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• Cancer Fatigue

The profound fatigue felt by many cancer patients undergoing treatment may be difficult for the patient and persons around them to understand. Cancer-related fatigue is one of the most common side effects of the disease and its treatment, although it varies with each individual. It can affect many aspects of the patient's life, and the caregivers, as well.

What causes cancer fatigue?

Cancer fatigue can have many causes. Among them are effects of the cancer treatment, inadequate nutrition, lack of exercise, and the cancer itself. Surgery, radiation and chemo-therapy can all contribute to a reduced quality of functioning on a temporary basis. This run-down feeling can persist for some time, even after therapy is completed. Fatigue may also be a reaction to the stress and depression of having cancer. Low blood counts, weight loss, and sleep difficulties are other contributing factors.

It sounds like a paradox, but research shows that too much rest can make you more tired. Rest is important, but staying in bed for extended periods can cause wasting of muscle tissues, producing further loss of performance.

How can cancer fatigue be managed?

"Cancer fatigue is a very real phenomenon," explains Randall Oyer, M.D., chairman of Hematology/ Oncology at John Muir Medical Center, Walnut Creek Campus. "It is important for physicians and patients to address the problem together. We try to identify the cause of fatigue. Anemia, medication side effects, thyroid imbalance, any infection or other medical problem, and depression may contribute to cancer fatigue. We address those conditions directly. If there is no identifiable cause, we recommend a healthy diet, periods of rest, exercise in gradual increments, and rationing of time and energy for the most important and enjoyable activities."

If you are continuing to work, try for a modified work schedule or flexible hours. Arrange the most challenging activities for a time of day when you are usually at your best. Talk with your employer and co-workers to help them understand what you are going through and to reassure them that these symptoms are temporary. Above all, be realistic about what your work goals might be during this time.

How does cancer fatigue feel?

"Some patients describe the unpredictable sensation as feeling suddenly like hitting a brick wall, or having a vacuum cleaner suck out all their energy," explains Candy Negrete, R.N., M.S., A.O.C.N., at John Muir Cancer Institute-Concord. "This fatigue is real, and it's unlike any other feeling of tiredness. At a time when the patient wants to be closest to family and friends, they may have little energy to interact." Negrete is a specialist in cancer fatigue who belongs to a national —organization focusing on this problem. She frequently devotes time to helping cancer patients cope with their inability to continue their accustomed pace and activities.
Tips for managing cancer treatment- related fatigue:

• Stay as active as you can, walking several times a week
• Drink plenty of liquids and eat nutritious foods
• Participate in activities you enjoy, such as reading, listening to music, or being outdoors with nature
• If you live alone, call upon friends, your church or social agencies to help
• Learn and practice stress management techniques
• Join a support group
• Save your energy for the most important things

"Carefully managing your symptoms of fatigue will help you adjust to your treatment program and allow you to participate more fully in modified daily activities," Negrete adds. "When the patient feels better, the caregiver's role also becomes easier." Studying the benefits of exercise for cancer patients.

Several recent studies have shown that regular aerobic exercise reduces fatigue in cancer patients. Further studies are ongoing to evaluate effects of different types of physical activity on the quality of life of cancer patients.

What therapies can help minimize cancer fatigue?

"We now have antidotes for some of the most problematic side effects of chemotherapy such as nausea and low blood counts," Dr. Oyer indicates. "An individualized approach is used, based on what is medically best and according to a person's performance. We discuss with patients whether to consider part-time work or short-term disability, which allows more focused efforts at getting better. Understand-ing that cancer-related fatigue has a limited time frame helps caregivers and colleagues to be more supportive, too. They need to respect and accept what a person is able to do in the face of ongoing treatment." With continuing clinical trials of new medications for cancer treatment, there is hope that the exact mechanism causing fatigue will be identified and that side effects may soon be greatly reduced.