. Talk to your healthcare provider before beginning a water-based exercise program since there may be times during cancer treatment when this may not be appropriate.

Energy Conservation
Conserving energy may decrease cancer-related fatigue. Plan your days so that energy-draining activities are spread out over several days instead of occurring all at one time. Prioritize your activities, and ask others to help with chores and other draining tasks. Try to combine errands, eliminating unnecessary trips. Pace yourself, and create a daily routine. Try to sit during activities whenever possible, and use devices such as handrails, walkers, and grab bars when needed. Write down your daily activities and fatigue levels in a journal. This will help you identify times of increased fatigue and the associated activities. Your most difficult tasks should be done during times of least fatigue.

Remember to eat sensibly and include foods with proteins, vitamins, and minerals in your diet. You should also drink plenty of fluids. Consider meeting with a nutritionist to assess your dietary needs.

Sleep Hygiene
People with cancer often experience disturbed sleep, which increases daytime fatigue. To improve your sleep hygiene, limit daytime naps, go to bed and rise at a regular time each day, and do not exercise near bedtime since this may be stimulating. A dark, cool, quiet, relaxing room is helpful in initiating sleep.

It is important to manage stress, as this may influence your level of fatigue. Consider joining a support group. Take part in hobbies that don’t require too much physical exertion. Talk with your family and friends, and ask for help when needed.

Sometimes medications are necessary to deal with fatigue. These are usually stimulants and are prescribed by a physician. They may help improve energy and memory. Side effects may include sleeplessness or a “jittery” feeling.

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Dr. Carmen Escalante is chair of the department of General Internal Medicine, Ambulatory Treatment, and Emergency Care at the University of Texas MD Anderson Cancer Center in Houston, TX.

This article was published in Coping® with Cancer magazine, July/August 2010.