Doctor, Doctor: Tired of Being Tired
Network - Spring 2010
We asked Carmen Escalante, M.D., professor and chair of the Department of General Ambulatory Treatment and Emergency Care at M. D. Anderson, about cancer-related fatigue — one of the most troublesome side effects of cancer and cancer treatment.
What characterizes the fatigue experienced by many cancer patients?
Often, the fatigue experienced by cancer patients is not proportional to activities and is unrelieved by rest. Frequently, the patient feels “unrefreshed” upon awakening in the morning.
Cancer-related fatigue is persistent and often distressing to the patient and may encompass physical, emotional and/or cognitive (mental) tiredness.
What do you say to patients who wonder, "Will I ever not be tired?"
In the majority of patients, fatigue does improve as the patient gets further from the end of cancer treatment.
Often, the rapidity of improvement depends on the type and intensity of cancer treatment. Patients receiving multiple modalities (chemotherapy, radiation, surgery) tend to have more fatigue than those who receive a single modality.
For a smaller number of patients, fatigue may not disappear following cancer treatment.
What are a few things patients can do to address this debilitating condition?
Exercise has the best evidence for improvement of fatigue. It also may help with other conditions such as weight control, anxiety and stress, cardiovascular disease, diabetes and lipid control. Patients who are not conditioned and have not recently exercised should start slowly and increase the length of time and intensity as their conditioning and stamina improve.
Other things that may help improve fatigue include conserving energy (such as sitting to do things that don’t require standing or using devices such as a shower chair), prioritizing daily activities, and delegating chores that can be done by others.
For some patients, certain medications such as stimulants (methylphenidate, modafinil) may be helpful. Control of other symptoms that may increase fatigue — such as pain, depression, sleep dysfunction and anxiety — is also important.
Should patients suffering fatigue speak to their loved ones and physicians about how they feel?
Yes. It’s important that patients discuss this symptom with their health care providers, families and friends. Health care providers can offer treatment and reassurance that fatigue is not a sign of worsening disease or recurrence of the malignancy, which is often a significant relief to the patient.
Also, although many patients are hesitant to ask for assistance from families and friends, most are very willing to help. This may include taking on certain chores, bringing meals so that he or she doesn’t have to cook, or, most important, just listening to and supporting the patient.