Patients Get Advice on How to Deal With Cancer-Related Fatigue

NEW YORK--Fatigue related to cancer or its treatment does not go away after a good night’s rest, and may last a month or longer. In the cancer setting, there may be many reasons for chronic fatigue, Lois Almadrones, RN, MPA, clinical research associate, Memorial Sloan-Kettering Cancer Center, said at a Cancer Care teleconference for cancer patients.

Ms. Almadrones gave a vivid description of what cancer-related chronic fatigue is like: "You’re exhausted. It’s a big effort to do anything. You have no ambition. Your mood might change so that if you’re usually talkative, you don’t want to talk. A usually bubbly person is miserable. You can’t concentrate. You may be so run down, you don’t feel like putting your clothes on. Everything sort of has a cloud hanging over it. There is a constant sense of working against gravity."

She reminded her audience that even a small medical procedure can take its toll. "Maybe it was a bone marrow aspiration or the taking of blood or a small biopsy that didn’t require general anesthesia," she said. "But you still had to come into the hospital. You still had to have some kind of local anesthetic or mild sedation. And if you had tissue removed for a biopsy, that caused damage."

Ms. Almadrones noted that virtually all patients who have radiation treatments report fatigue, and that radiation of the large bones in the upper legs, pelvis, and lower abdomen is known to cause the greatest fatigue.

The increased activity of showing up for regular medical treatments, and sometimes having to get up earlier than usual for the appointments, adds to the debilitating effects of treatment, and so does trying to maintain one’s precancer schedule of activities. The result may be chronic fatigue. "Your body is telling you that you really need to stop and make priorities about how to spend your day," Ms. Almadrones said.

Not getting a good night’s sleep only adds to the fatigue, and there are many reasons why cancer patients cannot sleep. Ms. Almadrones advised patients to "make sure that any pain medication you take when you go to bed is long acting. If your sleep problems are due to gastro-intestinal symptoms, perhaps the medication for the GI symptoms can be taken closer to bedtime. If you have been told to drink two quarts of liquid a day and urinary frequency is interfering with your sleep, try drinking the liquid by 6 pm."

Sleeping pills are no panacea, she warned. "Although it helps you to get sleep, it leaves you groggy and it’s not the same as natural sleep. If you can, wean yourself off it."

Avoid Anxiety Before Bedtime

Engaging in activities that raise one’s anxiety level before going to bed does not help either, she said. Someone who is worried about money should not work on their checkbook before going to bed, for example. Rather, people should continue to observe the sleep rituals that worked for them before their diagnosis, like taking a warm bath or reading a magazine before retiring or taking a walk in the evening, she said.

Just because a health care provider fails to inquire about a patient’s energy level is no reason for a patient not to bring it up, Ms. Almadrones said. "If you’re feeling fatigued, you definitely need to talk about it with your doctor or nurse on your next visit," she said.

She also noted several things that patients can do to help assess the causes of their fatigue. Keeping a daily journal of when one feels tired or energetic will help tease out some of the causative factors, as well as some of the anxious thoughts that may be interfering with sleep. Discovering the ups and down of energy can also help patients schedule activities so that they are less draining.

Proper nutrition and taking lots of fluids are also key and so is getting adequate rest throughout the day. Ms. Almadrones encourages patients to take short naps. She also encourages them to detach themselves from any personal problems that family members are having. "They can be an emotional drain. You need to conserve your energy for your own body and use it to cope with your own problems," she said.