Kyla Johnson Occupational Therapist Segal Cancer Centre Jewish General Hospital
Ms. Kyla Johnson, M.Sc.A., originally from Edmonton, Alberta, Kyla Johnson works as an Occupational Therapist at the Segal Cancer Center of the Jewish General Hospital. She holds a Master of Science in Occupational Therapy from McGill University. Her goal as a rehabilitation professional in Oncology is to enable people with cancer to be able to do what they want and need to do, in all stages of their cancer experience. Kyla helps develop strategies and accommodations to facilitate a return to meaningful life roles, including work. She is specialized in cancer-related cognitive dysfunction and runs a weekly group teaching strategies to improve daily cognitive functioning. Kyla also leads a volunteer yoga class for young adults with cancer. She lives in Montreal, Quebec.
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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.
Is It Fatigue Or Depression
Some signs of fatigue or weakness often look a lot like those of depression, and its easy to confuse the two. Depression involves an inability to feel pleasure people who are depressed feel sad or unworthy. They may give up hope. You can have fatigue and not be depressed, although some people have both fatigue and depression.
Sometimes it may be hard to find a label for what youre feeling. Your doctor might want you to see a mental health professional to get another opinion on whether depression is part of the problem. If it is, treatment can help.
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What Are The 3 Types Of Fatigue
There are three types of fatigue: transient, cumulative, and circadian:
- Transient fatigue is acute fatigue brought on by extreme sleep restriction or extended hours awake within 1 or 2 days.
- Cumulative fatigue is fatigue brought on by repeated mild sleep restriction or extended hours awake across a series of days.
What Causes Fatigue In Chronic Lymphocytic Leukemia Patients
Dr. Escalante: We’re not sure. There’s lots of hypotheses about the etiology of actually what happens, the physiology of what happens in the body, whether it’s release of inflammatory substances called cytokines, whether it’s a muscle metabolism issue or a hypothalamus, which is part of the brain, issue. Bottom line is, we don’t really know. There’s lots of interesting basic science research going on to try to discern what that is. Certainly if we can figure out the path of physiology, we may be able to target treatment better, or at least predict who may have more problems with fatigue. But we don’t know.
Now when we assess for fatigue, we know it’s a very nebulous symptom, meaning lots of things can impact fatigue, other symptoms, other co-morbidities, anemia, hypothyroidism. Lots of things. So, we really need to do a very intensive look at all the aspects and try to grab on to the low hanging fruit first, to try to see if we can address those and start decreasing the level of fatigue.
Jeff Folloder: What’s the inventory of things that you do in your clinic to get a picture of someone’s fatigue to create a plan? How does that inventory work?
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How Long Can Fatigue Last
Cancer related fatigue is different from tiredness which is usually short term and you feel better after you stop, sleep or rest. Cancer fatigue doesnt usually go away with sleep or rest. It can be severe and last a long time.
Fatigue can last for different amounts of time depending on whats causing it. Most people start to feel better after treatment finishes. But it can take several weeks or months before you feel like your old self. In some people it may take a lot longer.
Is Cancer Pain Intermittent Or Constant
The presence of cancer cells can interfere with the normal maintenance of bone tissue, making your bones weaker. A growing tumor may also press on nerves around the bone. The pain from bone cancer often begins as a dull pain that comes and goes and is typically worse at night. Eventually, the pain can become constant.
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How Soon After Being Diagnosed With Cancer Does Treatment Start
Treatment delays Cancer treatment should start very soon after diagnosis, but for most cancers, it won’t hurt to wait a few weeks to begin treatment. This gives the person with cancer time to talk about all their treatment options with the cancer care team, family, and friends, and then decide what’s best for them.
What Is Cancer Fatigue
Fatigue means feeling very tired, exhausted and lacking energy. It can be a symptom of the cancer itself or a side effect of treatment.
Fatigue is very common in people with cancer. It can be the most troubling symptom. Many people say it’s the most disruptive side effect of all.
Cancer related fatigue can affect you physically, emotionally and mentally. How long it lasts, the degree of severity and how often you might have it is different from person to person.
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Fatigue Isoften Treated By Relieving Relatedconditions
Treatment of fatigue depends on the symptoms and whether the cause of fatigue is known. When the cause of fatigue is not known, treatment is usually given to relieve symptoms and teach you ways to cope with fatigue.
Treatment of anemia
Anemia causes fatigue, so treating anemia when the cause of anemia is known, helps decrease fatigue. When the cause is not known, treatment for anemia is supportive care and may include the following:
- Change in diet
Eat more foods rich in iron and vitamins combined with other treatments for anemia.
- Transfusions of red blood cells
Transfusions work well to treat anemia. Even though problems from a transfusion are low, there are risks of an allergic reaction, infection, graft-versus-host disease, immune system changes, and too much iron in the blood.
- Medicine
Drugs called erythropoiesis-stimulating agents cause the bone marrow to make more red blood cells and may be used to treat anemia-related fatigue in terminal patients receiving chemotherapy.Since ESAs increase the risk of blood clots, few patients are offered this treatment. The Food and Drug Administration has not approved these drugs for the treatment of fatigue. Discuss the risks and benefits of these drugs with your doctor.
Treatment of pain and depression
How Fatigue Can Affect Your Daily Life
Fatigue can be very frustrating. You and your relatives might underestimate how much it can affect daily life.
Everyday life can be hard work and you might not have the energy to cook, clean, bathe or go shopping. You might not even feel up to a chat. Things that you used to find second nature or easy are now a task and can be hard work.
You and your doctor can sometimes overlook fatigue, especially if you have other side effects. Its important to tell your doctor or nurse about how youre coping day to day and if you are struggling.
Fatigue can affect the way you feel about yourself and your relationships with other people. You can feel very down and not want to go out or be with people which can be hard for them to understand.
You might have to stop working or cut down your hours. This can affect how much money you have.
You might feel like fatigue is a constant reminder of your cancer and this can be hard to accept.
You might worry that because you feel so tired all the time your cancer could be getting worse. But it is more likely to be a side effect of treatment, or due to the fact that cancer can cause fatigue.
Fatigue is very real and can have a big impact on your life. Let your doctor or nurse know if you think you have symptoms of fatigue. There are ways of managing it and your medical team will try to help you.
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Finding The Cause Of Your Fatigue
If youre experiencing unexplained fatigue thats concerning you and interfering with your daily activities, start with a visit to your primary care physician to investigate more common reasons for fatigue.
Your physician will probably ask about the level of fatigue youre experiencing and when it began. He or she should evaluate medications you may be taking for other health conditions because fatigue is a side effect of some medications.
Some common blood tests your doctor may order include:
- A blood chemistry panel to check for kidney disease, liver disease, electrolyte imbalance and signs of cardiovascular disease
- A complete blood count to screen for conditions such as anemia, immune deficiency or infection
- Thyroid function tests to evaluate thyroid gland function
- A vitamin D test to determine whether you have vitamin D deficiency
Other screenings may include a psychological analysis to determine whether youre depressed or a sleep study to see whether youre at risk for obstructive sleep apnea.
If those tests are negative, your physician should start looking for another possible underlying cause of fatigue.
How Your Doctor Can Help
The first step is to try to figure out the source or sources of your fatigue. There may be more than one reason youâre feeling this way.
Your doctor can do tests to check for anemia or hypothyroidism. If you have one of these conditions, treatments can help.
If you think your cancer treatment is the cause, talk to your doctor about ways to help you manage it, or discuss other options.
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Managing And Treating Cancer Fatigue
There are ways to manage fatigue and the symptoms you might have. It’s important to tell your doctor or nurse if you think you might have it.
Treating the causes of cancer related fatigue can sometimes help to reduce tiredness. Help is also available for the symptoms of fatigue. There are some suggestions below.
It might take some trial and error to learn how to manage fatigue and to know what works for you.
The NHS website mention’s an app called Untire: Beating cancer fatigue. It has handy tips and advice, online support, it records your energy levels and you can see your progress.
How Long Will The Fatigue Last
Cancer-related fatigue may begin to ease when treatment ends, but many people will continue to feel fatigued for some time after treatment is finished.
It is not uncommon for fatigue to go away, only to return. You may be frustrated if your recovery takes longer than you expected. Try to be patient with yourself.
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Fatigue And Memory Problems May Be Related
During and after cancer treatment, you may find that you cannot pay attention for very long and have a hard time trying to think, remember, and understand. This is called attention fatigue. Sleephelps to relieve attention fatigue, but sleep may not be enough when the fatigue is related to cancer. Take part in restful activities and spend time outdoors to help relieve attention fatigue.
Certain Drugs Are Being Studied For Cancer Fatigue
The following drugs are being studied for cancer fatigue:
- Psychostimulants are drugs that improve mood and help decrease fatigue and depression. Psychostimulant drugs may help some patients have more energy, a better mood, and help them think and concentrate. The use of psychostimulants for treating fatigue is still being studied. The FDA has not approved psychostimulants for the treatment of fatigue.
- Bupropion is an antidepressant that is being studied to treat fatigue in patients with or without depression.
- Steroids are being studied in patients with advanced cancer. Dexamethasone is a steroid that reduces inflammation, but has unwanted side effects. In one clinical trial, patients who received dexamethasone reported less fatigue than the group that received a placebo.
Talk to your doctor about the risks and benefits of these drugs.
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Cellular Immunity Latent Viral Reactivation And Fatigue
Cancer treatments can cause pronounced and prolonged alterations in the cellular immune system, , which may underlie alterations in inflammatory activity and associated symptoms of fatigue. Our group has documented alterations in T cell populations and myeloid dendritic cells in breast cancer survivors with persistent fatigue that are correlated with inflammatory processes, . Other groups have shown more global changes in the cellular immune system in relation to fatigue, including elevations in leukocyte numbers among fatigued breast cancer survivors, , though these effects have not been consistently replicated. One of the few longitudinal studies in this area found that elevated leukocyte counts in the post-treatment period predicted persistent fatigue over a 2â3 year follow-up in breast cancer survivors.
Another potential explanation for elevated inflammatory processes and fatigue in cancer patients is reactivation of latent herpesviruses, . A recent study conducted with breast cancer patients prior to treatment found that elevated cytomegalovirus antibody titers were associated with a greater likelihood of being fatigued, as well as higher levels of CRP. Cancer treatments such as chemotherapy promote viral reactivation and associated increases in inflammatory markers which may have long-term implications for immune regulation and recovery as well as fatigue and other behavioral symptoms.
Get Help With Anxiety And Depression
Tell your healthcare provider if you feel anxious or depressed. They can help you find a social worker or mental health provider who you can talk with.
Complementary therapies, such as relaxation techniques, may also help you manage anxiety. For more information about complementary therapies, call the MSK Integrative Medicine Service at or go to www.mskcc.org/cancer-care/integrative-medicine.
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Interventions For Patients Posttreatment
More than 11 million US residents now living have a history of cancer. Of the approximately 1,658,370 persons in the United States who will be diagnosed with cancer in 2015, 68% are expected to survive at least 5 years.144 These improvements in survival have led to efforts to enhance symptom management, QOL, and overall functioning of individuals posttreatment. As previously mentioned, fatigue can be an acute effect of cancer or treatment, but it can also be a long-term or late effect.145 Patients may continue to report unusual fatigue for months or years after treatment cessation.11,12,1418 Researchers have suggested that such fatigue may be due to persistent activation of the immune system11,146 or to other factors, including the late effects of treatment on major organ systems.146 However, there are few longitudinal studies examining fatigue in long-term disease-free survivors.
Prior treatment patterns may affect the fatigue. Women who had received radiation therapy had the lowest fatigue scores. Two studies testing the effects of physical activity interventions on fatigue in breast cancer survivors found that individualized, prescriptive exercise reduced fatigue. However, researchers emphasize that it is critical for exercise to be individualized to the survivor’s abilities to prevent exacerbation of cancer treatment toxicities.157,158
What To Look For
- You feel tired and it doesnt get better with rest or sleep, it keeps coming back, or it becomes severe.
- Youre more tired than usual during or after an activity.
- Youre feeling tired and its not related to an activity.
- Youre too tired to do the things you normally do.
- Your arms and legs feel heavy and hard to move.
- You have no energy.
- You spend more time in bed and/or sleep more. Or, you may have trouble sleeping.
- You stay in bed for more than 24 hours.
- You become confused or cant concentrate or focus your thoughts.
- Your tiredness disrupts your work, social life, or daily routine.
It may be hard for you to talk about it, but tell your cancer care team about your fatigue. Tell them how its affecting your life. Someone on your team should be able to help you if they know youre having this problem. Managing fatigue is part of good cancer care. Work with your cancer care team to find and treat the causes of your fatigue.
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Causes Of Cancer Fatigue
Someone with cancer may experience fatigue for several reasons.
With leukemia and lymphoma, cancer cells in the bone marrow can interfere with the normal production of blood cells. This can lead to anemia, and anemia can then lead to fatigue.
Colon cancer and stomach cancer can cause anemia through blood loss in the bowels, likewise leading to fatigue.
The metabolic processes of tumors can also contribute to fatigue. Cancer cells aggressively compete for nourishment with normal cells.
Some cancers lead to fatigue by disrupting normal hormone functioning. Others secrete substances known as cytokines, which in turn can cause fatigue.
Fatigue has many causes besides cancer, though. In that respect, fatigue accompanied by unintentional weight loss is more concerning than fatigue alone.
What Is The Difference Between General Fatigue And Cancer
Dr. Escalante: There is a specific definition of cancer-related fatigue, and you’re absolutely right. When I or you or people without cancer or cancer treatment go out and do things, we become fatigued, but we rest and generally we get better. The fatigue either resolves or it decreases. Whereas, when a cancer patient often rests, the fatigue just minimally changes, so is not improved with rest.
Michele Nadeem-Baker: Personally, I know I was always… I mentioned it a few times and then I stopped. So I was like, “Well, maybe you’re supposed to feel this way.” Then, I pursued it again and I was told, not by my CLL Specialist, but I was told by a doctor I was referred to, that there was no diagnostic code and that just took the wind out of my sail. So, what would you say to a patient who is told that?
Dr. Escalante: Well, now there is a diagnostic code, but it doesn’t matter. Back I mean, fatigue is important and it’s not just about the billing component. It’s a symptom and as physicians, we treat symptoms as well as the cancer. We treat nausea. We treat bleeding and blood clots, so why wouldn’t we address and treat fatigue just like we treat fever?
Michele Nadeem-Baker: When you opened the clinic, was it dismissed, fatigue, as being all in your head? Has there been a dramatic change and how have you seen all this evolve?
Jeff Folloder: Thank you.
Dr. Escalante: That it is real and that it needs to be addressed.
Jeff Folloder: What causes this cancer fatigue?
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