Fatigue

Sometimes survivors may feel extremely tired or feel like they do not have enough energy to carry out their daily activities. Knowing the causes of fatigue can help you manage it.

Detailed Information

Suggestions

Additional Resources

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Fatigue: Detailed Information

This information is meant to be a general introduction to this topic. The purpose is to provide a starting point for you to become more informed about important matters that may be affecting your life as a survivor and to provide ideas about steps you can take to learn more. This information is not intended nor should it be interpreted as providing professional medical, legal and financial advice. You should consult a trained professional for more information. Please read the Suggestions and Additional Resources documents for questions to ask and for more resources

Fatigue is a feeling of tiredness or not having enough energy that can have a negative impact on quality of life. Many cancer survivors experience chronic fatigue after their active treatment has ended.

There are two main types of fatigue:

• Acute fatigue is when you feel tired for a short time.
• Chronic fatigue is a feeling of tiredness that is always with you. It can also be a feeling of tiredness that comes and goes but never goes away completely.

Survivors can experience chronic fatigue because of the treatment they received for their cancer or because of the different emotions they are feeling during the cancer journey. Fatigue also can be a sign of a recurrence or another illness.

You may notice that you are tired all the time but think that you should not complain. However, do not ignore these feelings. It may be that you can work with your health care team to manage fatigue symptoms.

Do all survivors experience fatigue?

Fatigue is one of the most common symptoms experienced by survivors during active treatment. In most cases, your energy level will return to normal within the first six months after active treatment ends. However, studies have found that about 30 percent of cancer survivors may experience fatigue that lasts much longer, even for years.

Survivors who receive certain types of treatments for their cancer are more at risk for fatigue such as:

• Chemotherapy
• Biological therapies (such as Interferon)
• High doses of chemotherapy followed by a bone marrow transplant or a stem cell transplant
• Certain medications that can cause fatigue
• Treatment with chemotherapy, radiation or surgery that affects hormones

What are the symptoms of fatigue?

Symptoms of fatigue that survivors might experience may include:

• Feeling tired even after a good night's sleep
• Feeling sleepy throughout the day
• Feeling sudden, extreme tiredness
• Feeling too weak to stand
• Finding it difficult to start routine activities
• Needing to stop in the middle of activities to rest
• Not being able to do activities for very long
• Difficulty concentrating
• Irritability

Many people think that fatigue is something that survivors will only experience during treatment. This is not true. Some survivors experience fatigue months or years after completing active treatment.

If you have been feeling good but suddenly start to become extremely tired again, you may be experiencing a new, severe fatigue. This can be a sign of infection or a late effect of cancer treatment. Make an appointment to discuss your fatigue with your health care team.

What are some of the physical causes of fatigue?

Sometimes the exact cause of your fatigue may be unknown, but that does not mean that you and your health care team can't work together to help manage your fatigue. Some of the physical causes of fatigue are:

• Low red blood cell counts (anemia)
• Difficulty breathing
• Changes in how well your heart pumps blood
• Changes in muscle or bone due to surgery or treatment
• Changes in the hormone levels in your body
• Changes in your immune function or the way your body responds when your immune system is challenged
• Changes in kidney function so your body is not as good at clearing out waste products
• Trouble sleeping
• Symptoms such as pain or numbness in your feet that make it harder to move
• Side effects of medications
• Chronic pain
• Inactivity
• Poor nutritional intake or dehydration

What are some of the emotional causes of fatigue?

Fatigue and depression can both happen during your experience with cancer. Both are real problems that you should discuss with your health care team. However, being tired does not necessarily mean a survivor is depressed. Sometimes survivors hear things like, "You're not tired – you're just depressed." While depression may be one cause of fatigue, it is important to discuss all possible physical and emotional causes with your health care team.

Some emotional causes of fatigue are:

• Anxiety
• Frustration
• Boredom
• Depression

Fatigue is a treatable condition, and you can work with your health care team to manage the symptoms. The medical community is working to understand fatigue and to find a cure.

Take steps to minimize the risks of fatigue:

• Maintain a comfortable balance between activity and rest.
• Work closely with your health care team to identify and treat physical conditions that may be contributing to fatigue such as chronic pain and infection.
• Make an effort to create balance in your life with a healthy lifestyle.
• Pay attention to your sleep habits.

This document was produced in collaboration with:

Lillian M. Nail, PhD, RN, CNS, FAAN
Rawlinson Distinguished Professor of Nursing & Senior Scientist
Oregon Health & Science University

Works Cited

Harpham, Wendy. After Cancer, A Guide to Your New Life. New York: Harper Collins Publishers, 1995.

National Cancer Institute, U.S. National Cancer Institutes of Health Fatigue (last modified 10.04.07) http://www.Cancer.gov/cancertopics/pdq/supportivecare/fatigue/patient

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Fatigue: Suggestions

The suggestions that follow are based on the information presented in the Detailed Information document. They are meant to help you take what you learn and apply the information to your own needs. This information is not intended nor should it be interpreted as providing professional medical, legal and financial advice. You should consult a trained professional for more information. Please read the Additional Resources document for links to more resources.

• Maintain a comfortable balance between activity and rest:
  
  
  • Keep a list of your activities and how much rest you get.
  • Keep track of situations that seem to make you feel more tired such as traveling across time zones, sitting down for too long, being in a room that is too warm or having to concentrate for a long period of time. Planning ahead may help you avoid these activities.
  • Find ways to break up your activities into shorter time periods, or allow yourself time to rest between activities.
    
• Try to find balance with a healthy lifestyle:
  
  
  • Do not use tobacco products.
  • Work with your health care team to develop an exercise plan.
  • Work with your health care team on developing stress management skills.
  • Maintain a healthy body weight.
  • Work with your health care team to develop a diet that includes the right amounts of fruits, vegetables, protein, carbohydrates and fat.

  A well-balanced diet is important. A normal, healthy diet consists of protein, carbohydrates, some fat, fiber, vitamins and minerals. If you unintentionally gain or lose weight, ask your health care provider to refer you to a dietitian or nutritionist to evaluate your nutrition.

• Pay attention to your sleep habits:

  Keep a sleep diary to track your sleep habits. Some items to write down in a sleep diary are:

  • The time you turn out the light to go to sleep
  • When you wake up and why you awakened, such as noise, pain, to take medication
  • The time you get out of bed in the morning
  • Naps you take during the day including length and time of day

  This information can help you and your health care team decide if sleep problems play a role in your fatigue.

  Other suggestions to improve sleep quality include:

  • Sleep in a comfortable bed.
  • Avoid sleeping on the sofa or in a chair.
  • Sleep with the lights out in a quiet room.
  • Wear comfortable sleep garments.
  • Avoid heavy meals, food or drinks containing caffeine, and intense exercise prior to bedtime.

If fatigue or sleep problems begin when you start a new medication, ask your health care provider if it might be a side effect of the medication. If it could be, ask about changing the medication or changing the times when you take the medication.

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Fatigue: Additional Resources

The resources listed below provide more detailed information and support services to help you with fatigue.  Please read the Detailed Information and Suggestions document for more information and questions to ask.

LIVESTRONG Care Plan
www.livestrongcareplan.org

This free online tool was created to help you develop a personalized plan for post-treatment care. It can help you work with your oncologist and primary health care provider to address medical, emotional and social challenges that may arise after cancer treatment is completed. By answering some questions related to your cancer treatment, you will receive information about your follow-up care. This information includes symptoms to watch for in the future and steps you can take to stay healthy.

LIVESTRONG SurvivorCare Program
www.livestrong.org/survivorcare

Email: Send email through the LIVESTRONG website.
Phone: 1-866-673-7205
1-866-927-7205 (Spanish)
Intake Coordinator is available for calls Monday through Friday, 9:00 a.m. to 5:00 p.m. (Central Time). Voicemail is available after hours.

LIVESTRONG SurvivorCare offers assistance to anyone affected by cancer, including the person diagnosed, loved ones, caregivers and friends. The program provides information about treatment options and matching to clinical trials or treatments in development. Counseling services and assistance with financial, employment and insurance issues are also available. To provide these services, LIVESTRONG SurvivorCare has partnered with several organizations including CancerCare, Patient Advocate Foundation and EmergingMed.

American Institute for Cancer Research (AICR)
www.aicr.org

Email: aicrweb@aicr.org
Phone: 1-800-843-8114
TTY for deaf and hard of hearing callers: 202-855-1000

Since its founding in 1982, the American Institute for Cancer Research has grown into one of the nation's leading charities in the field of diet, physical activity and weight management as it relates to cancer prevention. AICR supports research into the role of diet and physical activity in the prevention and treatment of cancer. It also offers a wide range of cancer prevention education programs.

Cancer Hope Network
www.cancerhopenetwork.org

Email: info@cancerhopenetwork.org
Phone: 1-877-HOPE NET (1-877-467-3638)
This number is answered Monday-Friday, from 8:00 a.m. to 5:30 p.m. (EST). Voicemail is available after hours.

Cancer Hope Network is a not-for-profit organization that provides free and confidential one-on-one support to cancer patients and their families. They offer support by matching cancer patients or family members with trained volunteers who have already undergone and recovered from a similar cancer experience. You can submit your request by phone or by email. A volunteer will try to contact you within 24 hours.

National Coalition for Cancer Survivorship (NCCS)
www.canceradvocacy.org

Email: info@canceradvocacy.org
Phone: 1-877- 622-7937
An information specialist is available from 8:30 a.m. to 5:30 p.m. (EST).

The NCCS website provides comprehensive information on a wide range of cancer topics. These include managing the side effects of cancer treatment, controlling pain, understanding clinical trials, maintaining good nutrition and exercise habits, getting the most out of your health insurance coverage and addressing employment issues. The NCCS also offers the Cancer Survival Toolbox, a free audio program created to help people develop skills to help with communicating, decision making, problem solving, finding information, negotiating, and standing up for your rights. They also offer a variety of publications that can be ordered free of charge. Information on the NCCS website is available in Spanish, and the Cancer Survival Toolbox is available in both Spanish and Chinese.

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