Fatigue: How to Tackle the Pesky Side Effect

Jerry Wilson claimed a front row seat. Wilson, diagnosed with stage IV colorectal cancer in 2009, has beaten the disease so far. What he can't shake is the fatigue he's experienced during his cancer journey.

"If you ever had a severe case of flu that totally drains you both physically and mentally, this is what I felt like all the time after starting a multiple chemo treatment," Wilson says.

Wilson has regained some of his energy now that he's taking a lower dose of chemotherapy and has learned to pace himself. He attended the recent Anderson Network Cancer Survivorship Conference to hear about other options.

He is among more than 100 cancer survivors and caregivers who heard Ellen Manzullo, M.D., professor in the Department of General Internal Medicine at MD Anderson, offer management strategies for cancer-related fatigue.

Manzullo, deputy division head in Internal Medicine, is one of two specialists who regularly evaluate patients in the MD Anderson Cancer-Related Fatigue Clinic.

According to Manzullo, fatigue is a common symptom. In fact, 30% of cancer survivors experience fatigue years after receiving treatment. Cancer and cancer treatment could be the cause, but Manzullo says many other medical conditions also could cause fatigue. These include:

• Anemia
• Hypothyroidism
• Sleep apnea
  

Patients at the Fatigue Clinic undergo a complete history, physical examination, diagnostic laboratory evaluation and an assessment for the presence of symptoms that can cluster with cancer-related fatigue such as:

• Pain
• Depression
• Anxiety
• Sleep disturbances
  

"We take a comprehensive approach," Manzullo says. "What we want to do is decrease the severity of the fatigue, and hopefully improve the patient's quality of life."

In addition, with the aid of a questionnaire, the Fatigue Clinic team gets an assessment of the severity of the patient's fatigue. "We also try to assess its impact on the patient's daily life," Manzullo explains.

The patient's next step
After the initial evaluation, Manzullo and her colleagues develop a tailored program to help alleviate the fatigue. This could include a prescription for antidepressants to fight depression, a stimulant like Ritalin to increase energy, or an individualized exercise program.  

Manzullo also offered the audience general strategies to conserve energy throughout the day:

• Set your priorities and pace yourself
• Delegate chores
• Schedule activities at peak times of the day
  

So what strategies will Jerry Wilson put into place?

"While this sounds contradictory, I've now signed up at a gym, and after one week of exercising on the various machines for about 30-45 minutes a day," Wilson says, "I can see a definite improvement in my energy level."

For more information or to make an appointment, contact the Cancer-Related Fatigue Clinic at 713-563-7100.