Coping with Fatigue

Feeling exhausted, zapped, beat, drained, wilted, flat, worn-out, and just plain pooped?? You’re definitely not alone. Fatigue is highly prevalent in the cancer population, and all adults with cancer are at risk for developing cancer-related fatigue (“CRF”). Regardless of their diagnosis, stage of disease or type of treatment, the overwhelming majority of cancer patients report symptoms of fatigue; it is the most commonly reported symptom of cancer and cancer therapy.

CRF is distinct from feelings of tiredness. Unlike fatigue, tiredness is a universal sensation that happens at certain times of the day, follows certain levels of activity, and is easily dissipated by a good night’s sleep or rest. CRF, on the other hand, can be
(1) a subjective state characterized by feelings of weariness and a perception of decreased capacity for physical or mental work involving physical, affective, and cognitive sensations, and
(2) an objective state of diminished physical or mental performance with repeated or prolonged activity.

Many factors–alone or in combination–can lead to fatigue. They include:
(a) the mere presence of sarcoma because cancer cells compete with your normal cells for nutrients,
(b) many cancer treatments, including radiation, chemotherapy, biological therapy, and bone marrow transplants,
(c) surgery or even a small biopsy,
(d) medications routinely used to treat vomiting, pain, depression, and other cancer-related symptoms,
(e) dehydration, electrolyte imbalances, or poor nutrition– all common byproducts of treatments such as chemotherapy that cause nausea, vomiting, diarrhea, and loss of appetite,
(f) sleeplessness, which often accompanies depression or anxiety,
(g) respiratory difficulty, and
(h) simply trying to maintain your pre-sarcoma schedule and commitments.

Fatigue creates natural impulses to sleep and minimize physical activity. But, inactivity actually increases fatigue. Instead of staying in bed, punctuate your day with brief naps or periodic rests. Other tips for coping with fatigue:

Consult your physician. Fatigue is not trivial or something you must simply endure. Your physician has ways to treat some of the factors that lead to fatigue. For example, a routine blood draw could reveal anemia, which can be treated with medication and dietary changes. Perhaps there are substitutes for your current medications that will have fewer side-effects, like sleeplessness or loss of appetite, that exacerbate fatigue. A referral to a therapist may help you develop coping strategies for symptoms of anxiety, stress, or depression that may be elevating your level of fatigue.

Exercise regularly and in moderation. Make sure that any exercise regimen is approved by your physician, and be careful not to overdo it. Exhaustion, soreness, and shortness of breath are signs that you should ease up. A brisk walk is ideal. Try varying your path from day to day to keep things interesting. Physical therapy, certain forms of yoga, swimming, and low impact aerobics are other safe alternatives. Consider asking different friends to join you. Or, slip on a walkman and listen to your favorite tunes or a book on tape while you exercise. It just may become the time of day you most anticipate.

Give high priority to activities that lift your spirits. Fatigue and your state of mind are integrally related. Fatigue undoubtedly affects you psychologically. And, your psychological well-being can impact your susceptibility to factors that cause fatigue. As a result, doing things that make you feel good are not frivolous indulgences. Rather, they should be a highly valued part of your wellness plan. So… make a date with that friend who always brings a smile to your face and try to reserve time for the pastimes that energize you and enhance your feeling of self-worth.

Eat healthy foods and drink plenty of water. Fight fatigue by giving your body the nutrients it needs. This may be a major challenge if you’re feeling nauseous or have no desire for food. Be aware of what you’re managing to eat and its nutritional value. If you see that your nutrition is lacking, add vitamins and dietary supplements (in consultation with your physician) at an early stage; don’t wait until you’ve dropped 10 pounds and feel even weaker.

Maximize your chances for a good night’s sleep. If certain activities or people stress you out but can’t be avoided, try to schedule them earlier in your day. Try winding down with meditation or soft music. A soothing neckrub or footrub can also work wonders.

Drinking lots of water is important but may mean your sleep is interrupted by trips to the restroom; if that’s true for you, try to drink most of the water before dinnertime.

Resources:

http://cancer.gov/cancertopics/pdq/supportivecare/fatigue/Patient

Schwartz, A.L. (1999). Fatigue mediates the effects of exercise on quality of life. Quality of Life Research, 8, 529-538

Vogelzang, N.J., Breitbart, W., Cella, D. Curt, G.A. Groopman, J.E., Horning, S.J., Itri, L.M., Johnson, D.H., Scherr, S.L., & Portenoy, R.K. (1997). Patient, caregiver, and oncologist perceptions of cancer-related fatigue: Results of a tripart assessment survey. Seminars in Hematology, 34 (3 Suppl 2), 4-12.

Stone, P., Richard, M., & Hardy, J. (1998) Fatigue in patients with cancer. European Journal of Cancer, 34 (11), 1670-1676