Contributor: Josette Snyder, RN, MSN, AOCN
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“I feel so wiped out!”
In my work with cancer patients in person and on the Cancer Answer line, I hear this phrase all the time. Fatigue is one of the most commonly experienced side effects from cancer treatment.
Cancer-related fatigue is different from feeling tired. When you feel tired, you get some sleep and then you awake feeling refreshed and otherwise fine. Symptoms of cancer-related fatigue may persist even when you’re getting enough sleep.
Many cancer patients want to know why they feel so tired. A number of factors can cause fatigue.
First of all, there is the cancer treatment. Chemotherapy, radiation therapy, biotherapy and surgery can all contribute to feelings of fatigue. This may be due to side effects of the treatment such as anemia (a lowering of the red blood cells which help carry oxygen throughout the body) or side effects leading to dehydration or decreased nutrition. Medications used to treat side effects also can contribute to cancer-related fatigue.
Then there is the emotional and mental aspects of undergoing cancer treatment. In addition to absorbing the fact that you have a very serious illness, you also have to deal with the details of managing tests, scheduling doctor’s visits and learning about your disease. Some patients experience depression, anxiety or difficulty in sleeping. All these can lead to fatigue.
The best way to combat fatigue is to treat the underlying cause. Unfortunately, the exact cause may be unknown, or there may be multiple causes.
So when I talk to patients about cancer-related fatigue, I focus on self-care and how patients can help themselves. Here are some tips I like to share:
- Stay well-hydrated. Ask your health care team how much water you should drink. Plain water is best, but if you dislike plain water, try drinking flavored water or adding a slice of lemon. Other decaffeinated, non-alcoholic fluids, such as milk, juice and tea, also can keep you hydrated. Try to minimize caffeine as it may contribute to dehydration, especially if you’re not used to it.
- Try to maintain a daily routine. Ever wonder why we all feel so dragged out on Mondays? It’s because on the weekend, we go to bed later and sleep in longer, which disrupts our weekday routine. If you’re constantly trying to read just, that can be tiring. You’ll feel better if you stick to familiar habits because our bodies like routine. So try to get up and go to bed at the same time every day. Then once you’re up, get out of your pajamas. Putting on your day time clothes helps you feel more energetic for the day.
- Set priorities among your activities. There are activities that have to be done, like taking care of yourself by getting up and dressing for the day. Also, some people may need to continue to work while on treatment, so they need to have energy for their jobs. After that, it’s important to look to activities that can be rejuvenating. This is very much up to the individual and could include activities such as woodworking, puttering in the garage, cooking or light gardening. I tell my patients to decide what they absolutely need to keep doing. As much as possible, keep the activities that are enjoyable. Cut out the rest so you’re doing the things that you truly love and that can restore your soul.
- Take a “power nap” during the day. What I label a power nap is a rest period that lasts less than an hour. I encourage patients to build in one or, if necessary, two power naps each day. This short amount of time tends to be the most restful. Anything longer might interfere with your rest cycle and can add to your fatigue.
- Exercise. It may seem counterintuitive, but physical activity can actually decrease your fatigue. Studies with breast cancer patients and other cancer patients show that if they move as little as walking for 30 minutes three to five times a week, they experience less feelings of fatigue. You may need to start with light activity for short periods of time. Check with your health care team before starting an exercise program to be sure there are no limitations specific to your situation.
- Eat well. Talk with your health care team members and follow their advice for eating a balanced diet. At times, your diet may need to include extra calories or protein, such as milk, cheese and eggs.
Although fatigue is a common and often expected side effect of cancer and its treatments, you should feel free to mention such feelings to your health care team. There are times when fatigue may be a clue to an underlying medical problem. Other times, there may be medical interventions to assist in controlling some causes of fatigue.