Cancer Fatigue
When people think about the side effects of cancer treatment, they usually think about hair loss (which is common with some types of chemotherapy), and nausea (which is not nearly as common as it used to be). In my mind, though, the side effect of cancer treatment that's most universal and least appreciated is fatigue.
Fatigue is different than simply being tired. People often describe it as a complete loss of energy. I hear the phrases, "dead tired" or "bone tired" all of the time. Washing the dishes can seem like climbing Mount Everest. And people often wake up in the morning feeling just as depleted. Fatigue is more than a nuisance, it can completely disrupt one's life.
Some causes of cancer-related fatigue are organic and respond well to treatment. Anemia, for example, is sometimes caused by chemotherapy. If people don't have enough red blood cells, they won't feel very peppy. Anemia can be treated.
Sometimes fatigue is caused by simply not eating enough. Treatment (and cancer itself) can affect a person's appetite or ability to swallow. Nutritionists can help identify foods and supplements that are both palatable and provide enough calories.
Sleep is often disrupted during cancer treatment. A person's life rhythms get out of whack - they go to bed at odd hours, nap during the day, and worry at regular intervals. The medications themselves can affect sleep cycles. A good night's sleep is restorative. If sleep is a problem, talk with your doctor about medication and/or other solutions.
Depression is common for many people with cancer, and depression can affect sleep, appetite, and energy. Sometimes it's hard to sort out what's causing what. Is depression causing the fatigue, or is it something else? When a person is in middle of treatment and suffering significant side effects, if often makes sense to see what helps, even if the cause isn't completely understood.
For many, fatigue is caused by a lack of activity. It's easy to become out of shape after months of surgery, chemo, and radiation. It's a vicious cycle in that fatigue can cause one to stay on the couch which, in turn, causes more fatigue. Gentle exercise, such as walking, is almost always helpful.
Even when the fatigued can't be "fixed," it can be managed. One nurse tells her patients that it's like beginning each day with $100 dollars in their energy bank. Once it's gone for the day, it's gone, so they need to prioritize their activities. At the top of the list are things that have to get done as well as those things that provide the greatest pleasure. Other activities can wait or friends can be called in to help with the dishes or shop for groceries. Friends who want to help are often delighted to have concrete tasks assigned.
Cancer-related fatigue is just beginning to receive the attention it deserves. Just as pain assessment has become a standardized and regular component of medical care, fatigue assessment is entering the realm of routine cancer care. One survey of cancer patients found that most experienced fatigue, but few discussed it with their physicians. I hope this soon changes. Just like pain, fatigue can be overwhelming and debilitating. It can and should be addressed on a regular basis.
Reprinted with permission from the Ithaca Journal
Original Publication Date: November 5, 2011
