ost cancer patients experience fatigue at some point during their illness. And this is not regular run-of-the-mill fatigue either.  Cancer Related Fatigue (CRF) can be mild or debilitating or anywhere in-between.  You just feel completely spent - physically, emotionally and mentally.

The first rule is tell your doctor. Your medical team relies on your subjective reporting about how you are feeling – are you tired? how tired are you? when are you tired? and so on.  Just like pain, the best definition of fatigue is what YOU say it is.

Fatigue can be caused by the cancer itself or the treatment against it.  In 1999, researchers found that people with blood cancers tended to experience greater fatigue than people with solid tumors. Severity was associated with trouble sleeping and trouble eating. 

Fatigue may be caused by other factors : dehydration, anemia, electrolyte imbalances or oxygenation.  Steps can be taken to reduce fatigue.  For instance, medications such as Procrit and Epogen can be prescribed to combat anemia. You should tell your medical team if you are feeling tired.

YOUR SCHEDULE – SLOW DOWN

You may be extra tired because you’re still following your pre-illness schedule. It’s time to reassess. Certainly low-priority items can wait until you are feeling more up-to-it. 

PAIN MEDICATIONS

Perhaps the medications you are taking sap your energy but also keep you from sleeping or sleeping well.   Opioids, some hypnotics and other medicines such as hormones, steroids and non-steroidal anti-inflammatory drugs (NSAIDS) can effect the quality of sleep (see below)  Talk to your medical team about developing a strategy to offset these effect such as adding some caffeine with pain medications. 

NUTRITION – EATING WHEN YOU DON’T FEEL WELL

Maybe your diet needs to be examined. If the chemo or radiation is making you feel nauseous or your food taste bad, a nutritionist or dietician can help you find high protein foods that you can get down, keep down and get your energy level back up.

 SLEEP – GETTING ENOUGH?

Are you able to sleep through the night?  Sleep disruption is a common contributor to fatigue. If your sleep patterns have changed since you became ill, tell your doctor. Keep a sleep log to help your medical team understand and assess the severity of the problem. . Make notes of when you lie down, how long you slept, what awoke you, when you took naps and whether you used a sleep aid.   You may be prescribed therapy or medicine to help reduce natural anxieties that may be keeping you awake.

EXERCISE – GET THE POWER OF ENDORPHINS 

Exercise can battle fatigue. When you exercise, endorphins are released. Endorphins are naturally occurring painkillers in your brain. They promote a feeling of well-being and when you’re fighting the fight-of-your-life, you can use all the help you can get. Talk to your healthcare team. Perhaps you need to meet with a physical therapist to develop an exercise regimen vigorous enough to help battle fatigue without hindering your treatment schedule.

STRESS – ANXIETY - DEPRESSION

And finally, fatigue can be caused by emotional or psychological stress.  There’s no doubt about it – battling a life threatening disease is stressful. You have probably felt angry , anxious, and depressed.  A psychiatric nurse, social worker, psych-oncologist or psychiatrist should be seen. They can help you in this time of need.

ALTERNATIVE TREATMENTS 

You may be inclined to check out alternative therapies such as vitamins, mineral supplements, herbal remedies and hormones to combat your fatigue.  It’s important to discuss this with your medical team, even if you are hesitant to do so, because these agents could impact the effectiveness of the treatment your team is administering.

written by Rachael Myers Lowe, cancerpage.com
reviewed by Katie Mullaly, RN, MSN

SOURCE: 

-National Guideline Clearinghouse.
-National Comprehensive Cancer Network -Proceedings, November 1999, pp 91-97
-Oncology Nursing, Fatigue. pp. 234-238
-Mind, Body and Soul: a Guide To Living With Cancer  - by Nancy Hassett Dahm  (Taylor Hill Publishing, IBSN: 0-9702904-0-3)

WEB RESOURCES:

-Oncology Nursing Society
-Cancer Fatigue Website
-Mayo Clinic – Nutrition tips for cancer patients.
- CancerCare.org teleconference archives offers recorded discussions on fatigue
- Cancer Supportive Care Program - Web site derived from the  book Cancer Supportive Care by Ernest H. Rosenbaum, MD & Isadora R. Rosenbaum, MA

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