From time to time, everyone has experienced exhaustion: as a child, after a slumber party; as a teenager, after intense sports practices; in college, from studying all night for an exam; and throughout the first year of being a new parent, when you are rarely granted uninterrupted sleep. For cancer patients, exhaustion can be relentless, and unfortunately, very common. Studies estimate that somewhere between 50% and 90% of cancer patients experience this exhaustion, known as cancer-related fatigue. For Kelly Hicks, a breast cancer survivor from Lebanon, Missouri, this persistent and intense tiredness required purposeful changes to her daily activity to help her cope.
What causes cancer-related fatigue?
Cancer-related fatigue may be the result of a number of factors, including:
- The type and stage of cancer
- Treatment history
- Current medications
- Sleep patterns
- Psychological profile
- Other conditions, such as anemia, breathing problems, decreased muscle strength, etc.
Fatigue set in the second day after Hicks’ first chemotherapy treatment at Cancer Treatment Centers of America® (CTCA) at Southwestern Regional Medical Center (Southwestern) in Tulsa, Oklahoma: “I scheduled my chemotherapy appointments on Fridays so I could recover on the weekend and go to work on Monday. After my first treatment, I began to feel fatigue on Saturday, but it wasn’t too bad. On Sunday, I stayed in bed all day. I didn’t have much energy to do anything. This pattern repeated itself after each treatment, but finally improved with my last couple chemo treatments.”
According to Stephanie Moore, DNP, APRN, ACNS-BC, Advanced Practice Provider at Southwestern, while every patient’s fatigue is unique, Hicks’ experience isn’t uncommon. Often, fatigue occurs at different times during treatment. Moore also notes that fatigue varies by treatment, and sleep disruptions and/or lack of adequate sleep can impact your level of fatigue.
Combating fatigue with rest and activity
Hicks maintained a goal of continuing to work throughout her treatment. After her first treatment, she tried to go back to work on her normal schedule. “Typically, I went into work at 7:00 a.m. and the Monday after my first treatment, I could hardly make it. The rest of the week dragged by, and finally by the second week, I was beginning to feel better.”
For Hicks, letting herself wake up naturally without an alarm helped her to better function throughout the day. She began listening carefully to her body’s needs.
“The best thing I could do was rest when I felt tired. That’s what my doctors and care managers at CTCA® told me, and I listened to them. If I felt like going to bed at 5:00 p.m., that’s what I did. If I felt like sleeping until 9:00 a.m. instead of my normal time of 5:30 a.m., then that’s what I did.”
Though there were times when fatigue impacted her while at work, she is glad she was able to continue go in to the office throughout treatment. “I really think working helped me more than anything as it kept me focused on something besides my illness. The challenges of the day pushed me through each day. I had things to solve and that felt good.”
By adjusting her schedule, Hicks continued to work throughout her treatment, reducing her schedule the week after treatment by a few hours. She also set up a cot in her office to rest in case she needed it.
“One important strategy for combating fatigue is energy conservation,” notes Moore. “It’s important to set priorities for activities, plan rest periods while effectively managing other side effects and symptoms that could worsen fatigue.”
Moore also notes that for many people, exercise can help improve fatigue. “Exercise or physical activity helps with blood flow, can assist in promoting sleep and decrease blood pressure. While there are benefits to exercising, it should be done in consultation with your care team to determine the best type and amount of activity for you.”
Getting help for your fatigue
If you’re feeling fatigue, getting to the root cause and learning strategies to cope with it can help you persevere throughout treatment.
“Sometimes fatigue during cancer treatment is caused by infection, anemia, fluid or electrolyte problems, or a hormone imbalance. The only way to figure out the problem is by first communicating with your care team,” says Moore.
It’s also important to keep track of how your fatigue changes. A simple way to report changes is to rate your fatigue, using a scale from 0 (no fatigue) to 10 (extreme fatigue). Determine your level of fatigue before treatment, during treatment and after treatment.
“You can also ask for a referral to a physical therapist or occupational therapist, who can assess your functional status and provide suggestions for energy conservation,” suggests Moore.
“I had to let a lot of things go during cancer treatment. I was fighting for my life and all those things just didn’t matter. Focusing on taking care of my health, resting and following my doctor’s advice was the best thing I could do. All of those things I had to let go of would be there once I got through treatment,” says Hicks.
She offers one piece of advice based on her experience: “If you have any issue at all, whether it is fatigue or some other problem, call your doctor or care managers. They are there to help.”