Research Into The Causes Of Fatigue
Its still unclear the exact cause of fatigue. Researchers want to understand the biology of how cancer related fatigue happens. Once they know this, they can look for treatments that might be able to help.
Researchers are looking at the information inside the cells that control how we look and function . They want to check for changes that might be linked to how fatigue develops. They also think that different cancers and their treatments affect how fatigue develops.
There is some evidence to say that fatigue is related to inflammation and the bodys immune response. Researchers think that genes that control inflammation are a possible risk factor for people who have long term fatigue.
Knowing who is likely to have long term fatigue, could then mean that doctors can help lower these effects early on with treatment advice.
In many cancers, cells within the body release higher levels of chemicals. These chemicals are called cytokines. Researchers are looking into the link between cytokines and fatigue. Higher than normal levels of cytokines could cause fatigue by affecting hormones and chemicals that nerves use to communicate.
Fatigue Health Professional Version
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Cancer-related fatigue is a distressing, persistent, subjective sense of physical, emotional, and/or cognitive tiredness or exhaustion caused by cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning. Fatigue is the most common side effect of cancer treatment with chemotherapy, radiation therapy, bone marrow transplantation, or selected biologic response modifiers. Clinically significant levels of fatigue may also negatively impact survival. The specific mechanisms underlying a common pathophysiology for CRF are unknown.
Fatigue, like pain, is a self-perceived state and patient-reported outcome. Patients may describe fatigue as feeling:
- Tired.
- Like they have no energy or get-up-and-go.
Healthprofessionals have included fatigue within concepts such as:
- Asthenia.
- Lack of energy.
- Weakness.
Studies of women with breast cancer have attempted to define specific fatigue trajectories. For example, some patients may experience a high degree of fatigue during treatment and recovery, while others may suffer from little fatigue throughout treatment. Suggested fatigue trajectories include the following:
- Very low fatigue.
- Late fatigue .
- Recovery .
- High fatigue.
Fatigue has a negative impact on all areas of function, including the following:
- Mood.
- Sense of self.
- Activities of daily living in older cancer survivors.
- Physical activities .
- Psychosocial interventions .
References
Psychological And Biobehavioral Risk Factors
Pre-treatment fatigue
Across studies, the strongest and most consistent predictor of post-treatment fatigue is pre-treatment fatigue. Patients who report higher levels of fatigue before radiation and/or chemotherapy also report elevated fatigue immediately after treatment completion, over the following year, , , and up to 2.5 years later. In studies that compared multiple predictors, pre-treatment fatigue emerged as one of the strongest, if not the strongest predictor of fatigue in the post-treatment period, . Together, these findings suggest that whatever biological, psychological, or behavioral dysregulation contributes to cancer-related fatigue may be present before treatment onset.
Depression
Sleep disturbance
Physical activity, physical deconditioning, and body mass index
Coping and appraisal
Other psychosocial risk factors
Emerging evidence has identified other psychological risk factors for cancer-related fatigue. Exposure to childhood stress, including experiences of abuse and neglect, is associated with elevated fatigue in cross-sectional studies of breast cancer survivors, . These findings are consistent with research conducted in non-cancer populations showing that early life stress is associated with increased risk for fatigueâ. Loneliness is also associated with elevated fatigue in cancer survivors and predicts increases in fatigue over time.
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Ways To Manage Fatigue
If you think you’re experiencing fatigue, talk to your doctor. If possible, give your doctor specific information about your fatigue. Instead of saying, “I’m tired all the time,” give an example such as, “I get tired when I walk up the five stairs to my office.”
Because there are so many causes of fatigue, there’s no one medicine that can relieve fatigue. Together, you and your doctor can figure out ways to reduce or manage your fatigue.
What The Patient Can Do
- Rest, but not too much. Plan your day so you have time to rest. Take short naps or rest breaks , rather than one long nap during the day. Too much rest can lower your energy level and make it harder to sleep at night.
- Certain drugs used to treat pain, nausea, or depression can make a person feel tired and sleepy. Talk with your cancer care team about this. Sometimes adjusting the doses or changing to a different drug can help.
- Talk to your health care team about any problems with your nutritional intake
- Regular moderate exercise especially walking is a good way to ease fatigue. Talk to your doctor about the right exercise plan for you.
- Ask your family or friends to help with the things you find tiring or too hard to do.
- Try to sleep 7 to 8 hours each night. Sleep experts tell us that having regular times to go to bed and get up helps us keep a healthy sleep routine.
- Each day, prioritize decide which things are most important to you and focus on those tasks. Then plan ahead. Spread activities throughout the day and take breaks. Do things slowly, so that you wont use too much energy at once
- Avoid caffeine
- Avoid exercising too late in the evening.
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Neuroendocrine Alterations And Cancer
Hypothalamic-pituitary-adrenal axis dysregulation and fatigue
Alterations in the HPA axis have been proposed as a mechanism underlying cancer-related fatigue, either directly or through effects on inflammatory processes. The HPA axis is an important regulator of cytokine production and has potent anti-inflammatory effects. These effects can occur via alterations in glucocorticoid production and/or decreased sensitivity of the glucocorticoid receptor to hormone ligation. Preliminary evidence suggests alterations in both pathways among patients with cancer-related fatigue. In terms of cortisol production, breast cancer survivors with persistent fatigue show alterations in diurnal cortisol slope, with elevated levels of evening cortisol relative to non-fatigued controls. Fatigued breast cancer survivors also demonstrate blunted cortisol responses to psychological stress that are correlated with elevations in stimulated cytokine production and may underlie elevated inflammatory activity. However, studies have not shown alterations in total daily cortisol production or 24-hour urinary free cortisol in breast cancer survivors with post-treatment fatigue, . In ovarian cancer patients, higher levels of evening cortisol and reduced cortisol variability are associated with fatigue before treatment onset, and normalization of cortisol profiles in the following year is associated with reductions in fatigue.
Autonomic nervous system dysregulation and fatigue
How Can Exercise Help Reduce Cancer Fatigue
You may feel ill from your cancer or treatment, which may lead to less physical activity. Decreased levels of physical activity can lead to tiredness and lack of energy. Scientists have found that even healthy athletes forced to spend extended periods in bed or sitting in chairs develop feelings of anxiety, depression, weakness, fatigue and nausea. Regular, moderate exercise can decrease the feeling of fatigue and help you feel energetic. Even during cancer therapy, it’s often possible to continue to exercise. Be sure to check with your healthcare provider before starting an exercise program.
Exercise has many health benefits. Regular exercise can:
- Increase your appetite.
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Research Into Cancer Fatigue
Many people with cancer say fatigue is one of the symptoms that impacts them most. Researchers are looking into what causes fatigue and how to treat it. Let your doctor or nurse know if you have fatigue. There are things that can help manage it.
We have included ongoing research to give an example of the type of research happening. Some of the research and trials on this page have now stopped recruiting people. It takes time for the results to be available.
Go to Cancer Research UKs clinical trials database if you are looking for a trial. You need to talk to your specialist doctor about any trials that you think you might be able to take part in.
Can Stress Management Help With Cancer Fatigue
Managing stress can play an important role in combating fatigue. Here are some ways you can manage stress:
- Adjust your expectations. For example, if you have a list of 10 things you want to accomplish today, pare it down to two and leave the rest for other days. A sense of accomplishment goes a long way to reducing stress.
- Help others to understand and support you. Family and friends can be helpful if they can “put themselves in your shoes” and understand what cancer fatigue means for you. Cancer support groups can be a source of support as well. Other people with cancer truly understand what you are going through.
- Relaxation techniques including guided meditation, deep breathing or visualization can help reduce stress and minimize cancer fatigue.
- Divert your attention. Activities that divert your attention away from fatigue can also be helpful. Activities that require little physical energy but demand attention include knitting, reading or listening to music.
If your stress feels overwhelming, talk to your healthcare provider. They are there to help.
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Ways To Save Up Your Energy
Spotting The Difference: Cancer Related Fatigue Vs Everyday Fatigue
Each Sunday this year, we’ll be looking at a symptom of leukaemia as part of our #LC50 campaign. This month, we’re focussing on fatigue, and how cancer-related fatigue differs from everyday fatigue. Read all about this symptom and how to spot it.
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Fatigue is by far the most common symptom experienced by blood cancer patients prior to a diagnosis. According to our 2018 patient survey, 56% of leukaemia patients will experience fatigue in the lead up to their diagnosis.
The fatigue that comes with leukaemia or any cancer is known as cancer-related fatigue and it is characterised by extreme or persistent exhaustion that disrupts your daily activities and function. People who have CRF have no energy and find it extremely difficult to complete even the simple, everyday tasks that others take for granted. Spotting the difference between harmless and harmful fatigue may be key in diagnosing leukaemia early.
I was a physical guy, and then all of a sudden, no explanation, I felt like I was in treacle. Very fatigued and very tired.
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The best way to cite this PDQ summary is:
PDQ® Supportive and Palliative Care Editorial Board. PDQ Fatigue. Bethesda, MD: National Cancer Institute. Updated < MM/DD/YYYY> . Available at: . Accessed < MM/DD/YYYY> .
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Follow A Healthy Diet
Eat small, well-balanced meals and snacks throughout the day. Aim to drink 8 to 10 glasses of liquids every day.
For more information about following a healthy diet, read the resource Eating Well During Your Cancer Treatment. Talking with a clinical dietitian nutritionist may also be helpful. Your healthcare provider can give you a referral to meet with a clinical dietitian nutritionist.
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Different Activities And Therapies
Exercise, yoga, massage therapy, counseling, and dietary or nutritional counseling are all used to help treat fatigue and weakness.
If youre having problems sleeping or sleeping too much, your doctor or nurse may suggest sleep therapy. This therapy can help you minimize sleep disturbances and learn improved sleep hygiene.
More research is needed and is being done in this area, but there are stimulant drugs your health care team may prescribe you if your fatigue doesn’t improve. These stimulants are only prescribed for a short period. It’s important you talk to your doctor about the benefits of taking these drugs, as well as the different side effects that may occur such as daytime sleepiness, withdrawal symptoms, insomnia, memory problems, or allergic reactions.
Risk Factors For Cancer
As noted previously, fatigue typically increases during cancer treatment and improves in the year after treatment completion. However, there is considerable variability in the experience of fatigue before, during, and after treatment, , suggesting that certain individuals may be at particular risk for this disabling symptom. Of note, there is also variability in the inflammatory response to treatment, which is correlated with variability in fatigue . Over the past several years, longitudinal studies have begun to examine risk factors for cancer-related fatigue, and particularly fatigue that persists for months or years after cancer treatment. Studies in this area have focused primarily on demographic, medical, behavioral, and psychosocial predictors, but genetic risk factors are of growing interest. Identification of these factors is important for advancing our understanding of this symptom and for improving identification and treatment of vulnerable patients. In this section, we review this growing literature and suggest pathways through which these factors may influence fatigue.
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Exercise Has A Positive Effect On Fatigue During And After Cancer Treatment
Exercise may help people with cancer feel better and have more energy during and after treatment. The effect of exercise on fatigue in people with cancer is being studied. One study reported that breast cancersurvivors who took part in enjoyable physical activity had less fatigue and pain and were better able to take part in daily activities. In clinical trials, some people with cancer reported the following benefits from exercise:
- More physical energy.
- More enjoyment with life.
- A greater sense of well-being.
Moderate activity for 3 to 5 hours a week may help cancer fatigue. You are more likely to follow an exercise plan if you choose a type of exercise that you enjoy. Your healthcare team can help you plan the best time and place for exercise and how often to exercise. You may need to start with light activity for short periods of time and build up to more exercise little by little. Studies have shown that exercise can be safely done during and after cancer treatment.
Mind and body exercises such as qigong, tai chi, and yoga may help relieve fatigue. These exercises combine activities like movement, stretching, balance, and controlled breathing with spiritual activity such as meditation.
Cognitive behavior therapy
- Stress from coping with cancer.
- Fear that the cancer may come back.
- Feeling hopeless about fatigue.
- Lack of social support.
- A pattern of sleep and activity that changes from day to day.
Other ways to manage fatigue
How Does Nutrition Impact Energy Level
Cancer-related fatigue is often made worse if you are not eating enough or if you are not eating the right foods. Maintaining good nutrition can help you feel better and have more energy. The following are strategies to help improve nutritional intake:
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