Cancer Related Fatigue: Symptoms, Causes and Management

What is cancer fatigue?

Fatigue is often confused with tiredness. Tiredness happens to everyone — it's a feeling you expect after certain activities or at the end of the day. Usually, you know why you are tired and a good night's sleep solves the problem.

Fatigue is a daily lack of energy; it is excessive whole-body tiredness not relieved by sleep. It can last for a short time (a month or less) or stay around for longer (1-6 months or longer). Fatigue can prevent you from functioning normally and gets in the way of things you enjoy or need to do.

Cancer-related fatigue is one of the most common side effects of cancer and its treatment. It is not predictable by tumor type, treatment, or stage of illness. Usually, it comes on suddenly, does not result from activity or exertion, and is not relieved by rest or sleep. It is often described as "paralyzing" and may continue even after treatment is complete.

What Causes Cancer-Related Fatigue?

The exact reason for cancer-related fatigue is unknown. It may be related to the disease itself or its treatments.

The following cancer treatments are commonly associated with fatigue:

Chemotherapy. Any chemotherapy drug may cause fatigue, but it may be a more common side effect of drugs such as vincristine, vinblastine, and cisplatin. Fatigue usually develops after several weeks of chemotherapy. In some, fatigue lasts a few days, while others say the problem persists throughout the course of treatment and even after the treatment is complete.

Radiation therapy . Radiation can cause fatigue that increases over time. This can occur regardless of the treatment site. Fatigue usually lasts from 3 to 4 weeks after treatment stops, but can continue for up to 2 to 3 months.

Combination therapy. More than one cancer treatment at the same time or one after the other increases the chances of developing fatigue.

Bone marrow transplant. This aggressive form of treatment can cause fatigue that lasts up to one year.

Biological therapy. In high amounts, the biological substances used can be toxic and lead to persistent fatigue.

What Other Factors Contribute to Fatigue?

Tumor cells compete for nutrients, often at the expense of the normal cells' growth. In addition to fatigue, weight loss and decreased appetite are common.

Decreased nutrition from the side effects of treatments (such as nausea, vomiting, mouth sores, taste changes, heartburn, or diarrhea) can cause fatigue.

Cancer treatments, specifically chemotherapy, can cause reduced blood counts, which may lead to anemia, a blood disorder that occurs when the blood cannot adequately transport oxygen through the body. When tissues don't get enough oxygen, fatigue can result.

Medicines used to treat side effects such as nausea, pain, depression, anxiety, and seizures can cause fatigue.

Research shows that chronic, severe pain increases fatigue.

Stress can worsen feelings of fatigue. Stress can result from dealing with the disease and the "unknowns," as well as from worrying about daily accomplishments or trying to meet the expectations of others.

Fatigue may occur when you try to maintain your normal daily routine and activities during treatments. Modifying your schedule and activities can help conserve energy.

Depression and fatigue often go hand-in-hand. It may not be clear which started first. One way to sort this out is to try to understand your depressed feelings and how they affect your life. If you are depressed all the time, were depressed before your cancer diagnosis, are preoccupied with feeling worthless and useless, you may need treatment for depression.

QUESTION

Cancer is the result of the uncontrolled growth of abnormal cells anywhere in the body.
See Answer

What Can I Do to Combat Fatigue?

The best way to combat fatigue is to treat the underlying medical cause. Unfortunately, the exact cause is often unknown, or there may be multiple causes.

There are some treatments that may help improve fatigue caused by an under-active thyroid or anemia. Other causes of fatigue must be managed on an individual basis. The following guidelines should help you combat fatigue.

Assessment

Keep a diary for one week to identify the time of day when you are either most fatigued or have the most energy. Note what you think may be contributing factors.

Be alert to your personal warning signs of fatigue. Fatigue warning signs may include tired eyes, tired legs, whole-body tiredness, stiff shoulders, decreased energy or a lack of energy, inability to concentrate, weakness or malaise, boredom or lack of motivation, sleepiness, increased irritability, nervousness, anxiety, or impatience.

Energy Conservation

There are several ways to conserve your energy. Here are some suggestions:

Plan ahead and organize your work

Change storage of items to reduce trips or reaching.
Delegate tasks when needed.
Combine activities and simplify details.

Schedule rest

Balance periods of rest and work.
Rest before you become fatigued — frequent, short rests are beneficial.

Pace yourself

A moderate pace is better than rushing through activities.
Reduce sudden or prolonged strains.
Alternate sitting and standing.

Practice proper body mechanics

When sitting, use a chair with good back support. Sit up with your back straight and your shoulders back.
Adjust the level of your work — work without bending over.
When bending to lift something, bend your knees and use your leg muscles to lift, not your back. Do not bend forward at the waist with your knees straight.
Carry several small loads instead of one large one, or use a cart.

Limit work that requires reaching over your head

Use long-handled tools.
Store items lower.
Delegate activities when possible.

Limit work that increases muscle tension

Breathe evenly; do not hold your breath.
Wear comfortable clothes to allow for free and easy breathing.

Identify effects of your environment

Avoid temperature extremes.
Eliminate smoke or harmful fumes.
Avoid long, hot showers or baths.

Prioritize your activities

Decide what activities are important to you, and what could be delegated.
Use your energy on important tasks.

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When Should I Call my Doctor?

Although cancer-related fatigue is a common, and often expected, side effect of cancer and its treatments, you should feel free to mention your concerns to your doctors. There are times when fatigue may be a clue to an underlying medical problem. Other times, there may be treatments to help control some of the causes of fatigue.

Finally, there may be suggestions that are more specific to your situation that would help in combating your fatigue. Be sure to let your doctor or nurse know if you have:

Increased shortness of breath with minimal exertion
Uncontrolled pain
Inability to control side effects from treatments (such as nausea, vomiting, diarrhea, or loss of appetite)
Uncontrollable anxiety or nervousness
Ongoing depression

Reviewed by the doctors at The Cleveland Clinic Taussig Cancer Center.

Edited by Charlotte E. Grayson, MD,, Feb. 2004.