Understanding the Problem

Chronic fatigue is one of the most common problems for cancer patients. People describe this symptom in many ways: tired, weak, sad, bored, no energy, exhausted, depressed, and unable to concentrate.

Unlike acute fatigue that is relieved with rest, chronic fatigue is related to medical conditions or treatments and is not relieved by rest. Almost all patients have some fatigue after surgery. Many things can cause this: blood loss, bedrest or decreased activity, medicines, and sadness due to diagnosis of cancer.

Fatigue is also a common side effect during and after chemotherapy or radiation therapy. It can last a few weeks or even for several months. Chronic fatigue interferes with your life and simple tasks such as shaving or brushing your teeth may seem impossible to do.

Fatigue is often caused by more than one problem. Two types of approaches are used to manage fatigue.

The first approach is to find any causes for fatigue that can be treated. Some treatable problems that cause fatigue are anemia (low red blood cell counts), emotional distress or depression, sleep difficulties, poor nutrition, pain, and low thyroid gland function.

The second approach is to conserve your energy, cope with stress, and restore your ability to focus.

Things You Can Do to Reduce Fatigue

• Use your energy for what is important to you. List your activities according to how important they are to you when you have the most energy. Keep a diary of peak energy and peak fatigue times to help you plan your day. Establish a structured daily routine that matches your most important activities with the times you have the most energy.
• Balance rest and activities. Excessive bed rest promotes weakness. Try to avoid it. Schedule activities so that you have time for short rest periods during the day that do not interfere with your nighttime sleep.
• Conserve energy during activities of daily living. Use a shower chair. Wear comfortable clothing and flat shoes. Minimize leaning over. Space your household tasks over the week. Place things that you use often within easy reach to save your energy.
• Ask for help and delegate tasks when you can. Many people have friends and family who are willing to help, but don’t know what will be helpful to you. If asking for help is stressful, consider asking one person to coordinate the help of others.
• Eat a well-balanced diet. Unless you are given other instructions, eat a balanced diet that includes protein (meat, milk, eggs, and beans) and drink about two liters (eight to 10 glasses) of liquids a day. Eat small meals and healthy snacks frequently, rather than fewer large meals. When cooking, make double portions and freeze half. Use nutritious convenience foods. Limit caffeine if you have trouble sleeping at night.
• Reduce stress and participate in pleasurable activities. Use methods to reduce stress, such as deep breathing, visual imagery, meditation, prayer, talking with others, participating in a support group, reading, listening to music, painting, or any other activity that gives you pleasure.
• Exercise. Light exercise and stretching can help maintain or improve your energy level. Talk to your doctor about starting an exercise program, if appropriate. Try to maintain the level of activity appropriate for your situation.
• Get other symptoms under control. Talk to your doctor about how to manage pain, nausea, breathing problems, depression, or any other symptoms that use your energy.
• Share concerns and needs with family. Tell your family how you are feeling and what help you need. Teach children to climb up on the lap or into the high chair to avoid lifting. Spend time with children doing quiet activities such as drawing, playing games or computer games, and reading. Get help with more physically demanding childcare needs.

When to Call Your Health Care Provider

Contact your health care team if you have any of the following:

• Dizziness, headache, shortness of breath, heart palpitations, cold intolerance
• Change in your activity tolerance or difficulty walking short distances
• Trouble sleeping at night
• Uncontrolled symptoms or side effects that can worsen fatigue, such as nausea, vomiting, diarrhea, shortness of breath, or new or increased pain
• Persistent feelings of sadness, worthlessness or irritability, decreased desire to participate in daily or social activities
• Loss of concentration

Additional Resources

Cancer-Related Fatigue Treatment Guidelines for Patients (PDF)
National guidelines describing cancer-related chronic fatigue, including assessment, management of medical causes, and self-care. Available from the National Comprehensive Cancer Network online or toll-free at 888-909-NCCN or 888-909-6226

Activities to Help Cancer Patients Restore Focus and Attention
Teaching sheet available online under ‘self care guides’ at http://cancer.duke.edu/pated/ or ask your Duke nurse for a copy

Share the Care: How to Organize a Group to Care for Someone Who is Seriously Ill
by Cappy Capossela, Sheila Warnock, Sukie Miller. Available to check out from the Duke Cancer Patient and Family Resource Center or purchase from your favorite bookseller.

Don’t Let Stress Get the Best of You
Workbook created by Duke nurses to help you identify and manage sources of stress in your life. Available to inpatients through the Stress Management consult nurses or through the Duke Cancer Patient and Family Resource Center.

This article is intended as a resource for patients receiving their cancer care at Duke University Hospital or Duke Clinic. It is not intended to substitute for medical advice from your health care team. If your doctor’s instructions differ from the information in this article, please talk with your doctor before making any changes.

Source: Duke Cancer Patient Education Program / approved Patient & Family Education Committee 9/05