Combating Cancer Related Fatigue

Sometimes when our lives are so busy and full, we may wonder, why do we even sleep? Sleep is, in fact, as important as oxygen, food, and water. It provides our bodies daily restoration and enables us to perform at our maximum function. Despite this necessity in our lives, many individuals fighting cancer find themselves unable to sleep, in addition to fighting daily fatigue for a variety of reasons.

What is cancer related fatigue?

Cancer Related Fatigue (CRF) is a distressing, persistent, subjective sense of physical, emotional, and/or cognitive tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning. This means that for someone who is not fighting cancer, walking to their mailbox is an easy daily activity; but for someone fighting cancer, this task may prove truly exhausting.

• Patients find this symptom highly distressing, even more so than pain or nausea, which can often be managed by medications
• Fatigue is highly prevalent; up to 80 percent of those receiving active chemotherapy or radiation reported CRF
• CRF can extend into survivorship

It may not be as simple as one factor!

Your team may be able to help address CRF by addressing multiple factors that could be impacting your fatigue. CRF can improve by addressing:

• Sleep disturbance
• Pain
• Depression/anxiety
• Anemia
• Treatment related effects
• Nutrition
• Medication effects
• Deconditioning or activity intolerance

Treatment related effects

Treatment related effects may be transient -- this means that your fatigue may improve between treatments or after discontinuing a certain medication. That being said, talk to your provider if you suddenly feel more fatigued or if you are concerned about your fatigue. Many patients fear that their disease is getting worse, and are unaware fatigue may be a side effect of a particular cancer treatment.

Other medical conditions not related to cancer that can cause fatigue include: Heart disease, COPD, Thyroid dysfunction, and anemia. If you have any of these conditions, be certain to alert your oncologist so they can also be aware of how you are functioning and if there are other contributing factors to your fatigue. They may refer you to a specialist or back to your primary care provider to address some of these issues.

Strategies: What can I do to feel better?

First, speak to your provider. Ask if medications (i.e. pain medications, antihistamines, antidepressants, anti-nausea meds, medications for anxiety, etc.) can be adjusted if they are making you drowsy. Your provider may also order tests or make some of the following suggestions to help pinpoint the causes of your fatigue:

• Order lab tests to assess for anemia, electrolytes, nutrition, thyroid, or testosterone levels;
• Make a referral to a cancer center registered dietitian;
• Reevaluate medication effects;

Your provider may also want to evaluate your pain management strategy if you are suffering from chronic or cancer-related pain. Unrelieved pain can interrupt sleep and lead to activity intolerance, which can, in turn, worsen fatigue. Similarly, untreated depression or anxiety can impact your energy levels; if you are feeling depressed or anxious, talk to your provider. Talk therapy, CBT, medications, journaling, and meditation can all be helpful in addressing these issues.

Exercise

Although it may seem counterintuitive, exercise helps prevent fatigue! Even 5 minutes of movement can help. Start by walking on a flat surface -- perhaps your sidewalk -- for just a few minutes, and build up over time. You can adjust your exercise routine for more tired days, or try yoga or tai chi at home. Another exercise option which may have multiple benefits is physical therapy or aquatherapy.

Save your energy

In addition to talking to your provider and finding interventions to help with your fatigue, it is also important to save your energy for activities and events to which you are most looking forward. In order to do so, make choices daily, be realistic, consider what you can do, delegate, or skip altogether.

Ask for help! Contact your support network to help with food preparation or tasks around the house. Schedule errands and activities for when you typically have the most energy. Take naps and consider making changes in your work schedule, if you are able. Finally, eat a healthy diet, stay hydrated, and plan caffeine intake accordingly.

Remember -- you are not alone! CRF can be debilitating but you can fight back!