Continuum Cancer Centers of New York
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> Fatigue
What is cancer-related fatigue?
Fatigue remains one of the most overlooked and under-treated side effects of
having cancer, although it has a profound effect on the lives of cancer patients.
Cancer itself can cause a great deal of fatigue, and a loss of energy is one
of the major side effects of most forms of cancer treatment. For many people,
it is a daily reminder that they are ill.
The health care professionals at Continuum Cancer Centers of New York can provide you with help that can lessen the effects of fatigue.
Fatigue is a feeling of weariness, tiredness, or lack of energy that varies in degree, frequency and duration. For most people, fatigue is a temporary condition, something you feel after strenuous activity, which will go away if you take a quick nap. Fatigue can affect quality of life in many different ways — physically, emotionally, socially and spiritually. Fatigue can also affect the way you think and feel. It can cause you to have difficulty concentrating, to lose interest in your activities, and to become impatient.
Chronic fatigue doesn't go away. It is associated with a disease or treatment of a disease that does not improve with rest. Chronic fatigue can seriously affect a person's ability to function and their quality of life. For cancer patients, fatigue is a common medical condition.
Unfortunately, many patients don't talk to their doctor about fatigue, because they don't understand exactly what it is, or they think that feeling tired from cancer or cancer treatment is "normal." You should tell your doctor when you are experiencing fatigue and ask for information about underlying causes and treatment side effects.
What is causing
my fatigue?
Though little is known about fatigue prevention and treatment, fatigue is caused
by a variety of medical and physical conditions and psychosocial factors. These
factors include:
• Anemia
• Major organ dysfunction, including heart and lung disease, and liver or kidney failure
• Hypothyroidism (insufficient production of the thyroid hormone) or adrenal problems
• Neuromuscular disorders
• Malnutrition, infection, dehydration, or salt imbalances
• Sleep disorders, immobility and lack of exercise
• Chronic pain or pain medication
• Anxiety, depression and stress
Another common cause of fatigue is chemotherapy treatment. Chemotherapy can lower the number of red cells in your blood, which carry oxygen throughout your body and give you energy. Fatigue can also result from surgery and radiation oncology. Cancer and cancer treatment can also disrupt your eating or sleeping habits, both of which may result in fatigue.
Fatigue in people with cancer may have other causes. Tumors can cause fatigue directly or indirectly by forming toxic substances in the body that interfere with normal cell functions. Medication, lack of exercise, or pre-existing physical or psychological conditions can cause fatigue.
How is my fatigue related
to my treatment?
Fatigue is a common symptom associated with chemotherapy, radiation, surgery,
and anemia.
Fatigue caused by chemotherapy
Fatigue from chemotherapy affects most patients, lasting for one to two weeks
following treatment, then decreasing gradually. Chemotherapy can lower the number
of red cells in your blood, which carry oxygen throughout your body and give
you energy. Having fewer red blood cells means that your body gets "out
of breath" when you do something even mildly strenuous.
Fatigue caused by radiation
Fatigue as a result of radiation oncology affects almost all patients and may
worsen during the course of your treatment, peaking at four to six weeks. In
order to heal itself, the body uses a lot of energy during radiation oncology.
The additive effects of stress related to your illness, daily trips for treatment,
and the effects of radiation on normal cells all may contribute to fatigue.
Fatigue usually lessens after your therapy is completed, although not all patients
return to their normal levels of energy.
Fatigue caused by surgery
Fatigue is a problem following surgery, but fatigue from surgery improves with
time. It can be worse, however, when it is combined with the fatigue caused
by other cancer treatments. Fatigue from cancer surgery can last for weeks or
months, and may be caused by anxiety from surgical preparation and presurgical
testing. Pain after surgery, the effects of anesthesia, sedatives, or analgesics
may also cause fatigue.
Anemia
Anemia is a major factor in cancer-related fatigue and quality of life in people
with cancer. It may be caused by the cancer itself or by cancer treatments,
or it may be related to other physiological changes. A medical history, a physical
examination, and blood tests may be used to determine the kind and extent of
anemia that a person may have.
Does chronic fatigue mean that my cancer has worsened?
Cancer patients experiencing fatigue often do not report it to their doctors.
They may be fearful that fatigue symptoms are associated with recurrence, or
that their cancer has spread. However, fatigue may be related to cancer treatment,
anemia, liver function, kidney function, lung function, inactivity, or a variety
of other causes. Treatment interventions that alleviate fatigue symptoms are
available, and patients should report their fatigue symptoms to their doctors.
How will Continuum Cancer
Centers of New York assess my fatigue?
Our assessment of fatigue begins with a detailed description of its history,
development, symptoms and causes. This information is acquired from your self-report,
medical history, physical examination and a review of laboratory tests such
as blood counts and imaging studies (CT or MRI scan).
We assess the onset of your fatigue, the course of your symptoms, the severity or intensity, the level of distress, and the degree of interference with your daily activities. We also examine factors that relieve fatigue or make it worse. These factors may be emotional (e.g., moods), social (relationships with family and friends), or psychological (effect on thought process). They are assessed using either a verbal rating scale (none, mild, moderate, and severe) or a numerical scale of zero to 10.
If you feel fatigue (or think you do), talk to your physician, nurse or caregiver. Your medical team can provide you with information to reduce fatigue, or prescribe medications to treat any physical conditions that may be the cause.
What treatments
do Continuum Cancer Centers of New York provide for fatigue?
We help patients with fatigue by working with Beth Israel's Center for Fatigue,
which is a collaborative project between the Department of Pain Medicine and
the Cancer Center. An interdisciplinary team assesses and treats patients who
experience chronic fatigue as a result of cancer and cancer treatment.
The center takes a comprehensive approach to care and uses a variety of pharmacological and non-pharmacological treatments. The program also promotes research by allowing patient participation in clinical trials, as well as education for patients, their caregivers, and medical professionals. Treatments are tailored to meet the individual needs and lifestyles of each patient, and are provided by a specialty team of physicians, advanced practice nurses, psychologists, social workers, nutritionists, exercise therapists and other key personnel.
The Center for Fatigue currently operates as a demonstration project, offering a model of care for the management of fatigue and improved quality of life, supported in part by an unrestricted educational grant from Ortho Biotech, Inc.
For more information, contact:
www.stoppain.org/palliative_care/index_fatigue.html
or
Marilyn Bookbinder, RN, PhD
Director of Nursing
Department of Pain Medicine and Palliative Care
Beth Israel Medical Center
First Avenue at 16th Street
New York, NY 10003
Phone (212) 844-1462
mbinder@bethisraelny.org
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.
10 tips to help you lessen fatigue, or assist you in treating it
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
© 2003 Continuum Cancer Centers of New York, Inc.