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Patients Need to Tell Doctors About Fatigue

CancerWise - April 2007


By Darcy De Leon

Do you find yourself without energy or motivation to perform the day’s simplest tasks? Are you unable to rejuvenate after a good night’s sleep? Does lethargy impact your relationships with family and friends?

If the answer to any of these questions is “yes,” and you have been diagnosed with cancer at any point in your life, you may be experiencing cancer-related fatigue.

The condition, which is the most common side effect of cancer or cancer treatment, is recognized in April during National Cancer Fatigue Awareness Month. Fatigue occurs in up to 90% of cancer patients, says Carmen Escalante, M.D., director of M. D. Anderson’s Cancer-Related Fatigue Clinic and chair of the cancer center’s Department of General Internal Medicine, Ambulatory Treatment and Emergency Care.

Fatigue clinic specialists say patients need to tell their doctors and nurses about their symptoms because they may be able to reduce or eliminate them. Symptoms can be physical and also involve cognitive thinking.

“We can see if there is something that is reversible like anemia or hypothyroidism and develop a treatment approach, then measure follow-up,” Escalante says.

Not all fatigue can be eliminated, but it is in the best interest of patients to explore treatment for a condition that can be debilitating.

Cancer and cancer treatment are major causes

The first step in addressing the problem is patients becoming aware of their symptoms and then talking to their oncologist or asking for a referral to a cancer fatigue specialist. Experts can conduct a comprehensive examination to help zero in on the problem, Escalante says.

Doctors can evaluate possible causes, which include:

  • Cancer
  • Cancer treatment side effects such as:
    • Anemia
    • Pain
    • Sleep disorders
    • Emotional distress
    • Medical disorders

Cancer alone can cause fatigue for many reasons, including anemia brought on by the spread of tumors to the bone marrow.

Cancer treatments – including chemotherapy, radiation and surgery – are another major culprit. “Many patients are getting very aggressive treatments that cause fatigue,” Escalante says. “You can’t give these aggressive and toxic drugs and have no side effects, and fatigue is a big one.”

A frustrating characteristic of the condition is that no one knows how long fatigue will last, says Rosalie Valdres, a nurse practitioner in M. D. Anderson’s fatigue clinic. “Some patients are OK after one to two years, and some patients followed by our clinic are still experiencing fatigue up to nine years later,” she says.

Specialists investigate anemia, depression, sleep

Fatigue caused by chemotherapy-induced anemia can be treated with blood transfusions. A class of drugs called erythropoiesis-stimulating agents (ESA) are also used to treat anemia to avoid transfusions.

ESAs recently were given a warning by the U.S. Food and Drug Administration (FDA) because the drugs were found to increase the risk of death when they were used to raise patient hemoglobin levels higher than the product label recommends.

The FDA says the drugs can continue to be used as long as doctors are aware of the product recommendations and they frequently monitor blood hemoglobin levels. Patients also should report shortness of breath, pain or swelling in the legs, or increases in blood pressure.

In addition to anemia, depression also can cause or contribute to fatigue.

Treatments for patients with depression might include:

  • Antidepressants
  • Exercise
  • Pain medication (if needed)
  • Alternative therapy, such as:
    • Meditation and relaxation
    • Self-hypnosis

Patients with sleep disorders, such as sleep apnea, might be prescribed night-time breathing machines, which help keep their airway open, resulting in better breathing and less interrupted sleep. Relaxation exercises (including hypnosis) also might help patients who have trouble sleeping.

Some patients might be candidates for psychostimulants to help them stay awake and focused during the day so that they can do their routine activities, Valdres says.

Other diseases, physical conditions contribute to fatigue

Chemical imbalances or deficiencies also can contribute to fatigue, Valdres says. “For instance, we can see if a patient’s electrolytes, such as potassium or magnesium, are low, then make sure it is replaced.”

Medical conditions that can cause fatigue include:

  • Uncontrolled diabetes
  • Thyroid problems
  • Heart disease
  • Rheumatoid arthritis

Changes or adjustments in medication could help lessen the problem.

Fatigue is an unexpected byproduct of cancer

No matter what the cause of fatigue, one universal recommendation is to exercise regularly – first, starting slowly, Escalante says. In some cases, patients need physical therapy.

Although fatigue may be a result of successful cancer treatment, the bad news is that even after a thorough fatigue assessment and treatment, some patients may experience fatigue the rest of their lives, she says.

“We’ve been so successful in treating our cancer patients so that they live longer, but now we are seeing the effects of our treatment,” Escalante says. “Survival can be several years, and cancer is more of a chronic disease. Unfortunately, the side effects may leave patients impaired.”

For more information about cancer-related fatigue, ask your doctor about cancer fatigue specialists in your area.

M. D. Anderson’s Cancer-Related Fatigue Clinic accepts patients no matter where they have received cancer treatment. To request an appointment, submit an online self-referral form or call 1-877-632-6789.

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© 2014 The University of Texas MD Anderson Cancer Center