Figuring Out Fatigue

There’s nothing like a good night’s sleep—unless cancer is what’s making you tired.

About nine of every 10 patients struggle with fatigue during treatment, and unlike everyday fatigue, cancer-related fatigue is a debilitating exhaustion that can’t be cured with a soft bed or cup of coffee. Sleep offers no relief against the persistent tiredness. And the side effect can drain some patient to the point where they can’t stand in the shower or muster the energy to dress.

The exact reason for cancer-related fatigue remains unknown. Treatment may be the culprit, though the cancer itself may be to blame.

So what’s an exhausted cancer patient to do? Experts offer these tips:

• Conserve energy. Prioritize so you have enough energy to do what’s most important. And don’t rush—take your time, even if it feels like you’re moving at a snail’s pace. Spread chores throughout the week and make rest part of your daily routine—but limit naps to no more than 30 minutes.

Most importantly: Ask for help. If mowing the lawn, doing laundry or running errands are too tiring, enlist friends and family to help. If a trip to the grocery store is necessary, most stores offer motorized carts for customers.

• Get moving. It may sound contradictory, but regular physical activity can lessen fatigue. Patients can increase their energy by exercising several times a week, says Wendy Crabbe, RN, an oncology nurse practitioner at University of Texas Health Science Center at San Antonio. But she cautions them to start slow and increase slowly.

A half-hour walk is a good place to start for patients battling severe fatigue. You can even split it up—15 minutes in the morning and 15 minutes in the afternoon. Patients with the energy to do more can try a combination of exercises. There’s aerobic (walking, swimming or bicycling), resistance/strength (light weights and resistance bands) and simple stretches to improve flexibility.

• Rearrange your environment. Simply picking up or putting away the things you use most can add up to sap your energy. So place things you use often within easy reach, whether it’s your favorite cooking pot or the shampoo in the shower.

• Optimize sleep quality. Go to bed and get up at about the same time every day, including weekends. Don’t exercise in the evening and avoid caffeinated drinks and foods. You may also consider creating a relaxing bedtime ritual that starts one hour before bedtime—and that means turning off the television. Listen to calming music or take a bath instead. Do not drink alcohol or eat immediately before going to bed.

• Screen for and treat the possible underlying cause. Sometimes fatigue serves as a clue to another medical problem. If cancer treatment depletes a patient’s red blood cell count, for instance, the body’s tissues don’t get enough oxygen and fatigue sets in. Treat the anemia, and you’ll start to get your energy back. Other side effects of treatment that can lead to fatigue include pain, depression, anxiety and nausea.

Patients expect to be fatigued during treatment. “The issue is how much of a fuss they’ll make about it,” says Charles Cleeland, PhD, chair of the department of symptom research at M.D. Anderson Cancer Center in Houston. Too often, he says, patients don’t bring it up, and physicians don’t ask.

It’s helpful for patients to know they’re not losing their marbles. Fatigue is a natural consequence of treatment...

So M.D. Anderson came up with a kind of safeguard: a one-page questionnaire given to patients that’s called the Brief Fatigue Inventory. The assessment, developed by Cleeland and his colleagues, instructs patients to rate their fatigue on a scale of zero to 10. It also asks patients to rate how fatigue has interfered with their quality of life—how active they are, what their mood is like, how far they can walk before exhaustion kicks in.

Other places are creating websites so patients can report fatigue and other symptoms to their physicians in real time. Researchers at Memorial Sloan-Kettering Cancer Center have developed the Symptom Tracking and Reporting for Patients, or STAR, website. Patients don’t have to wait days or weeks until their next office visit if the symptoms are affecting their quality of life. They can simply go online and alert their physician to a new or worsening symptom. The study testing the web-based approach should be complete early next year.

As for treating cancer-related fatigue, what works for one patient may not work for another. But a number of strategies are gaining traction. Yoga, acupuncture and massage may be effective at fighting off fatigue, according to some studies. The stimulant Ritalin (methylphenidate), a drug typically prescribed for attention deficit hyperactivity disorder (ADHD), is being used with some success to treat fatigue in cancer patients. The narcolepsy drug Provigil (modafinil) may also offer relief.

Fatigue typically subsides after treatment ends, Cleeland says. Until then, a support group may offer a platform for patients to share how fatigue has impacted their lives—and even swap tips and tricks for managing it. Chronic fatigue after treatment is a different type of fatigue, but strategies for managing the long-term effect may be similar, such as introducing an exercise regimen (see “Fighting Fatigue” from the Summer 2009 issue).

“It’s helpful for patients to know they’re not losing their marbles,” says Cleeland. “Fatigue is a natural consequence of treatment, and that often comes out in support groups.”