You don't have to put up with cancer-related fatigue
Xingwei Sui, MDFatigue is a common problem and also one of the most distressing symptoms associated with cancer and its treatment, yet it has been consistently under-reported. Many patients believe that feeling weak, tired or exhausted is a necessary evil when your body is fighting cancer. Cancer-related fatigue profoundly affects the quality of life of patients and their families through physical, psychosocial, and economic/occupational aspects.
The most important factors contributing to cancer-related fatigue are:
- treatment with chemotherapy or radiation therapy (RT)
- anemia
- pain
- lack of exercise
- sleep disturbance
- poor nutrition
- emotional distress
Anemia is the most common reversible cause of cancer-related fatigue, particularly among patients receiving chemotherapy. Treatment includes red blood cell (RBC) transfusion, or using erythropoietin stimulating agent such as procrit.
Pain: Pain in cancer patients is also considered under-reported. If you are in pain talk with your doctor, it could be contributing to your cancer-related fatigue.
Lack of exercise: To avoid fatigue, cancer patients often are advised to rest and down-regulate their daily activities. However, because inactivity can induce muscular wasting, prolonged rest can lead to further loss of physical strength and endurance. Although you may not think so, physical exercise training programs can increase your functional capacity, leading to reduced effort in performing usual activities and a decreased sense of fatigue. Again, talk with your doctor to develop a program that is right for you.
Emotional distress and sleep disturbance: Sleep disturbance associated with fatigue is often difficult to treat and manage. It may be influenced by numerous factors including daytime naps, depression, anxiety, medication, sleep interruption because of nocturia or hot flashes, and evening food and/or beverage intake. Cognitive-behavioral therapy and stress reduction may help insomnia and sleep disorders.
Poor nutrition: One of the most common side effects of cancer is a change or loss of appetite which results in fatigue. However, your body has never needed proper nutrition more. It may be helpful to keep a journal of what you are eating. When you speak with your doctor next you can go through it together and make sure your diet is providing your body with all the essential nutrients it needs.
Medication:Psychostimulants (methylphenidate, dexmethylphenidate, or modafinil) and antidepressants may be useful if the above methods do not improve fatigue.
If you are suffering from cancer-related fatigue don’t just assume that being exhausted “goes with the territory.” Talk with your doctor to develop a plan and get you functioning at your best level.
Reader Comments (6)
I was diagnosed with breast cancer December 2008. After surgery, chemo, and radiation ending July 2009 I felt quite good. Then October 2009 I started complaining to my doctors about a really deep fatigue and underlying pain that nothing seemed to help. After seeing heart and arthritis doctors with no help my oncologist referred me to a doctor specializing in nutrition for the cancer patient and a sleep study doctor. I took myself to a chiropractic doctor (which I never thought I would) who dealt with the major pain. After a long hard summer 2010 getting used to an APAP machine and Really changing my diet and adding some supplements I am Finally getting my energy back. I might add that I was addicted to walking, so did that throughout treatment and fatigue . Just this to say, keep looking for help with your fatigue. It took me over a year to get my energy back:)
Barbara,
Thank you for sharing your personal struggle and also your success! The really great part about this is that you continued talking to your doctor throughout your own journey when you knew something wasn't right with your body.
Would you mind sharing with us how you changed your diet?
Hah, how I changed my diet! That in itself is an ongoing adventure. I asked for a sensible nutrition plan (I had been getting too much advise from others).
At this point I try to eat nothing out of a box, try to eat five different colors of fruits and vegetables--5- 8 servings a day. I do eat a green salad daily. I am supposed to avoid baked goods, but don't always. This includes even whole grain breads. I used to drink two glasses of milk a day, I now limit milk to a splash on my steel-cut soaked- overnight oatmeal--there go the Cheerios and bran flakes.
The naturopath said to eat two cups of cooked whole grains a day. That was the biggest change. I like to keep cooked brown rice and barley on hand in the fridge and I throw quinoa in just about everything I cook. When I eat the cooked whole grains I do not crave bread. Limiting bread and milk was a big change. My favorite treat is a cup of blueberies every day. I could also do cranberries and raspberries daily, but haven't yet. Eggs, breans and nuts and yogurt are my main protein with some chicken, lamb, venison and a little cheese. I was told to limit red meat which I already did. A little protein with each meal.
I am still experimenting--got tired of broccoli, so am enjoying a cabbage slaw with homemade Asia an dressing. I make my own dressings and use sparingly. Even like it with my breakfast egg instead of toast. Olive oil and Irish butter are included daily. My favorite cookbook is The Cancer Fighting Kitchen Cookbook. There is more, but this gives you an idea. It is all very doable and not too crazy.
When I was diagnosed and at the time of my surgery, I was attending Weight Watchers and at my goal weight determined to keep it that way. I quit the meetings during treaments and did fine, but when the heavy fatigue set in I found myself feeding my tiredness and gained unwanted weight. I went back to WW and lost most of the weight without using what I call "fractured foods." This includes lowfat, reduced calorie, artificially sweetened, messed up foods. Whole foods are much better for you. I do not do any juicing or raw vegetable type diets. I find variety and trying new things helps.
Wow! Those really are some changes. I think you've inspired another blog post! We'll follow up with our fabulous staff in the Integrative Cancer Care Program with some more information. Again, thank you for sharing and keep up the great work!
I am currently having this exact problem among other things. My old doctor Hui Wang, thought i was just making it all up. "your too young" or "i dont think chemotherapy would do that" well im having pain and fatigue... but that must just be me over reacting or lying. Thank goodness i have a new doctor monday! Never have been so disrespected by a doctor, and i spent over 3 years just trying to get my cancer diagnosed so that is saying something! Oh and mrs. wong. in regards to our misunderstanding being a "cultural difference" i grew up in Thailand and Kadena Airbase Okinawa, most my life i spent conversing and living with South East Asians... never have i had issues doing so, but now i guess i had a midlife cultural fiasco. to that i say heres a personal message: ni gen ben mei you nao. yong ni de xi gai xiang shuan le!
Daniel,
We have sent you a private e-mail. Please don't hesitate to contact us directly. Our e-mail is provcancer@providence.org