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Feeling Fatigued?

Here are some strategies to help you cope.


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Fatigue is a common symptom in people with cancer that causes a lack of energy for many usual activities. Most people receiving cancer treatment experience fatigue, and some cancer survivors have fatigue for months and even years after treatment. Cancer-related fatigue differs from other types of fatigue, such as when not getting enough sleep, in that the feeling of exhaustion does not improve with rest.

Fatigue’s Effect on Quality of Life
Fatigue can have negative effects on the overall physical, psychological, social, and economic well-being of people with cancer. For some, it can be slightly bothersome, while for others the experience can be devastating. Fatigue can influence a person’s activities of daily living, hobbies and other enjoyable activities, social relationships, mood and emotions, job performance, feeling of well-being and sense of joy, attitude toward the future, and ability to undergo treatment.

Researchers now think that a regular exercise program is the best strategy to help relieve cancer-related fatigue.

Identifying Causes of Fatigue
There are multiple causes of cancer fatigue, but not all of them are well understood. In situations where many different reasons contribute to a sense of exhaustion, it is still important to develop effective strategies to help deal with this symptom. Some of the common causes of fatigue include the cancer itself, anorexia (involuntary loss of appetite), cancer-related treatment, anemia (low red blood cell count), uncontrolled pain, stress, depression, lack of sleep, medications, lack of regular exercise, inadequate nutrition, and coexisting medical conditions.

Exercising and Healthy Eating
Researchers now think that a regular exercise program is the best strategy to help relieve cancer-related fatigue. Athletes and physically fit individuals may continue a program of modified regular exercise while undergoing some cancer treatments. However, most people with cancer will experience some degree of deconditioning, making their regular exercise routine more difficult and, in some cases, even dangerous. Exercise helps prevent muscle loss, and once lost, resistance training can help to rebuild it. Talk with your doctor about modifying your exercise program to meet your needs. A gradual program will increase muscle tone and lead to a sense of well-being. Even people who are fairly weak benefit from getting out of bed and walking around the house.

Eating well and drinking enough fluids are important to maintaining an adequate weight and meeting nutritional requirements. If available, consider talking with a nutrition counselor or registered dietitian at the treatment center. He or she can provide helpful hints on eating a well-balanced diet and tips on eating when there is a lack of taste and during times of nausea and vomiting.

Conserving Your Energy
Many people who complete treatment expect an immediate return to normal functioning. However, fatigue may take some time to resolve, so it is important to prioritize tasks and schedule periods of rest whenever possible. Plan your days to use the time of greatest energy for the most important tasks. Some people may be able to maintain the same lifestyle by pacing activities according to how they feel. It is important to get the rest you need, which may mean altering the times you sleep and the amount of sleep you need.

Many people who complete treatment expect an immediate return to normal functioning. However, fatigue may take some time to resolve.

Some people also experience mental fatigue, making it difficult to concentrate. It may also contribute to feelings of being overwhelmed and frustrated because your lifestyle has been disrupted. Talk with your doctor, nurse, or social worker about these concerns.

Sharing Responsibilities with Family and Friends
It may be helpful to seek assistance with everyday activities and delegate some of the tasks to others. Maintaining certain household and family responsibilities, such as childcare, meal preparation, and food shopping, may become difficult. Some online communities offer tools to help coordinate caregiving tasks among family members and friends. Healthcare professionals, such as social workers, will often counsel people to ask for help from friends and family members.

Treating Fatigue Related to Anemia
Many people with cancer have anemia, which is a decrease in the amount of circulating red blood cells. Anemia may be caused by the cancer or caused by the treatment given for the cancer. People who have anemia also report a feeling of extreme and overwhelming fatigue. The treatment for anemia may include nutrition supplements, drugs, and blood transfusions.

Managing Other Causes of Fatigue
Living with constant pain will almost always make a person feel exhausted. Many of the medications usually prescribed for the treatment of pain also cause drowsiness, sleepiness, and fatigue. Your doctor can help you understand the options available and give you information about common side effects of pain medications.

In addition to physical reasons that contribute to fatigue, the situation itself can lead to feelings of distress and depression. This can elevate the feeling of exhaustion and complicate treatment. If a person feels exhausted all the time, he or she may be unable to perform at work or at home. The first step in treating depression is to recognize it as a condition and talk about ways to resolve it with your doctor. Treatment for depression can make a huge difference, and it is regularly offered to people who experience extreme sadness or hopelessness.

Sleep is necessary for normal function and performance. Stress, pain, and worry can interfere with a person’s ability to sleep through the night. In some cases, medications can also disturb the normal sleep pattern. For those who are chronically tired, sleep may come in spurts at different times of the day or evening. What is important to remember is that if you are not refreshed by sleep or simply unable to sleep more than one to two hours, it will contribute to feelings of exhaustion and will likely affect your mood and performance. Talk with your doctor or nurse about any sleep problems.

Coping with Fatigue in the Workplace
Cancer-related fatigue can also affect a person’s ability to work. It is common for most people undergoing cancer treatment to make a change in their work schedule or responsibilities. Even long-term survivors of cancer, who still have some fatigue, may require changes in their work routine. If you are comfortable with your employer knowing about your cancer, talk with a human resources representative about the effects fatigue has had on your ability to maintain your job responsibilities and about any adjustments or accommodations that can be made. You may need to take prolonged sick leave and disability leave in some situations. It is important that you know your company’s policy on sick leave and that you understand the Americans with Disabilities Act and Family Medical Leave Act so that you know your rights.

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Reprinted with permission from ©2011 American Society of Clinical Oncology. All Rights Reserved.

This article was published in Coping® with Cancer magazine, March/April 2011.