More than half of people diagnosed with cancer experience cancer-related fatigue (CRF). Many patients find CRF to be more distressing and disabling than other cancer-related symptoms such as pain, depression and nausea. The fatigue often begins before cancer is diagnosed, worsens during the course of treatment and may persist for months — even years — after treatment ends.
CRF can have a major impact on quality of life, with physical, emotional and economic consequences. People with cancer who suffer with fatigue typically feel mentally and physically defeated; many are hard on themselves because they're less active than they were before diagnosis or treatment. They typically describe CRF as overwhelming exhaustion that can't be overcome with rest or a good night's sleep.
As with other cancer-related symptoms, CRF isn't necessarily an unavoidable part of your journey. Medical treatment, regular exercise, good nutrition, psychological support, stress management and other lifestyle changes can help you feel more energized and better able to cope with fatigue.
The National Comprehensive Cancer Network has identified several factors that contribute to, or are intensified by, CRF:
- Anemia (decreased number of red cells)
- Poor nutrition
- Loss of physical fitness
- Sleep disturbances
- Emotional distress
- Pain and opioid analgesics pain medications
- Other health problems, such as an underactive thyroid; infection; problems with heart, lung, kidney, or liver function; or neurologic problems
The Leukemia & Lymphoma Society of Canada has produced the following booklet Cancer Related Fatigue you may find helpful.
Facts You Should Know About Fatigue
- More than 50 percent of all cancer patients are estimated to have had cancer-related fatigue (CRF).
- CRF interferes with a person's ability to fulfil daily responsibilities and to enjoy life. It's a health problem that requires medical management.
- When compared with fatigue that healthy people experience, CRF is more severe, depending on a person's activity level. CRF is also less likely to be relieved by sleep or rest.
- Signs of CRF may include physical weakness, changes in mood or motivation, withdrawal from social activities, irritability and impaired ability to perform daily activities, concentrate or make decisions.
- It's important for patients to talk with their doctors if they experience signs of fatigue before, during or after treatment. Assessing fatigue can be a challenge, and good patient-doctor communication is key to successful evaluation.
Treatments for Fatigue
Although there's no standard treatment for CRF, the first step in treating it is often to identify its underlying causes (such as anemia or poor nutrition) and other contributing health problems. Several therapies and lifestyle changes may help restore your energy, including:
- Psychological support
- Stress management
- Nutritional changes
- Improved sleep habits
Drugs that relieve certain treatment side effects, such as nausea or loss of appetite, may improve sleep and nutrition and, as a result, ease fatigue. A combination of drug and nondrug treatments is often recommended.
Physical activity (walking, swimming, yoga, resistance training), stress reduction and psychosocial support (counseling and coping strategies) can help reduce fatigue and increase your energy levels.
Studies have found that:
- Exercise helps maintain or build stamina and strength. It can also increase your circulation, leading some experts to think that exercise may reduce cytokines and other harmful substances in the body that can increase fatigue.
- Cognitive-behavioral strategies such as progressive muscle relaxation or relaxation breathing may improve CRF in patients receiving radiation therapy or hematopoietic stem cell transplantation.
Researchers are studying the effectiveness of other nondrug therapies — alone and in combination — in clinical studies, such as:
- Energy therapies that use gentle human touch to balance the flow of energy in the body
- Mindfulness-based stress reduction
- Restorative yoga
Drugs can play a role in managing CRF, but there's no consensus about which drugs are most effective. Studies show that those who take drugs used to stimulate the central nervous system or boost hemoglobin levels (for patients with anemia) have greater improvements in CRF compared with those who received a placebo. The following are some drugs doctors may consider to treat your fatigue:
- Erythropoiesis stimulating agents (ESAs). ESAs stimulate the body to make red cells. The ESAs epoetin alfa (Epogen®, Procrit®) and darbepoetin alfa (Aranesp®), given by injection, are approved to treat chemotherapy-induced anemia. However, some studies suggest that ESAs may increase the risk of blood clots and that use of an ESA may be associated with a worse outcome. Talk with your doctor about the risks and benefits of ESAs before deciding on this therapy.
- Psychostimulants. Psychostimulants stimulate the central nervous system and have been found to enhance alertness and reduce fatigue in people with multiple sclerosis and HIV. Because many people with cancer have sleep complaints, these drugs may be beneficial for easing CRF. Although some data support the use of methylphenidate (Ritalin®, Methylin®) or dexmethylphenidate (Focalin®) to treat CRF, researchers are still questioning whether methylphenidate is better than a placebo in treating CRF. Common side effects of methylphenidate include irritability, anorexia, insomnia, nausea and rapid heart rate.
- Antidepressants. Researchers are studying the benefits of using antidepressants to treat CRF. Paroxetine (Paxil®) is a selective serotonin reuptake inhibitor (SSRI) that appears to improve mood but doesn't reduce CRF in patients receiving chemotherapy. Bupropion (Wellbutrin® SR), which has been used to treat chronic fatigue syndrome and fatigue associated with multiple sclerosis, was associated with improvements in fatigue within two to four weeks of the start of treatment during an open-label study. More research is needed to better understand the relationship between depression and fatigue in people with cancer.
Take Care of Yourself
Try some of these suggestions to deal with your fatigue:
- Be flexible. Don't measure your energy against how you felt before you were diagnosed. Set realistic goals. Allow yourself to shift your focus from fatigue (and what you may not be accomplishing) by listening to music, reading a book, meeting friends, watching a movie or going for a walk or a car ride.
- Stay active. Staying physically fit may help ease fatigue. If you don't already have an exercise regimen, begin one gradually and aim to exercise at least three times a week. Adjust your routine if you feel overly tired. Focus on activities that will help you gradually build strength but won't deplete your energy level. Light activity, such as walking, can help you relax and sleep better.
- Practice good nutrition. People with cancer are at risk for malnutrition and other problems resulting from either the cancer or treatment side effects. Eat a balanced diet that provides sufficient calories, protein, vitamins and minerals, especially iron. Maintain energy levels by eating frequent small meals or snacks throughout the day. Drink plenty of noncaffeinated liquids to help eliminate toxins from the body. For more tips on getting the nutrients you need, see Food and Nutrition.
- Manage stress. Stress can zap your energy. Try to relieve its effects with exercise, relaxation techniques, meditation, spiritual or religious practices, socializing and counseling.
- Address sleep habits. For tips on getting a good night's sleep while undergoing cancer treatment, see Sleep Disturbances.
- Ask for help. Seek out friends and loved ones who can help you with routine tasks such as shopping, cooking, housekeeping, laundry or driving. Rest when you feel tired.
- Plan your treatment schedule. Schedule treatment for times when it will have the least impact on your job or other activities. For example, many patients find that scheduling treatment in the afternoon or at the end of the week allows them to be more productive at work.
- Keep a journal. Track your fatigue and review your journal entries with your doctor to help him or her determine possible causes, recommend treatment and suggest coping strategies. In your journal, include:
- Severity, timing, duration, activities or treatments that make it worse or better and how it interferes with daily activities
- Fatigue symptoms such as tired legs or eyes, poor concentration, weakness or sleepiness, shortness of breath after light activity, difficulty performing Household chores, irritability or impatience
- Daily activities, including your eating and sleeping habits, medications and treatments
- Weight changes
- Financial stressors
- Strategies that have worked to reduce fatigue, such as undertaking difficult tasks when your energy is highest, or pacing yourself and scheduling rest
- Seek support. Many patients and their families find support groups to be comforting and informative. The Leukemia & Lymphoma Society can help with referrals to support groups and the Patti Robinson Kaufmann First Connection program, which links newly diagnosed patients with similarly diagnosed cancer survivors.