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Fatigue and Cancer

Cancer-related fatigue is described as a feeling of intense exhaustion that can be more severe than typical fatigue. In some patients, the fatigue can be mild. In extreme cases, some patients may struggle to carry on with day-to-day activities. It is a very common cancer symptom, so it is important to talk to your doctor about how to minimize the impact it has on your quality of life.

What causes cancer fatigue?

The causes of cancer fatigue vary but they are often related to cancer treatments or the way cancer stresses the body. Excess inflammation, the activation of cortisol, hormonal imbalances, changes in metabolism associated with weight loss and weakened muscles all contribute to cancer fatigue.

Other conditions that can cause cancer fatigue include chemotherapy-induced anemia, pain, depression or emotional distress, insomnia and alterations to thyroid and other hormone levels. Other causes can include:

Aggressive surgery, chemotherapy, immunotherapy or radiation treatments
Complications from pre-existing medical conditions such as uncontrolled diabetes, thyroid problems, heart disease or rheumatoid arthritis
Sleep disorders
Cytokine reactions
Poor nutrition
Chronic respiratory illness
Autoimmune disorders

How long does cancer fatigue last?

How long cancer fatigue lasts will depend on the cause and how it is treated. For some patients, cancer fatigue tends to get worse towards the end of their chemotherapy/radiation treatment. For others, cancer fatigue can last even during survivorship of certain blood or bone cancers or if hormonal maintenance therapy is required.

What are some strategies to help with cancer related fatigue?

You should address the medical conditions that can be corrected.

Anemia is a condition in which the body does not have enough healthy red blood cells. It is one of the most common conditions that contributes to cancer fatigue. Additional tests may be ordered to establish the cause and a treatment plan. Blood transfusions can help anemias without a treatable cause and red blood cell stimulating medications are a good option for chemotherapy-related bone marrow suppression.
Optimizing pain management can improve cancer fatigue but some medications may have drowsiness as a side effect. Correct dosing and choosing the right medication can help with this.

Exercise

Exercise is regarded as the most effective way to prevent or improve cancer fatigue during and after treatment. The recommendations include 150 minutes of moderate aerobic exercise per week and 2-3 strength training sessions per week.
Maintaining the physical endurance and muscle strength to continue activities you enjoy can help cancer related fatigue significantly.
MD Anderson’s Rehabilitation Services can help develop treatment plans to combat fatigue or manage specific health concerns.

Insomnia management

Minimize daytime naps (especially after 3 p.m.) and keep them short (about 20 minutes). Long naps can cause your fatigue to worsen.
Avoid screens, phones, tablets and other sources of blue light for at least one hour before going to bed.
Keep a regular sleep routine with a similar bedtime and awake time throughout the week, even on weekends. Try not to vary by more than 1 hour.
Integrative medicine interventions like yoga, meditation and cognitive behavioral therapy can also be helpful in improving sleep.

Medications for fatigue

Psychostimulant medications can increase energy levels and may be taken on a schedule or even as needed in certain cases.
Corticosteroids have been used to treat cancer related fatigue. The evidence to support these medications is mixed and varies depending on how advanced the cancer is.
Some patients are interested in trying vitamins or herbal supplements for fatigue. It is important to discuss these and potential interactions with other medications with your doctor.

Medication for mood disorders

Antidepressants for people with concurrent depression can help with fatigue. Cancer diagnosis and treatment can also trigger depression in some people who were not depressed before. These people may also benefit from antidepressants.
Medication for endocrine abnormalities
Patients with low levels of certain hormones and vitamins can receive supplements. These include supplements for testosterone and for vitamin D.
Thyroid hormone levels can be imbalanced by cancer. Patients can receive medication to manage their thyroid hormone levels.

Cancer treatment side effect: Fatigue

If you’re always feeling physically, mentally or emotionally exhausted, you’re not alone. Fatigue is the most common side effect experienced by patients during and after cancer treatment.

And, because there’s no way to test for cancer-related fatigue, it tends to be underdiagnosed.

The good news is that it’s possible to alleviate cancer-related fatigue. By recognizing the signs and symptoms of fatigue, you can empower yourself to discuss this side effect with your care team and get help.

Here’s what you should know about cancer fatigue, according to our clinical nurse Kim Kitchen.

Cancer-related fatigue is different from the fatigue experienced by healthy people

When healthy people are fatigued from their daily activities, extra rest typically helps. But that’s not always the case for cancer patients. That’s because fatigue can be caused by many cancer treatments, as well as the cancer itself and even other side effects. And that means cancer-related fatigue can last for long periods – and that cancer patients may get tired more easily and by exerting less energy than fatigued healthy individuals.

Cancer and cancer treatment put you at risk for fatigue

Part of the reason fatigue is so common among cancer patients is because it can be caused by so many different aspects of the cancer experience. This includes:

Cancer treatment, including chemotherapy, hormone therapy, radiation therapy, surgery and even recovery from surgery.
Anemia, a common side effect of chemotherapy
Loss of appetite, which may be caused by nausea and vomiting and can keep you from getting enough nutrients, such as vitamin B12, folic acid, iron and protein
Medications, such as those prescribed for depression, pain, sleep and nausea
Insomnia, another common cancer treatment side effect
Anxiety, depression and other mood disturbances, which are often triggered by a cancer diagnosis or treatment
A decline in physical activity

It’s possible to manage cancer fatigue

Cancer-related fatigue can affect your quality of life and make it harder for your body to heal from cancer treatment. So it’s important to try to manage your cancer-related fatigue. Here’s what Kitchen recommends.

Get rest, but not too much. Opt for small rest breaks or naps between activities instead of one big nap. That’s because too much rest may make you even drowsier or make it difficult to sleep at night.
Accept help from others. When people offer to help, take them on it. Let them do things like go to the grocery for you, mow your lawn or drive your kids to school and activities. This way, you can conserve your energy for when you need it.
Maintain a healthy diet. This can be hard during cancer treatment, especially if you’re dealing with appetite loss or nausea, but do your best to eat enough protein and calories so that your body can get healthy. If you are having trouble getting enough calories and are an MD Anderson patient, ask a member of your care team to refer you to a dietitian.
Distract yourself. Dance, watch TV, listen to music or read a good book to distract yourself from the fatigue. Doing something you enjoy may also boost your mood.
Exercise. Though you’re tired, exercise is the best way to reduce cancer-related fatigue. Kitchens recommends taking a brisk walk, or trying cycling, swimming, aerobics, strength training or resistance training – basically, whatever it takes to get you moving, even if it’s only for a few minutes. Bonus: exercise will also help you sleep better and boost your mood.
Keep a fatigue journal so you can start to see patterns and prioritize your activities.

MD Anderson has resources to help you manage your cancer fatigue

You don’t have to try to manage cancer fatigue alone. Talk to your doctor about the fatigue symptoms you’re experiencing. And, if you’re an MD Anderson patient, ask your doctor to refer you to our Cancer-Related Fatigue Clinic. Our team of doctors and nurses will work with you to develop a comprehensive, personalized plan for managing your fatigue so you can get back to living your life faster.

Request an appointment at MD Anderson online or by calling 1-877-632-6789.