Cancer-Related Fatigue

Cancer-related fatigue is a daily lack of energy or strength and unusual or excessive whole-body exhaustion that, unlike tiredness, is not the result of activity or effort and cannot be relieved by rest or sleep.

When healthy individuals experience fatigue (tiredness), it can be relieved by sleep and rest. Cancer-related fatigue is a daily lack of energy or strength and unusual or excessive whole-body exhaustion that, unlike tiredness, is not the result of activity or effort and cannot be relieved by rest or sleep. Cancer-related fatigue is the most common symptom experienced by cancer patients. Most patients consider fatigue to be one of their most distressing symptoms, which can often disrupt a patient’s normal routine and even cause changes in their work status. Historically, cancer-related fatigue was underreported, underdiagnosed, and undertreated; however, a renewed focus by the healthcare community is helping to address this lapse.

One of the challenges in managing cancer-related fatigue is being able to distinguish it from other conditions such as depression. Cancer-related fatigue often occurs with other symptoms, such as pain or distress, and is known to occur with depression in cancer patients. Cancer-related fatigue can be caused by a range of factors, including cancer treatments, medications, pain, nutritional deficiencies, metabolic changes (changes in chemical processes that take place in the body to produce energy and other materials needed for essential life processes), stress, insomnia, anxiety, and depression. In particular, cancer treatment such as chemotherapy, radiation therapy, stem cell transplantation, and biologic therapy are often associated with fatigue. Anemia (a drop in the number of red blood cells that carry oxygen throughout the body) can be caused by the lymphoma or its treatments. This condition often leads to fatigue because with less oxygen available, the body struggles to sustain its normal activity levels.

Managing fatigue is an important part of the comprehensive healthcare of individual patients; therefore, patients are usually assessed for fatigue at diagnosis and throughout the course of their disease management. Cancer-related fatigue can last long after treatment is complete.

Symptoms of Fatigue:

• Extreme weariness and/or overall lack of energy
• Muscle weakness, especially in the arms and legs; difficulty climbing stairs or walking short distances
• Shortness of breath
• Difficulty performing simple tasks (such as cooking, cleaning, making the bed, or taking a shower)
• Difficulty concentrating or making decisions
• Moodiness, frustration, and/or irritability
• Waking up tired after a full night’s sleep

It is important that patients inform their physician about their fatigue, so it can be evaluated. Although not all causes of cancer-related fatigue are well understood, the patient’s physician may want to perform tests to try to determine what might be causing the fatigue. Patients should be as specific as possible about their level of fatigue and when it occurs (such as in the morning, after treatment, etc.), as well as the activities that cause the most difficulty. As with other aspects of cancer and its treatment, fatigue varies from person to person.

Fatigue can have an extremely negative impact on one’s quality of life. The severity of fatigue and how long it lasts depends on many factors including the type and length of cancer treatment and a patient’s overall health status. Many patients and physicians avoid discussing fatigue because they believe there is little that can be done to alleviate it. Although fatigue may not be completely preventable, the following tips may help patients manage or minimize this troublesome symptom.

Patient Tips For Managing Fatigue

• Keep a diary to help identify which times of the day or times related to treatment cycles you have the most energy.
• Document which activities make you feel fatigued or energized.
• This information can help you plan your activities around the times you have the most energy and will also help you communicate with your physician.
• Delegate. Ask family or friends for assistance with your most energy-draining activities or chores that must be done during your lowest energy times. Often, family members or friends are happy to help with chores and other everyday tasks.
• Make sure you schedule appropriate time to rest between your daily activities. Prioritize tasks so your energy is used to accomplish your most important tasks or those that cannot be delegated.
• Organize your surroundings. Keep the items you need most frequently in an easily accessible location.
• Consider if you are experiencing any specific symptoms that may be related to fatigue. Treating or managing symptoms such as nausea, vomiting, pain, fever, or lingering depression can help increase your energy supply.
• Avoid food and drinks that may not provide you with sustainable energy. For example, drinking too much caffeine can cause fatigue.
• Try to identify any causes of stress. Speak with a professional counselor to help you cope with the stress of your illness and incorporate relaxation or other stress-relieving techniques into your routine.
• Exercise if your physician recommends it. An expert on your healthcare team can help you develop a personalized exercise plan.
• Eat a healthy, well-balanced diet, and drink at least eight glasses of water each day. Review your diet with your physician or a nutrition counselor. Treatment and recovery often put extra demands on your body for calories, nutrition, and fluids.
• Maintain a regular sleep schedule. If you are having trouble sleeping, consult your health care team about possible solutions. In addition, napping can be a quick refresher, but avoid spending too much time in bed.

Treatment for Fatigue

If tests determine that a patient’s fatigue is caused by anemia or low thyroid hormone levels, for example, a physician may prescribe treatments for these conditions that will also relieve their fatigue. For patients with advanced disease or those receiving cancer treatments, psychostimulants such as methylphenidate or wakefulness agents such as modafinil may help. However, these drugs do not seem to work well in patients who are disease free and not receiving cancer treatments.

Treatment options can incorporate complementary therapies as well. In addition to previously mentioned recommendations, including a balanced diet and physical activity, other options such as acupuncture may help to relieve fatigue. For more information, please view the Integrative Oncology fact sheet on the Foundation’s website at lymphoma.org/publications.

Lymphoma Care Plan

Keeping your information in one location can help you feel more organized and in control. This also makes it easier to find information pertaining to your care and saves valuable time. The Foundation’s Lymphoma Care Plan document organizes information on your health care team, treatment regimen, and follow-up care. You can also keep track of health screenings and any symptoms you experience to discuss with your health care provider during future appointments. The Lymphoma Care Plan document can be accessed by visiting lymphoma.org/publications.

Patient Education Programs

The Foundation also offers a variety of educational activities, including live meetings and webinars for individuals looking to learn directly from lymphoma experts. These programs provide the lymphoma community with important information about the diagnosis and treatment of lymphoma, as well as information about clinical trials, research advances and how to manage/cope with the disease. These programs are designed to meet the needs of a lymphoma patient from the point of diagnosis through long-term survivorship. To view our schedule of upcoming programs, please visit lymphoma.org/programs.

Lymphoma Resource Center

The Foundation’s Lymphoma Resource Center staff are available to answer your general questions about lymphoma and treatment information, as well as provide individual support and referrals to you and your loved ones. Callers may request the services of a language interpreter. The Foundation also offers a one-to-one peer support program called the Lymphoma Support Network and clinical trials information through our Clinical Trials Information Service. For more information about any of these resources, visit our website at lymphoma.org, or contact the Lymphoma Resource Center at (800) 500-9976 or [email protected].

Para información en Español, por favor visite lymphoma.org/es. (For Information in Spanish please visit lymphoma.org/es).