Treatment Of Fatigue In Cancer Patients

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.

Can Sleep Be Improved To Reduce Cancer Fatigue

Sleep is an important part of wellness. Good sleep can improve your mental and physical health. Several factors contribute to how well you sleep, and there are things you can do to improve your sleep, including:

• Doing relaxation exercises, meditation or relaxation yoga before going to sleep.
• Avoiding long afternoon naps.
• Going to bed only when sleepy. Use your bedroom only for sleep and sexual activities.
• Setting a consistent time to lie down and get up.
• Avoiding caffeine and stimulating activities in the evening.
• Establishing a relaxing pre-sleep routine.

Fatigue In Children And Teens With Cancer: Tips For Families

• Talk to your care team about fatigue.
• Keep a record of symptoms. Write down when fatigue occurs, what makes it worse, what makes it better, and any related factors such as pain, stress, or sleep problems.
• Keep a consistent schedule of sleep, rest, and activity.
• Make sure that food and fluid intake support good nutrition and hydration.

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Some Of The Symptoms Of Cancer Fatigue May Be Concerning To A Medical Team You Should Discuss The Specifics Of Your Exhaustion With Them If You Have Done So And They Have Offered No Further Investigation Or Treatment Read On

Clearly, we are up against it when dealing with low energy as one goes through treatment. We are fighting the might of pharmaceutical side-effects and the devastation of a diagnosis.

The best advice I have ever heard is from patients themselves, in recognising that their energy is limited. I love the 5 spoonfuls of sugar analogy. I have found it so helpful in my life, it makes perfect sense to me.

Visualise your energy for the day as 5 spoonfuls of sugar. You only have 5 spoonfuls and you can use them however you wish, but you only have 5. You can use 2 on the school run and one brushing your hair, but you only have 5. When they are used, you have exhausted your supply of sugar.

I cannot promise to give you more sugar but I have formulated some products with the aim of putting a spring in your step and to help with some of the factors affecting energy levels.

Your Healthcare Team Will Continue To Look For Patterns Of Fatigue

A fatigue assessment is repeated to see if there is a pattern for when fatigue starts or becomes worse. The same method of measuring fatigue is used at each assessment. This helps show changes in fatigue over time. The healthcare team will check for other causes of fatigue that can be treated. See the Causes of Cancer Fatigue section.

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Fatigue In Cancer Survivors

Bower et al., using the RAND Health Survey 1.0, found a 35% fatigue rate in 1957 breast cancer survivors . Cella et al. found a 17% rate of fatigue among 379 cancer survivors, using somewhat restrictive diagnostic criteria . In Hodgkin’s disease, a high incidence of fatigue was found in a cohort of 459 survivors at a mean of 12 years after treatment . Okuyama et al. studied 134 patients with stage I-III breast cancer a mean of 789 days after surgery, plus chemotherapy or radiation in 28.1% and 8.9%, respectively. Fifty-six percent of these patients reported fatigue .

Meet With An Ot Or Pt

OTs and PTs are healthcare professionals who can help you manage your fatigue.

• OTs help improve the skills you need for important everyday activities such as getting dressed, taking a shower, or cooking a meal. An OT can help you plan your activities so youre able to do as many physical activities as possible without getting too tired. They can also suggest ways that you can save energy and help you practice using special equipment or strategies like meditation or mindfulness.
• PTs help improve your ability to move by helping you build your strength and balance. They can also help you come up with an exercise plan that works for you.

OTs and PTs can help you stay motivated and set goals. They can also help you keep track of your energy level and make changes to your exercise plan as needed. If you would like more information about how an OT or PT can help you manage your fatigue, ask your healthcare provider for a referral.

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Box 1 Suggestions For Screening Of Chronic Fatigue In Adult Cancer Survivors The Overview Is Based On International Guidelines And The Norwegian Directorate Of Health’s Recommendations

Assessment of fatigue level

General history of fatigue: onset, pattern, duration, change over time, factors that exacerbate/improve the symptoms, pattern of activity throughout the day and week

Other factors:

• psychological factors, particularly high anxiety level and catastrophising sleep, pain, medication, abuse of alcohol or narcotics

• somatic comorbidity

• cancer treatment can predispose for comorbidity, for example cardiomyopathy after cardiotoxic chemotherapy or hypothyreosis following radiotherapy targeting the lower neck

A general physical examination should be undertaken to detect somatic conditions as an underlying cause. Recurrence of the cancer should be considered if a patient who has been in good shape develops fatigue

Additional examinations must be considered individually:

• Relevant blood tests are: haematological profile, hormone tests , electrolytes, liver/gallbladder function

• Radiological examinations should be performed if clinical signs of somatic disease

• Referral to other medical specialists must be based on findings and clinical evaluation. Referral to the following may be needed:

• Cardiologist after completion of cardiotoxic treatment

• Neuropsychologist in cases of memory and/or concentration difficulties, particularly in younger patients

• Psychologist/psychiatrist if signs of mental disorders

• Pain management team

How Can I Prevent Cancer Fatigue

You cant do much to prevent cancer-related fatigue. But these strategies may help minimize the problem:

• Adopt healthy sleep habits: To build better sleep habits, keep phones and TVs out of the bedroom, go to bed at the same time every night and sleep in a dark, quiet room.
• Ask for help: Let family and friends run errands, fix meals or help with housework or child care.
• Cut back on caffeine:Caffeine provides a temporary pick-me-up. But it can also keep you up at night.
• Drink plenty of fluids: Its important to stay hydrated and eat nutritious foods.
• Set priorities: Be realistic about what you can do. Save your energy for the things that matter most.
• Stay physically active: Go for a walk or try yoga or tai chi. Dont exercise too late in the evening. The activity may make it harder to fall asleep.
• Take 30-minute rest breaks: During the day, dont sleep longer than 30 minutes or you could have trouble falling asleep at night. Rest breaks can help if you have an upcoming event that requires a lot of energy.

A note from Cleveland Clinic

A chronic illness like cancer can bring many unwanted challenges. Cancer fatigue is one of them. It makes sense that fighting off cancer can tire out your body. Cancer treatments can also be physically and mentally exhausting. Still, you shouldnt hesitate to let your healthcare provider know how cancer fatigue is affecting your life. You can take steps to bring more energy back into your days.

References

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How Does Exercise Impact Energy Level

Decreased physical activity, which may be the result of cancer or treatment, can contribute 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, and fatigue.

Regular, moderate exercise can decrease these feelings, help you stay active and increase your energy. Even during cancer therapy, it is often possible to continue exercising. In fact, research has shown that cancer patients who perform a moderate exercise routine have a better quality of life and may have better outcomes.

Here are some exercise guidelines to keep in mind if you have cancer:

• Check with your doctor before beginning an exercise program.A physical therapist can be helpful in planning a program for you.
• A good exercise program starts slowly, allowing your body time to adjust.
• Keep a regular exercise schedule.
• The right kind of exercise never makes you feel sore, stiff, or exhausted. If you experience soreness, stiffness, exhaustion, or feel out of breath as a result of your exercise, you are overdoing it.
• Most exercises are safe, as long as you exercise with caution and don’t overdo it. Among the safest and most productive activities are swimming, brisk walking, indoor stationary cycling, and low-impact aerobics . These activities carry little risk of injury and benefit your entire body.

Do Physical Activity And Exercise

• Do your best to keep doing your current level of activity. Doing some physical activity for 3 to 5 hours a week may help cancer-related fatigue.
• Walk daily, if your healthcare provider says its safe for you.
• Think about starting an exercise program thats appropriate for your treatment. Yoga may be helpful to include as part of an exercise program.

If youre worried about doing physical activity or exercise, your healthcare provider can refer you to Memorial Sloan Kettering s Rehabilitation Service to meet with a physical therapist or occupational therapist . Read the section Meet with an OT or PT or talk with your healthcare provider for more information.

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Anxiety And Depression Are The Most Common Psychological Causes Of Fatigue In People With Cancer

The emotional stress of cancer can cause physical problems, including fatigue. It’s common for you to have changes in moods and attitudes. You may feel anxiety and fear before and after a cancer diagnosis. These feelings may cause fatigue. The effect of the disease on your physical, mental, social, and financial well-being can increase emotional distress.

About 15% to 25% ofpeople with cancer get depressed, which may increase fatigue caused by physical factors. Patients who have depression before starting treatment are more likely to have depression during and after treatment. The following are signs of depression:

• Lack of energy and mental alertness.
• Loss of interest in life.
• Problems thinking.
• Drowsiness.
• Feeling a loss of hope.

Patients who have a history of stressful experiences in childhood, such as abuse and neglect, may have increased fatigue. See the PDQ summaries on Adjustment to Cancer: Anxiety and Distress and Depression for more information.

Questions To Ask Your Health Care Team

• What is most likely causing my fatigue?
• What should I keep track of and share so we can develop a plan to help me feel better?
• What types of exercise do you recommend for me?
• How much rest should I have during the day? How much sleep should I get at night?
• What food and drinks are best for me?
• Are there treatments or medicines that could help me feel better?

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Fatigue In Cancer Patients

One of the most common symptoms our patients complain of is fatigue it is also one of the most debilitating.

Cancer-related fatigue is multifactorial. Chronic illness, chemotherapy, radiation therapy, anemia, pain, lack of sleep, medications, emotions, and poor nutrition are reasons patients experience fatigue. Persistent fatigue is something that should be discussed with your provider, especially if ongoing or prolonged.Fatigue can impact a patients quality of life it is important to realize that cancer fatigue differs from healthy people. People with cancer describe fatigue as feeling tired, weak, worn-out, heavy, slow, or having no energy, no oomph or get-up-and-go.

Some other ways to combat fatigue:

Managing cancer-related fatigue is an important part of cancer care. Discussing this with your provider is essential. The supportive and palliative team is also available to help manage or decrease this debilitating symptom that so many patients experience.

How Does Nutrition Affect Energy Level

Cancer-related fatigue is often made worse if you are not eating or drinking enough or if you are not eating the right foods. Maintaining good nutrition can help you feel better and have more energy. Make an appointment with a dietitian. A registered dietitian provides suggestions to work around any eating problems that may be interfering with proper nutrition . A dietitian can also suggest ways to maximize calories and include proteins in smaller amounts of food .

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The Clinical Characteristics Of Fatigue

Various attempts have been made to characterize fatigue. The ASCPRO working group defined CRF as the perception of unusual tiredness that varies in pattern and severity and has a negative impact on ability to function in people who have or have had cancer . The National Comprehensive Cancer Network practice guidelines for clinical management of fatigue define it as a persistent subjective sense of tiredness related to cancer or cancer treatment that interferes with usual functioning . ASCPRO further characterized CRF as physical, subjective, temporal, emotional, cognitive, unusual, and affecting the patient’s ability to function . Fatigue has also been described by word-terms such as weariness, exhaustion, lassitude, weakness, malaise, discomfort, and impatience, or as the inability to perform aspects of normal functioning.

However one may define it, CRF negatively impacts a patient’s daily functioning and diminishes quality of life. CRF lasts longer than typical fatigue and is more severe and unrelenting. It can be so overwhelming that a patient may request a chemo holiday or may even elect to discontinue therapy altogether. In either case, curative treatment may be compromised.

How Long Does Fatigue Or Weakness Last

Fatigue that is due to cancer and its treatment can last for weeks, months, or years. It often continues after treatment ends.

• For people who have surgery for cancer with no other treatment, fatigue often decreases or goes away over time as they recover from surgery.
• For people getting chemotherapy, targeted therapy, or immunotherapy in cycles, fatigue often gets worse at first and may get better until the next treatment, when the pattern starts again.
• For those getting radiation therapy, fatigue usually gets worse as the treatment goes on and often lessens within a few months after treatment is complete.

Fatigue can:

• Differ from one day to the next in how bad it is and how much it bothers you
• Be overwhelming and make it hard for you to feel well
• Make it hard for you to be with your friends and family
• Make it hard for you to do things you normally do, including going to work
• Make it harder for you to follow your cancer treatment plan.

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Describing And Managing Weakness

Weakness is decreased strength. If this is caused by surgery in a certain part of the body or loss of a body part, the weakness might be helped by physical therapy or occupational therapy. If weakness is caused by having an infection or having changes in blood levels, such as low blood counts, low electrolytes, or changes in hormones, treatment to help with the specific problem can help decrease weakness.

Talking With Your Health Care Team About Fatigue

Prepare for your visit by making a list of questions to ask. Consider adding these questions to your list:

• What is most likely causing my fatigue?
• What should I keep track of and share so we can develop a plan to help me feel better?
• What types of exercise do you recommend for me?
• How much rest should I have during the day? How much sleep should I get at night?
• What food and drinks are best for me?
• Are there treatments or medicines that could help me feel better?

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Mechanisms For Intervention Effects

The literature reviewed above suggests that a variety of different intervention approaches may be useful for cancer-related fatigue, including physical activity, psycho-education, cognitive-behavioral, and mind-body approaches. These interventions have different targets and may work through different mechanism, including cognitive, behavioral, and biological mechanisms. For example, cognitive approaches to treating cancer-related fatigue specifically target maladaptive thoughts about fatigue, including catastrophizing. Given that catastrophizing predicts more severe and persistent fatigue symptoms in cancer patients, reducing the use of this coping mechanism may be one of the âactive ingredientsâ that promotes reductions in fatigue. Even more physical approaches may work by changing thoughts and beliefs about fatigue for example, patients felt more confident about their ability to manage fatigue after learning certain yoga postures, which might lead to reductions in fatigue symptoms.

Nutrition Needs Change And Cause Or Increase Fatigue

For many patients, the effects of cancer and cancer treatments make it hard to eat well. The body’s energy comes from food. Fatigue may occur if the body does not take in enough food to give the body the energy it needs. In people with cancer, three major factors may affect nutrition:

• A change in the way the body uses food. A patient may eat the same amount as before having cancer, but the body may not be able to absorb and use all the nutrients from the food. This is caused by the cancer or its treatment.
• An increase in the amount of energy needed by the body because of a growing tumor, infection, fever, or shortness of breath.
• A decrease in the amount of food eaten because of low appetite, nausea, vomiting, diarrhea, or a blocked bowel.

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