How can I manage cancer-related fatigue?
Combating cancer fatigue
The best way to combat fatigue is to treat the underlying cause. Unfortunately, the exact cause may be unknown, or there are multiple causes. There are some medical interventions that may assist some causes, such as anemia or hypothyroidism. Other causes must be managed on an individual basis.
Energy conservation during cancer fatigue
Plan ahead and organize your work:
- Change storage of items to reduce trips or reaching.
- Delegate when needed.
- Combine motions and activities and simplify details.
- Balance periods of rest and work.
- Rest before fatigue.
- Frequent, short rests are beneficial.
- Moderate pace is better than rushing through activities.
- Reduce sudden or prolonged strains.
- Alternate sitting and standing.
Practice proper body mechanics to combat cancer fatigue:
- When sitting, use a chair with good support.
- Adjust work heights - work without bending over.
- Bend at the knees and hips, not at the back.
- Carry several smaller loads or use a cart.
Limit overhead work:
- Use long-handled tools.
- Store items lower.
Limit isometric work:
- Breathe evenly; do not hold your breath.
- Wear comfortable clothes to allow for free and easy breathing.
Identify effects of your environment that may cause cancer-related fatigue:
- Avoid extremes of temperature.
- Eliminate smoke or noxious fumes.
- Avoid long, hot showers or baths.
- Decide what activities are important to you, and what could be delegated.
- Use your energy on important tasks.
Nutrition to combat cancer fatigue:
CRF is often made worse if you are not eating enough or if you are not eating the right foods. Maintaining good nutrition can help you feel better and have more overall energy. The following are strategies to help improve nutritional intake.
Basic calorie needs:
- Estimated calorie needs for person with cancer is 15 calories per pound of weight if your weight has been stable. Add 500 calories per day if you have lost weight.
- Example: A person who weighs 150 lbs. needs about 2,250 calories per day to maintain weight.
Protein rebuilds and repairs damaged (and normally aging) body tissue:
- Estimated protein needs are 0.5 - 0.6 grams of protein per pound of body weight.
- Example: A 150 lb. person needs 75-90 grams of protein per day.
- The best sources of protein include foods from the dairy group (8 oz. milk = 8 grams protein) and meats (meat, fish, or poultry = 7 grams of protein per ounce).
- A minimum of 8 cups of fluid per day will prevent dehydration. (That is 64 ounces, 2 quarts, or 1 half-gallon.)
- Fluids can include juice, milk, broth, milkshakes, Jello®, and other beverages. Of course, water is fine, too.
- Beverages containing caffeine do NOT count.
- Fluid losses from excess vomiting or diarrhea will require extra fluids.
- A good idea if dietary intake of sufficient nutrients is in doubt.
- A recommended supplement would be a multivitamin that provides at least 100% of the recommended daily allowances (RDA) for most nutrients.
- Vitamin supplements do not provide calories, which are essential for energy production; so, vitamins cannot substitute for adequate food intake.
Role of a dietitian in fighting cancer fatigue:
- Provides suggestions to work around any eating symptoms that may be interfering with intake (i.e., early feeling of fullness, swallowing difficulty, or taste changes).
- Suggests ways of maximizing calories and proteins in smaller amounts of food (i.e., powdered milk, instant breakfast drinks, and other commercial supplements, or food additives).
Cancer-related fatigue and exercise
Decreased physical activity, which may be the result of illness or of treatment, can lead to tiredness and lack of energy. Scientists have found that even healthy athletes forced to spend extended periods in bed or sitting in chairs develop feelings of anxiety, depression, weakness, fatigue, and nausea. Regular moderate exercise can decrease the feeling of fatigue and help a person feel energetic and stay active. Even during cancer therapy, it is often possible to continue exercise. You need to check with your physician before you start an exercise program.
Benefits of exercise:
- Lower blood pressure
- Improvement in the heart's pumping ability
- More energetic feeling, less fatigue
- Increased endurance
- Stronger tendons, ligaments, joints, and bones
- Easing the pain or stiffness of arthritic joints
- A more positive attitude, less strain and tension
- Better sleeping patterns
- Improved appetite
What is the right kind of exercise?
- A good exercise plan starts slowly, allowing your body time to adjust.
- It is important that you do something to exercise the whole body on a regular basis. Regular means every day, or at least every other day.
- The right kind of exercise never makes you feel sore, stiff, or exhausted.
- Any kind of exercise is O.K. Walking, stationary bike, yoga, or swimming (if the immune system is O.K.) and strength training are examples of types of exercise. Whatever kind of exercise you do should be at a moderate intensity so you can say to yourself "I am working somewhat hard."
What is the wrong kind of exercise?
- Even more dangerous than doing no exercise is exercising only occasionally and doing too much, too fast.
- If you experience soreness, stiffness, exhaustion, or feel out of breath as a result of your exercise, you are overdoing it.
Managing stress can play an important role in combating fatigue. The following are suggestions:
- Adjust your expectations. For example, if you have a list of 10 things you want to accomplish today, pare it down to two and leave the rest for other days. A sense of accomplishment goes a long way to reducing stress.
- Help others to understand and support you. Family and friends can be helpful if they can "put themselves in your shoes" and understand what fatigue means to you. Cancer support groups can be a source of support, as well. Other people with cancer truly understand what you are going through.
- Relaxation techniques such as audio tapes that teach deep breathing or visualization can help reduce stress and minimize cancer fatigue.
- Activities that divert your attention away from fatigue can also be helpful. For example, activities such as knitting, reading, or listening to music require little physical energy but require attention.
- If your stress seems out of control, talk to a health care provider. They are here to help.
Measures to improve sleep:
- Relaxation exercises or relaxation yoga before going to sleep.
- Avoid long afternoon naps.
- Go to bed only when sleepy. Use bedroom only for sleep and sexual activities.
- Set a consistent time to lie down and get up.
- Avoid caffeine and stimulating activities in the evening.
- Establish a relaxing pre-sleep routine to be used consistently.
- Progressive muscle relaxation training and/or relaxing yoga.
- Massage and/or healing touch may also be helpful.
Talk to your healthcare providers
Although CRF is a common and often expected side effect of cancer and its treatments, you should feel free to mention such feelings to the people providing your care. 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 of the causes of fatigue. Finally, there may be suggestions that are more specific to your situation that would help in combating your CRF. Be sure to let your doctor or nurse know if any of the following are present:
- Fatigue that limits your ability to care for yourself
- Increasing shortness of breath with minimal exertion
- Uncontrolled pain
- Inability to control side effects from treatments (i.e., nausea, vomiting, diarrhea, or loss of appetite)
- Uncontrollable anxiety or nervousness
- Ongoing depression
Things your healthcare provider may recommend for cancer-related fatigue
The first step in treating fatigue is knowing the problem exists. Many people don't bother to mention fatigue to their doctors because they believe it is normal. It is vital that you discuss this and all symptoms or side effects with your health care provider. Then, efforts can be directed at determining the cause of the problem and prescribing appropriate treatment. Your particular cancer treatment regimen, with its known side effects, may provide clues for your doctor or health care professional. A simple blood test, for example, can determine if you are anemic.
There is no single medication available to treat fatigue. However, there are medications available that can treat some of the underlying causes. Make sure you speak with your health care professional if you are feeling fatigued.
Note: We strongly encourage you to talk with your healthcare professional about your specific medical condition and treatments. The information contained about cancer fatigue in this website is meant to be helpful and educational, but is not a substitute for medical advice.