A Weary Exhaustion: Managing Cancer-Related Fatigue
I thought these treatments were supposed to be helping me? Why do I feel so tired? Rest assured that fatigue is not necessarily a sign that your disease is worsening; instead it occurs primarily because the body needs extra energy to repair the healthy tissue damaged by treatment. Cancer-related fatigue is one of the most commonly reported and impairing side effects, often lasting far beyond the conclusion of active treatment.
CRF can be caused by the cancer itself or from the type of treatment you are receiving. Chemotherapy is likely to make you fatigued in the days right after treatment, with regimens like cisplatin, vincristine, and vinblastine being the worst culprits. Fatigue is likely to increase with each cycle of chemotherapy. The same “cumulative fatigue” is present in radiation, with the most intense fatigue occurring in the weeks following your last treatment day. CRF is common with surgery and can worsen if combined with other cancer treatments. Bone marrow transplant and immunotherapy have also been shown to result in fatigue.
Okay, if I’m so tired, shouldn’t I be able to have a restorative night of sleep and feel better? Unfortunately CRF does not resolve with a good night sleep and there can be a number of underlying causes. Firstly, be sure to have your iron levels checked. 7 in 10 patients receiving chemotherapy will experience anemia (low red blood cell counts), and this is the most common, reversible cause of CHF. Other causes of CHF include fever or infection, chronic pain, insomnia, medications that make you feel sleepy (e.g., Benadryl, opioids), side effects related to nutrition (e.g., dehydration, nausea, vomiting, taste bud changes), stress, and grief.
Both physical and emotional, CRF interferes with normal functioning and can present in a number of ways. You may wonder if you are depressed, which makes sense as many of the symptoms of CRF and depression overlap. Physical symptoms of CRF are things like anemia, low thyroid function, muscle weakness or heaviness, mobility challenges (e.g., difficulty climbing stairs), shortness of breath, weight changes, cold intolerance, hair loss, and difficulty concentrating. Emotionally, you may find yourself being more irritable than usual, thinking negatively, having a lack of motivation and depressed mood, and wanting to isolate yourself from others.
Will I feel like this forever? I would highly recommend having a conversation with your oncologist or primary care physician about your fatigue so that they can assess and treat any underlying, contributing medical issues. While fatigue is an expected part of cancer treatment, it does not mean that it cannot be improved. Additionally, below you will find some strategies to help you feel less tired during the day. Feel free to try some out and do what works best for you.
Practice good sleep hygiene. While sleep alone will not get rid of CRF, it is important that you have a strong sleep foundation to allow your body to rest and recuperate. If you suffer from insomnia, consider seeking out a therapist who offers CBT-I (cognitive behavioral therapy for insomnia).
Set your alarm for the same time every day and try to go to sleep the same time every night
Eliminate noise to the best of your ability or put on a sound machine
Exercise regularly, but not close to bedtime
Avoid or greatly limit nap time during the day
Regulate room temperature so that you are not too hot or too cold (the best bedroom temperature for sleep is approximately 65 degrees F)
Limit alcohol to 1 ounce, 2 hours before bedtime as alcohol can have a negative impact on your sleep quality
Avoid stimulants like chocolate, tea, coffee, or soda before bed
Reduce liquid consumption before bed as one of the main reasons we wake up in the night is to use the restroom
Take a warm bath
Limit screen time or wear blue light glasses while watching TV or looking at your phone at night-- Some people find that setting up their phone charger across the room prevents them from checking their phones when in bed
Plan ahead. Schedule time with friends, work meetings, etc. for when you are going to feel best physically. Some people notice that they have more energy at certain times of the day (e.g., first thing in the morning) or in their treatment cycle (e.g., week after treatment). Plan your schedule around when you are most likely to have energy to prevent having to cancel at the last minute.
Use a helpful app. The app “Untire: Beating cancer fatigue” is a great resource available to you on the app store. Its program includes education, tips to feel better, stress reduction exercises, and physical activities.
Reduce energy expenditure. Think of your personal energy like an energy vase (see Untire app). You are either filling up your energy vase or depleting it throughout the course of the day. Spend some time reflecting on what depletes your energy and prioritize tasks or activities that fill up your vase instead. Additionally, implement strategies like sitting down - rather than standing - in front of a mirror for activities that take more time (e.g., shaving, putting on makeup), and changing the location of commonly used household items to shelves that are easy to access (so you don’t have to carry heavy things or reach up high/ low).
Get regular exercise. It may sound counterintuitive (as you may think that exercise exerts energy rather than provides energy), but many studies have shown that regular exercise reduces CRF both during and after treatment. Moderate exercising - or the intensity of a brief walk - will help retain muscle mass and normal daily functioning. Try working up to 30 minutes of brisk walking, 5 times a week. Yoga has been found to be particularly beneficial for CRF.
Fuel your body with good nutrition. Your medical team may include a registered dietitian. They are wonderful resources and I would highly recommend consulting with them for strategies on how to meet your daily calorie and fluid needs. Much like a car, if you don’t have any gas in your tank you won’t get very far!
Talk to your doctor about the efficacy of dietary supplements or psychostimulants. There is not a whole lot of evidence behind dietary supplements or psychostimulants being effective in treating fatigue, and they have the potential to interact with your medications and treatment. However, some people have experienced a benefit from vitamins and supplements. Also as cognitive challenges can be a very debilitating part of fatigue (especially if you are currently working), psychostimulants may help with poor attention and concentration. Remember to always consult your doctor as the effectiveness of the above has not been established.
Explore mind-body interventions. Acupuncture, reiki and massage are great ways to compliment your treatment without adding any additional medications or side effects. Not only will you be taking some much needed time for yourself, but your body will thank you for it.
Seek out psychological support for stress management. CRF can be exacerbated by stress, and we know that having a cancer diagnosis can be immensely stressful. If you are in need of some additional support, find a licensed mental health provider that can help you navigate some of the challenges brought on by your diagnosis and treatment. The “Find a Therapist” tool on the Psychology Today website is an excellent way to search for a therapist who takes your insurance, is geographically convenient, etc.
Remember that even though it feels like it may last forever, your cancer-related fatigue can and will improve.
References
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