Symptom Specific Services

Click here for a printer-friendly version

Fatigue
• What is cancer-related fatigue?
• What is causing my fatigue?
• How is my fatigue related to my treatment?
• Does chronic fatigue mean that my cancer has worsened?
• How will Continuum Cancer Centers of New York assess my fatigue?
• What treatments do Continuum Cancer Centers of New York provide for fatigue?
• Specific treatments for cancer related fatigue
• 10 tips to help you lessen fatigue, or assist you in treating it
• Why does my fatigue continue even after I rest or sleep?

Specific treatments for cancer related fatigue:

Medication

• Treating Anemia
Anemia (below-normal levels of red blood cells) can be a major factor in cancer-related fatigue. Lack of red blood cells and oxygen in the body creates an energy deficit, causing tiredness or fatigue. Blood transfusion therapy, as well as recombinant human erythropoietin (a hormone produced by DNA technology), is used to treat anemia. Erythropoietin stimulates bone marrow to produce red blood cells, thereby increasing the number of red blood cells in the body.

• Commonly Prescribed Medications for Treating Fatigue
Drug therapy for treating fatigue associated with medical illness has not been evaluated through controlled studies. Some doctors prescribe psychostimulants, such as methylphenidate and pemoline. These drugs are often used to treat opioid-related cognitive impairment and depression in the elderly and severely ill.

Sometimes low-dose corticosteroids (e.g., dexamethasone or prednisone) are used in the treatment of cancer-related fatigue. Amantadine has been used for many years to treat fatigue brought on by multiple sclerosis. An antidepressant drug may be used to treat fatigue caused by clinical depression.

• Adjusting Current Medications
Patients on medication who complain of fatigue may need their drug regimens reviewed or adjusted by their physicians. Centrally acting drugs that are not essential may be eliminated or reduced (e.g., antiemetics, hypnotics or anxiolytics, antihistamines, and analgesics). If opioids are taken for controlling pain, dosage reduction is done cautiously to see whether fatigue improves without making the pain worse.

Exercise
Moderate exercise has been found to relieve fatigue symptoms in both healthy people and those with chronic diseases. Light to moderate exercise, as recommended by a physician, can gently energize a patient and increase function. Exercise differs from casual, everyday activity, in that an exercise program is a controlled therapeutic activity used to maintain energy and minimize fatigue.

An exercise program should be tailored to the individual according to age, gender, and physical and medical conditions. Exercises should involve rhythmic and repetitive movement of large muscle groups (such as walking, cycling, or swimming). These exercises should begin gradually, several days a week, and should not be performed to the point of exhaustion. There are some negative aspects to low-intensity exercise, including cardiac abnormalities, recurrent or unexplained pain, and the onset of nausea.

Education for Patients and Caregivers
Our staff can help patients and caregivers understand the nature of fatigue symptoms, treatment choices, and expected outcomes through education and counseling. We can prepare patients to deal with fatigue as a normal part of the course of cancer and its treatment. Our staff can also help patients learn energy conservation and restoration strategies while undergoing these treatments.

Visit stoppain.org for more information about fatigue.

Change in Activity and Rest Patterns
Using a diary to assess fatigue may help you identify specific activities that increase it. Patients should record changes in energy levels. This information can help you modify, schedule, or pace your activities throughout the day to maximize energy.

Naps should be taken in the morning or early afternoon; late afternoon or evening naps might interfere with sleep at night. Maintain good basic sleep patterns, including a specific bedtime and wake time, reduced noise and light, and diversion activities, such as music and massage. Avoid stimulants (e.g., caffeine, nicotine, steroids and methylphenidate) and central nervous system depressants (e.g., alcohol) prior to sleep. A specific wake time helps to maintain a normal sleep-wake rhythm. Consistent exercise tends to improve sleep and can promote deeper sleep; it should be done at least six hours before bedtime.

Stress Management and Cognitive Therapies
Patients can use stress reduction techniques or cognitive therapies (e.g., relaxation, deep breathing, hypnosis, guided imagery, or distraction) to promote coping skills and relieve stress.

Coping skills — such as seeking more information about the illness and its interventions, planning and scheduling activities, delegating tasks, and developing solutions to daily problems associated with fatigue — are all helpful to patients.

Mental fatigue may be relieved by activities that conserve and restore mental capacity, such as decreasing noise and distractions while trying to concentrate, walking outside, gardening, and other environmental activities.

Adequate Nutrition and Hydration
A balanced diet that combines adequate caloric intake and a variety of grains, green vegetables, legumes, and iron-rich food can help you maintain energy levels. Adequate fluid intake can prevent dehydration and low blood pressure, which can intensify fatigue symptoms. Regular exercise may improve appetite and increase nutritional intake.

top

10 tips to help you lessen fatigue, or assist you in treating it

1. Take several short naps or breaks, rather than one long rest period.
2. Plan your day so you have time to rest.
3. Take short walks or do some light exercise if possible. Some people find this decreases fatigue.
4. Try easier or shorter versions of the activities you enjoyed before.
5. Eat as well as you can, and drink plenty of fluids.
6. Ask your family or friends to help you with tasks you find difficult or taxing.
7. Keep a diary of how you feel each day. This will help you with planning your daily activities, and can help you and your medical team regulate any anti-fatigue medication you may be taking.
8. Join a support group, or seek help from an oncology social worker or counselor.
9. Find enjoyable activities that are less strenuous, such as listening to music or reading.
10. Save your energy for things you find most important.

top

Why does my fatigue continue even after I rest or sleep?
While rest may lessen fatigue associated with a medical illness, it does not always relieve it. Although patients with cancer who experience fatigue may need rest or naps during the day, they should recognize that these activities will not eliminate the problem.

Excessive bed rest can lead to weakness or decreased energy levels and eventually will increase fatigue. Mild to moderate exercise, such as walking and stretching, can help restore energy levels. Whatever the solution, it is advisable to check with your doctor before starting an exercise program.

If you would like additional information, these are recommended Web sites which you may find helpful if you or someone you love is suffering from fatigue from cancer or cancer treatment:
www.stoppain.org/palliative_care/index_fatigue.html
www.cancercare.org/managing/fatigue/index.asp

top

previous 3 questions and answers