Cancer-Related Fatigue

What is fatigue?

Fatigue can be confused with tiredness. Everyone gets tired. In fact, it is an expected feeling after certain activities or at the end of the day. Usually, we know why we're tired and a good night's sleep will solve the problem.

Fatigue is less precise, less cause-and-effect. Fatigue is a daily lack of energy; an unusual or excessive whole-body tiredness, not relieved by sleep. It can be acute (lasting a month or less) or chronic (lasting from 1 month to 6 months or longer). Fatigue can have a profound negative impact on a person's ability to function and quality of life.

What is cancer-related fatigue?

Cancer-related fatigue (CRF - sometimes simply called "cancer fatigue") is one of the most common side effects of cancer and its treatments. It is often described as "paralyzing." Usually, it comes on suddenly, does not result from activity or exertion, and is not relieved by rest or sleep. It may not end - even when treatment is complete.

What causes CRF?

The exact reason for cancer fatigue is unknown. CRF may be related to both the disease process and treatments, including surgery, chemotherapy, and radiation therapy. Cancer treatments commonly associated with CRF are:

Other factors that may contribute to cancer-related fatigue include:

Combating cancer fatigue

The best way to combat fatigue is to treat the underlying cause. Unfortunately, the exact cause may be unknown, or there are multiple causes. There are some medical interventions that may assist some causes, such as anemia or hypothyroidism. Other causes must be managed on an individual basis.

The following are tips you can use to combat fatigue: energy conservation, nutrition, exercise, and stress management.

Cancer-related fatigue assessment:

Energy conservation during cancer fatigue

Plan ahead and organize your work:
Schedule rest:
Pace yourself:
Practice proper body mechanics to combat cancer fatigue:
Limit overhead work:
Limit isometric work:
Identify effects of your environment that may cause cancer-related fatigue:
Prioritize:
Nutrition to combat cancer fatigue:

CRF is often made worse if you are not eating enough or if you are not eating the right foods. Maintaining good nutrition can help you feel better and have more overall energy. The following are strategies to help improve nutritional intake.

Basic calorie needs:
Protein rebuilds and repairs damaged (and normally aging) body tissue:
Fluid needs:
Supplemental vitamins:
Role of a dietitian in fighting cancer fatigue:
Cancer-related fatigue and exercise

Decreased physical activity, which may be the result of illness or of treatment, can lead to tiredness and lack of energy. Scientists have found that even healthy athletes forced to spend extended periods in bed or sitting in chairs develop feelings of anxiety, depression, weakness, fatigue, and nausea. Regular moderate exercise can decrease the feeling of fatigue and help a person feel energetic and stay active. Even during cancer therapy, it is often possible to continue exercise. You need to check with your physician before you start an exercise program.

Benefits of exercise:

What is the right kind of exercise?

What is the wrong kind of exercise?

Stress management

Managing stress can play an important role in combating fatigue. The following are suggestions:

Measures to improve sleep:

Talk to your health care providers

Although CRF is a common and often expected side effect of cancer and its treatments, you should feel free to mention such feelings to the people providing your care. There are times when fatigue may be a clue to an underlying medical problem. Other times, there may be medical interventions to assist in controlling some of the causes of fatigue. Finally, there may be suggestions that are more specific to your situation that would help in combating your CRF. Be sure to let your doctor or nurse know if any of the following are present:

Things your health care provider may recommend for cancer-related fatigue

The first step in treating fatigue is knowing the problem exists. Many people don't bother to mention fatigue to their doctors because they believe it is normal. It is vital that you discuss this and all symptoms or side effects with your health care provider. Then, efforts can be directed at determining the cause of the problem and prescribing appropriate treatment. Your particular cancer treatment regimen, with its known side effects, may provide clues for your doctor or health care professional. A simple blood test, for example, can determine if you are anemic.

There is no single medication available to treat fatigue. However, there are medications available that can treat some of the underlying causes. Make sure you speak with your health care professional if you are feeling fatigued.

Note: We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained about cancer fatigue in this website is meant to be helpful and educational, but is not a substitute for medical advice.

References

ONS PEP card for Fatigue 2005

NCCN Guidelines for Cancer Related Fatigue 2010

Berger, A.M. (2009) Update on the State of the Science: Sleep-Wake Disturbances in Adult Patients with Cancer. Oncology Nursing Forum Vol. 36, No 4, P E165-177.

Mustian,K.M. et al. Effect of YOCAS yoga on sleep, fatigue, and quality of life: A URCC CCOP randomized, controlled clinical trial among 410 cancer survivors. J Clin Oncol 28:15s, 2010 (suppl; abstr 9013)

 

This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. For additional health information, please contact the Center for Consumer Health Information at the Cleveland Clinic (216) 444-3771 or toll-free (800) 223-2273 extension 43771. If you prefer, you may visit www.clevelandclinic.org/health/ or www.clevelandclinicflorida.org. This document was last reviewed on: 12/10/2014

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