Fatigue is the most common symptom reported by cancer patients. Multiple factors such as pain, treatment side effects, and stress contribute to fatigue; and its management requires multiple techniques.
“Even after treatment is finished, up to 30% of cancer survivors experience fatigue,” said Carmen Escalante, M.D., a professor in and chair of the Department of General Internal Medicine at The University of Texas MD Anderson Cancer Center. “But fatigue isn’t something that cancer patients and survivors have to simply accept.”
At MD Anderson’s Cancer Fatigue Clinic, Dr. Escalante helps cancer patients and survivors develop strategies to overcome fatigue. Some of these strategies are summarized below and work for both patients and survivors, but the ideal approach to fatigue management for each person will depend on his or her symptoms.
At first it seems odd to tell someone who feels tired to go out and exercise, but research has shown that moderate exercise helps improve a person’s energy level. “Of all the techniques that have been studied, exercise has the best data to show that it can improve fatigue,” Dr. Escalante said. “But it takes a couple of months of regular exercise before patients see an improvement.”
The key for cancer patients with fatigue, especially those who have not exercised regularly in the past, is to start slowly by walking short distances or doing some other low-intensity activity and gradually increase the amount of exercise. Patients should consult a doctor before starting a new exercise routine.
Lack of sleep can contribute to fatigue. Minor changes such as avoiding caffeine, nicotine, and chocolate in the afternoon and evening and turning off the television an hour before bedtime help some patients sleep better. If such changes do not improve sleep, the patient may want to be evaluated for a sleep disorder.
Patients with fatigue can plan their activities to save energy. This planning can include setting priorities to make sure that the most important items get done and delegating some tasks to others. Activities that require a lot of energy can be scheduled for the time of day when the patient has the most energy, and rest breaks can be scheduled between tasks.
Manage stress and anxiety
Several options are available to relieve stress and anxiety, which contribute to fatigue. Relaxation techniques such as meditation or deep breathing can help reduce stress. Also, most cancer hospitals have counselors who can help patients cope with stress and anxiety. Some patients with cancer-related anxiety are given anti-anxiety medicines; however, these drugs are not appropriate for all patients.
Medicines such as stimulants and antidepressants have been tested for treating cancer-related fatigue. However, these studies have had mixed results, Dr. Escalante said. Therefore, medication is typically reserved for patients with specific disorders that contribute to fatigue and that can be treated with the drugs.
Dr. Escalante said that antidepressants alone will not help fatigue unless the patient has clinical depression. Stimulants, however, may be used with other interventions such as exercise for patients with moderate to severe fatigue. Dr. Escalante added that insurance companies are unlikely to pay for a drug such as a stimulant unless the patient has been diagnosed with a condition the drug is approved to treat, such as attention-deficit/hyperactivity disorder or obstructive sleep apnea.
Get professional help
At any point during or after cancer treatment, patients with fatigue can ask their doctor to refer them to a clinic that specializes in fatigue management. In MD Anderson’s Fatigue Clinic, about half of the patients are still receiving cancer treatment and half have completed treatment.
On their first visit to the clinic, patients are given a complete physical examination. “We do lab tests, if they haven’t recently been done, to look for medically reversible problems that contribute to fatigue, such as anemia, hypothyroidism, or kidney and liver dysfunction,” Dr. Escalante said.
Patients also fill out a detailed survey about their fatigue symptoms, anxiety, stress, pain, and sleep. “The survey helps us untangle this web of symptoms and develop a focused treatment plan for each patient,” Dr. Escalante said. These plans usually include exercise and some of the other techniques described above. Depending on a patient’s needs, he or she may also be referred to other experts, such as psychiatrists or sleep medicine specialists.
Follow-up visits are scheduled at least 6 weeks later. During these visits, the survey is repeated to monitor changes in fatigue levels. Dr. Escalante said her patients’ fatigue levels typically improve over time.
“Fatigue won’t always go away completely,” Dr. Escalante said, “but decreasing it from a severe level to a moderate or mild level can improve quality of life.”
For more information, ask your doctor , visit MD Anderson’s Fatigue Clinic, or contact the Fatigue Clinic at 713-563-7100.
OncoLog, July 2017, Volume 62, Issue 7