Cancer fatigue: a common complaint among cancer patients

When you’re otherwise healthy and have trouble keeping your eyes open in an afternoon meeting, an extra hour or two of sleep may be all it takes to replenish your energy. However, when you have cancer, rest is often not enough. Even after a few extra nights of sleep, many cancer patients still feel tired and unable to complete their normal daily activities.

If it looks familiar, it may mean that you are very tired. If you’re like most cancer patients, you may have a clinical case of fatigue. According to the National Cancer Institute, fatigue is the most common side effect of cancer treatment, and it is particularly common and long-lasting among patients who are older, have advanced cancer, or are receiving more than one type of treatment.

Early in treatment, many cancer patients are already emotionally and physically drained from diagnosis, medical exams, and, for some, initial surgery. Once treatment is started, this sluggishness can escalate to complete fatigue. Unlike episodes of exhaustion or situational fatigue, burnout is characterized by a persistent lack of energy and/or weakness. Think of that shopping trip that suddenly seems too hard to handle. A condition that can strike you at any time during your cancer journey, fatigue can develop because your treatment causes nausea and vomiting, depleting levels of vitamins and nutrients. Or it may start because you are losing weight or muscle mass. It can also be due to pain or an inability to move as much as before.

Intensity calibration

To diagnose fatigue, your doctor will likely ask you questions to see how your lack of energy affects your quality of life. These questions can measure the severity of certain symptoms you may also have, such as:

• pain
• lethargy
• Sleep disorders
• nausea
• drowsiness
• lack of appetite
• Sadnes
• numbness or tingling
• vomiting

Your doctor may also want to know if your symptoms have affected:

• rejoice
• Productivity at work
• Social interactions with others
• enjoy the life

If left untreated, fatigue can lead to depression, which may affect your ability to continue with your treatment regimen. If you don’t have enough energy to cook healthy meals for yourself, for example, you may experience unintended weight gain, which can leave you feeling depressed and disinterested in activities you once enjoyed. The domino effect can make you sick or too weak to continue treatment. “When you feel fatigued, you tend to gravitate toward foods that are easy to prepare, like fast food or highly processed foods,” says Crystal Langlois, MD, director of nutrition at our hospital near Atlanta. Although healthy foods may take longer to prepare, they actually make you feel better.

The role of the exercise

The same applies when you don’t have enough energy to go to the gym. If you don’t exercise, you are more likely to suffer from fatigue. In fact, a new study finds that exercise and psychological interventions can be powerful tools to combat cancer-related fatigue. The study, published this month in JAMA Oncology , followed more than 11,000 cancer survivors and compared how exercise, counseling and medication affected their stress. The researchers concluded that psychological exercises and interventions, such as counseling and advice to make healthy lifestyle changes, performed better than medications in helping study participants manage fatigue.

However, even as you work to increase your energy levels, don’t expect to have the same bounce back in your stride that you had before your diagnosis. It’s likely that cancer and its treatments will continue to affect your energy levels, Langlois says. “It’s a basic fact that caregivers can help cancer patients accept,” he says. “They can try to help patients by guiding and pushing them when appropriate, but also helping them understand that they may not be able to do everything they used to do, at least for now.”