Cancer Related Fatigue: Symptoms, Causes, and Mangement

*Cancer-Related Fatigue Facts Written by Charles P. Davis, MD, PhD

• Fatigue is a common side effect of many cancer treatments. The cause of fatigue is related to the effects of cancer treatments, and is a symptom of side effects like such as anemia, additional medications, and mental state.
  • Cancer-related fatigue can produce symptoms that include:
  • Feeling extremely tired
  • Weakness
  • Feeling worn out and/or run down
  • Having little or no energy
  • Body may feel heavy and/or slow to respond
• Resting may not help reduce or stop symptoms
• Cancer-related fatigue is different from the fatigue that a normal healthy individual experiences. Fatigue related to cancer may last a long time, increase with cancer treatment, and decrease slowly after cancer treatment.
• Treatment and management of cancer-related fatigue may involve plans to balance rest and activity, dietary changes, and appropriate consultations with counselors, psychologists, and/or psychiatrists).
• Call a doctor if you feel extremely tired and fatigued and unable to do your normal activities.
• Provided is a list of questions you should ask your doctors that manage your cancer treatments.

Fatigue is a common side effect of many cancer treatments, including chemotherapy, radiation therapy, biological therapy, bone marrow transplant, and surgery. Conditions such as anemia, as well as pain, medications, and emotions, can also cause or worsen fatigue.

Fatigue in cancer patients may be called cancer fatigue, cancer-related fatigue, and cancer treatment-related fatigue.

Cancer treatments such as chemotherapy, radiation therapy, and biologic therapy can cause fatigue in cancer patients.

Fatigue is also a common symptom of some types of cancer. Patients describe fatigue as:

• Feeling extremely tired
• Weak
• Worn-out
• Run down
• Having no energy
• Heavy
• Slow
• The person has no energy or get-up-and-go.

Resting does not always help with cancer-related fatigue. Cancer-related fatigue is one of the most difficult side effects for many people to cope with.

When a healthy person is tired by day-to-day activities, their fatigue can be relieved by sleep and rest. Cancer-related fatigue is different. Cancer patients get tired after less activity than people who do not have cancer. Also, cancer-related fatigue is not completely relieved by sleep and rest and may last for a long time. Fatigue usually decreases after cancer treatment ends, but patients may still feel some fatigue for months or years.

You may be advised to take these and other steps to feel better:

• Make a plan that balances rest and activity. Choose activities that are relaxing for you. Many people choose to listen to music, read, meditate, practice guided imagery, or spend time with people they enjoy. Relaxing can help you save your energy and lower stress. Light exercise may also be advised by your doctor to give you more energy and help you feel better.
• Plan time to rest. If you are tired, take short naps of less than 1 hour during the day. However, too much sleep during the day can make it difficult to sleep at night. Choose the activities that are most important to you and do them when you have the most energy. Ask for help with important tasks such as making meals or driving.
• Eat and drink well. Meet with a registered dietitian to learn about foods and drinks that can increase your level of energy. Foods high in protein and calories will help you keep up your strength. Some people find it easier to eat many small meals throughout the day instead of three big meals. Stay well hydrated. Limit your intake of caffeine and alcohol.
• Meet with a specialist. It may help to meet with a counselor, psychologist, or psychiatrist. These experts help people to cope with difficult thoughts and feelings. Lowering stress may give you more energy. Since pain that is not controlled can also be major source of fatigue, it may help to meet with a pain or palliative care specialist.

• 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 (and how much) 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?

Tell your health care team if you feel extremely tired and are not able to do your normal activities or are very tired even after resting or sleeping. There are many causes of fatigue. Keeping track of your levels of energy throughout the day will help your doctor to assess your fatigue. Write down how fatigue affects your daily activities and what makes the fatigue better or worse.