Tackling Cancer-Related Fatigue
by Yesne Alici, MD
Fatigue is one of the most prevalent and troubling side effects cancer survivors face, both during treatment and after treatment ends. Cancer-related fatigue is a distressing, persistent, subjective sense of physical, emotional, or cognitive tiredness that is caused by cancer or its treatment. Unlike the normal tiredness that most people experience from time to time, cancer-related fatigue is not proportional to recent activity, it does not go away with rest, and it interferes with everyday functioning. This type of fatigue can significantly diminish a cancer survivor’s quality of life.
What’s Causing Your Fatigue?
To determine what’s causing your fatigue, your doctor will look at a detailed history of the onset, pattern, and duration of your fatigue, as well as what triggers your fatigue and what makes it better. They may also conduct tests to look at your blood counts, electrolytes, vitamin levels, and liver, kidney, and thyroid gland functioning.
The most common causes of fatigue are medical conditions, medication side effects, alcohol or substance misuse, poor nutrition, pain, depression, anxiety, sleep disturbances, and poor physical fitness. The good news is these problems are often treatable. Once your oncologist figures out what is causing your fatigue, they may recommend that you see an internist, an endocrinologist, a psychologist, or a psychiatrist, depending on the factors involved.
This type of fatigue can significantly diminish a cancer survivor’s quality of life.
What Can You Do About It?
Physical activity, psychosocial interventions, mindfulness-based therapies, and medications 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 incorporates the methods that work best for you.
Engaging in physical activity can help prevent and 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 says otherwise. You might consider working with a physical therapist or an exercise specialist to help tailor an exercise program to meet your specific needs and physical capabilities.
Maintaining a long-term fitness routine might be challenging for some cancer survivors due to 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 mostly considered a safe physical activity for everyone, but you should always consult with your doctor before starting any exercise program.
A number of psychosocial interventions are effective in managing cancer-related fatigue:
♦ Cognitive behavioral therapy, or CBT, is a form of psychotherapy that focuses on examining the relationships among a person’s thoughts, feelings, and behaviors. Cognitive behavioral interventions that focus on modifying unhelpful 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 offer information on physical activity, distress management, sleep hygiene, energy restoration and conservation techniques, and fatigue management – are also helpful tools for cancer survivors.
♦ Practicing energy restoration and conservation strategies is an especially effective 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 taking part in enjoyable, restorative activities.
♦ Nutrition consultation and bright white light therapy are also helpful in reducing cancer-related fatigue.
Engaging in physical activity cancer-related fatigue.
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 help. Ask your doctor if they know of any mindfulness-based programs in your community.
Psychostimulants (such as methylphenidate and dextroamphetamine) and wakefulness-promoting agents (such as modafinil and armodafinil) are medications that have been tested and effectively used to reduce fatigue. Talk with your doctor to see if medication might help you.
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. And they choose not to report their symptoms to avoid seeming like complainers. But the truth is, you can find relief for cancer-related fatigue. The first step is telling your doctor about your symptoms. Then you can work together to make a plan for tackling cancer-related fatigue.
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 senior adult cancer survivors.
This article was published in Coping® with Cancer magazine, May/June 2017.