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Cancer-Related Fatigue: What You Need to Know

Published:February 21, 2017DOI:https://doi.org/10.1016/j.apmr.2016.12.020

      Many patients develop fatigue during and after treatment for cancer

      Cancer-related fatigue is the most common symptom in patients with a history of cancer.
      • Narayanan V.
      • Koshy C.
      Fatigue in cancer: a review of the literature.
      It is an overwhelming sense of exhaustion, tiredness, weakness, or lack of energy. Rest does not always improve fatigue. It may affect your memory, concentration, or ability to focus. Many people rate fatigue as the most bothersome symptom of cancer, even worse than pain. It can hinder people from their family and social life, their job, and other activities that they enjoy doing.

      Types of fatigue

      • Peripheral fatigue: This is caused by the nerves and muscles. You will feel very tired doing physical activities, and it will take a while to recover. Your muscles may feel heavy or weak. You may need to take frequent rest breaks and may feel profoundly tired after work or exercise.
      • Central fatigue: This is caused by changes in the brain. It may cause you to feel “foggy” and have poor memory. It may be made worse by exercise or exertion, but it may be present even when you are not physically active.
      • Central exhaustion syndrome: This is sudden, severe exhaustion. It may last 60 minutes or longer and usually occurs during or soon after activity. Unlike other types of fatigue, it is usually time limited. Patients with “chemobrain” (having trouble with memory, finishing tasks, or learning new things) may become exhausted after reading and other nonphysical activities.

      Is fatigue more likely with certain types of cancer or treatments?

      Aggressive cancers are more likely to result in fatigue because their treatments are harder on your body. Cancers in the brain are also more likely to cause fatigue than cancers elsewhere in the body. Radiation therapy often causes fatigue. Higher total doses of radiation and more radiation therapy sessions increase the risk of fatigue. Fatigue typically peaks 2 to 3 weeks after the beginning of radiation treatment. Radiation to the brain can cause chronic fatigue.
      Most chemotherapies have been known to cause fatigue as well. Receiving both chemotherapy and radiation may worsen your fatigue.

      What are other risk factors for and causes of fatigue?

      • Older age
      • Having fatigue before being diagnosed with cancer
      • Depression
      • Poor sleep habits or obstructive sleep apnea
      • Thyroid problems
      • Anemia
      • Poor nutrition

      How does a doctor diagnose cancer-related fatigue?

      A doctor can diagnose cancer-related fatigue by examining you and taking a detailed history of the type of cancer you have, the treatment you receive, and other health problems you may have. Your doctor may ask you to complete a questionnaire in order to assess your fatigue. Your doctor will also need to look for other causes of fatigue such as vitamin deficiencies, anemia, or hormone abnormalities. Blood tests or other lab tests may be ordered when you visit with your doctor.

      What kind of treatment is available for cancer-related fatigue?

      Most people see their symptoms gradually get better with time. If your vitamin levels are low, your doctor may give you supplements. Your doctor may also treat anemia or hormone imbalances. Here are some other ways that your doctor may treat your fatigue:
      • 1.
        Medications: Doctors may prescribe methylphenidate (Ritalin), modafinil, or amantadine. These medications are stimulants. Sometimes they improve your energy but do not work for all people. Antidepressants are also sometimes useful.
        • Mucke M.
        • Mochamat
        • Cuhs H.
        • et al.
        Pharmacological treatments for fatigue associated with palliative care: executive summary of a Cochrane Collaboration systematic review.
      • 2.
        Physical activity: Physical activity is the only treatment consistently proven to reduce fatigue. A regular exercise program will help with your fatigue and can even be completed during chemotherapy and radiation treatment. Walking or using a stationary bike is a good option (there are inexpensive stationary pedals that are not attached to a bike and can be placed on the floor to be used in your home while sitting). Twenty minutes of exercise 4 to 5 times per week is recommended, or 60 minutes 3 times a week.
        • Kuchinski A.M.
        • Reading M.
        • Lash A.A.
        Treatment-related fatigue and exercise in patients with cancer: a systematic review.
        Pacing yourself can also be helpful. Plan important, energy-sapping activities during those times of the day when you tend to be less fatigued. You should divide tasks throughout the day or week so you can complete them. You should take short rest breaks.
      • 3.
        Psychological health: Focus on a recreational activity that you can enjoy for 20 to 30 minutes, 3 times a week. Such activities can help reduce fatigue and improve memory and concentration. This will also improve your mood. If you are having trouble finding something to do, work with a counselor to learn ways to manage fatigue.
        It is important to treat anxiety and depression because these can worsen fatigue. Antidepressants can also be helpful if your fatigue is caused by or is the result of depression—ask your doctor.
      • 4.
        Eating healthy: Be sure to stay hydrated. You should avoid foods with simple sugars because they can give immediate energy but then cause you to be tired after they are digested. Alcohol can disrupt sleep and cause fatigue, so should be limited. Drinking a few caffeinated beverages a day can also help. Coffee and tea are the best sources of caffeine because they do not contain artificial ingredients. Keep in mind that sodas, energy drinks, and even some flavored waters may contain caffeine.
      • 5.
        Good sleep hygiene: Having good sleep habits is essential to lowering fatigue. These include going to bed at the same time every night, only using your bed for sleep, not using computers or other screens before bed, not taking naps more than 20 minutes during the day, and avoiding alcohol before sleep. If you have tried these and still do not feel that you are sleeping well, talk to your doctor about sleep. You may have an undiagnosed sleep disorder or benefit from a medication to help you sleep.
      • 6.
        Other treatment options that may help—ask your doctor: Qigong (a method of breathing deeply to relax), meditation, and acupuncture have been shown to help some people with fatigue. It is important to find an activity that works for you and to try many different options if you are struggling with fatigue.

      Authorship

      This page was developed by Sara A. Christensen Holz, MD, and Sean R. Smith, MD.

      Disclaimer

      This information is not meant to replace the advice of a medical professional. You should consult your health care provider regarding specific medical concerns or treatment. This information/education page may be reproduced for noncommercial use by health care professionals to share with their patients and caregivers with appropriate attribution. Any other reproduction is subject to approval by the publisher.

      References

        • Narayanan V.
        • Koshy C.
        Fatigue in cancer: a review of the literature.
        Indian J Palliat Care. 2009; 15: 19-25
        • Mucke M.
        • Mochamat
        • Cuhs H.
        • et al.
        Pharmacological treatments for fatigue associated with palliative care: executive summary of a Cochrane Collaboration systematic review.
        J Cachexia Sarcopenia Muscle. 2016; 7: 23-27
        • Kuchinski A.M.
        • Reading M.
        • Lash A.A.
        Treatment-related fatigue and exercise in patients with cancer: a systematic review.
        Medsurg Nurs. 2009; 18: 174-180