Fatigue and Cancer, Part 2

by National Cancer Institute

(Page 2 of 2)

Medications

Medications other than those used in chemotherapy may also contribute to fatigue. Opioids used in treating cancer-related pain often cause drowsiness, the extent of which may vary depending on the individual. Other types of medications such as tricyclic antidepressants and antihistamines may also produce the side effect of drowsiness. Taking several medications may compound fatigue symptoms.

Assessment

To determine the cause and best treatment for fatigue, the person's fatigue pattern must be determined, and all of the factors causing the fatigue must be identified. The following factors must be included:

1. Fatigue pattern, including how and when it started, how long it has lasted, and its severity, plus any factors that make fatigue worse or better.
2. Type and degree of disease and of treatment-related symptoms and/or side effects.
3. Treatment history.
4. Current medications.
5. Sleep and/or rest patterns and relaxation habits.
6. Eating habits and appetite or weight changes.
7. Effects of fatigue on activities of daily living and lifestyle.
8. Psychological profile, including an evaluation for depression.
9. Complete physical examination that includes evaluation of walking patterns, posture, and joint movements.
10. How well the patient is able to follow the recommended treatment.
11. Job performance.
12. Financial resources.
13. Other factors (for example, anemia, breathing problems, decreased muscle strength).

Underlying factors that contribute to fatigue should be evaluated and treated when possible. Contributing factors include anemia, depression, anxiety, pain, dehydration, nutritional deficiencies, sedating medications, and therapies that may have poorly tolerated side effects. Patients should tell their doctors when they are experiencing fatigue and ask for information about fatigue related to underlying causes and treatment side effects.

Anemia evaluation

There are different kinds of anemia. A medical history, a physical examination, and blood tests may be used to determine the kind and extent of anemia that a person may have. In people with cancer there may be several causes.

Treatment

Most of the treatments for fatigue in cancer patients are for treating symptoms and providing emotional support because the causes of fatigue that are specifically related to cancer have not been determined. Some of these symptom-related treatments may include adjusting the dosages of pain medications, administering red blood cell transfusions or blood cell growth factors, diet supplementation with iron and vitamins, and antidepressants or psychostimulants.

Psychostimulant drugs

Although fatigue is one of the most common symptoms in cancer, few medications are effective in treating it. A health care provider may prescribe medication in low doses that may help patients who are depressed, unresponsive, tired, distracted, or weak. These drugs (psychostimulants) can give a sense of well-being, decrease fatigue, and increase appetite. They are also helpful in reversing the sedating effects of morphine, and they work quickly. However, these drugs can also cause sleeplessness, euphoria, and mood changes. High doses and long-term use may cause loss of appetite, nightmares, sleeplessness, euphoria, paranoid behavior, and possible heart problems.

Treatment for anemia

Treatment for fatigue that is related to anemia may include red blood cell transfusions. Transfusions are an effective treatment for anemia, however possible side effects include infection, immediate transfusion reaction, graft-versus-host disease, and changes in immunity. Treatment for anemia-related fatigue, in patients undergoing chemotherapy, may also include drugs that stimulate the production of blood cells such as epoetin alfa.

Exercise

Exercise (including light- to moderate-intensity walking programs) helps many people with cancer. People with cancer who exercise may have more physical energy, improved appetite, improved ability to function, improved quality of life, improved outlook, improved sense of well being, enhanced sense of commitment, and improved ability to meet the challenges of cancer and cancer treatment.

Exercise may also help patients with advanced cancer, even those in hospice care. More benefit may result when family members are involved with the patient in the physical therapy program.

Activity and rest

Any changes in daily routine require the body to use more energy. People with cancer should set priorities and keep a reasonable schedule. Health professionals can help patients by providing information about support services to help with daily activities and responsibilities. An activity and rest program can be developed with a health care professional to make the most of a patient's energy. Practicing sleep habits such as not lying down at times other than for sleep, taking short naps no longer than one hour, and limiting distracting noise (tv, radio) during sleep may improve sleep and allow more activity during the day.

Patient education

Treating chronic fatigue in cancer patients means accepting the condition and learning how to cope with it. People with cancer may find that fatigue becomes a chronic disability. Although fatigue is frequently an expected, temporary side effect of treatment, other factors may cause it to continue.

Since fatigue is the most common symptom in people receiving outpatient chemotherapy, patients should learn ways to manage the fatigue. Patients should be taught the following:

• The difference between fatigue and depression
• Possible medical causes of fatigue (not enough fluids, electrolyte imbalance, breathing problems, anemia)
• To observe their rest and activity patterns during the day and over time
• To engage in attention-restoring activities (walking, gardening, bird-watching)
• To recognize fatigue that is a side effect of certain therapies
• To participate in exercise programs that are realistic
• To identify activities which cause fatigue and develop ways to avoid or modify those activities
• To identify environmental or activity changes that may help decrease fatigue
• The importance of eating enough food and drinking enough fluids
• Physical therapy may help with nerve or muscle weakness
• Respiratory therapy may help with breathing problems
• To schedule important daily activities during times of less fatigue, and cancel unimportant activities that cause stress
• To avoid or change a situation that causes stress
• To observe whether treatments being used to help fatigue are working

Posttreatment Considerations

This section is for patients who have had no cancer treatment for at least 6 months. The causes of fatigue are different for patients who are receiving therapy compared to those who have completed therapy. Also, the treatment for fatigue may be different for patients who are no longer receiving treatment for cancer.

Fatigue in people who have completed treatment for cancer and who are considered to be disease-free is a different condition than the fatigue experienced by patients receiving therapy. Fatigue may significantly affect the quality of life of cancer survivors. Studies show that some patients continue to have moderate-to-severe fatigue for up to 18 years after bone marrow transplantation. Long-term therapies such as tamoxifen can also cause fatigue. Fatigue can cause poor school performance years later in children who were treated for brain tumors and cured. Long-term follow-up care is important for patients after cancer therapy. Physical causes should be ruled out when trying to determine the cause of fatigue in cancer survivors.

About the Author

www.nci.nih.gov
The National Cancer Institute's research programs are extensive and contain many innovative initiatives. I invite you to explore our Web site to find out more about the exciting work being conducted here at NCI and by NCI-supported scientists throughout the country.