Fatigue (PDQ®): Supportive care - Patient Information [NCI]

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Fatigue (PDQ®): Supportive care - Patient Information [NCI]

This information is produced and provided by the National Cancer Institute (NCI). The information in this topic may have changed since it was written. For the most current information, contact the National Cancer Institute via the Internet web site at http://cancer.gov or call 1-800-4-CANCER.

Fatigue

Introduction

This patient summary on fatigue is adapted from a summary written for health professionals by cancer experts. This and other credible information about cancer treatment, screening, prevention, supportive care, and ongoing clinical trials is available from the National Cancer Institute. Fatigue is one of the most common complaints of people diagnosed with cancer and cancer survivors. This brief summary describes fatigue, its causes and treatment.

This summary is about fatigue in adults with cancer.

Overview

Fatigue occurs in 14% to 96% of people with cancer, especially those receiving treatment for their cancer. Fatigue is complex, and has biological, psychological, and behavioral causes. Fatigue is difficult to describe and people with cancer may express it in different ways, such as saying they feel tired, weak, exhausted, weary, worn-out, heavy, or slow. Health professionals may use terms such as asthenia, fatigue, lassitude, prostration, exercise intolerance, lack of energy, and weakness to describe fatigue.

Fatigue can be described as a condition that causes distress and decreased ability to function due to a lack of energy. Specific symptoms may be physical, psychological, or emotional. To be treated effectively, fatigue related to cancer and cancer treatment needs to be distinguished from other kinds of fatigue.

Fatigue may be acute or chronic. Acute fatigue is normal tiredness with occasional symptoms that begin quickly and last for a short time. Rest may alleviate fatigue and allow a return to a normal level of functioning in a healthy individual. Chronic fatigue syndrome describes prolonged debilitating fatigue that may persist or relapse, and is not related to cancer. Fatigue related to cancer is called chronic because it lasts over a period of time and is not completely relieved by sleep and rest. Chronic fatigue diagnosed in patients with cancer may be called "cancer fatigue", "cancer-related fatigue", or "cancer treatment-related fatigue". Although many treatment- and disease-related factors may cause fatigue, the exact process of fatigue in people with cancer is not known.

Fatigue can become a very important issue in the life of a person with cancer. It may affect how the person feels about him- or herself, his or her daily activities, family care, and relationships with others, and whether he or she continues with cancer treatment. Patients receiving some cancer treatments may miss work or school, withdraw from friends, need more sleep, and, in some cases, may not be able to think clearly or perform any physical activities because of fatigue. Finances can become difficult if people with fatigue need to take disability leave or stop working completely. Job loss may result in the loss of health insurance or the inability to get medical care. Understanding fatigue and its causes is important in determining effective treatment and in helping people with cancer cope with fatigue. Tests that measure the level of fatigue have been developed.

How long fatigue lasts and how much fatigue the patient feels depends on the type and schedule of cancer treatment. For example, patients treated with cycles of chemotherapy usually have the most fatigue in the days following treatment, then less fatigue until the next treatment. Patients treated with external-beam radiation therapy usually have more fatigue as their treatment continues. It is likely that most patients beginning cancer treatment already feel fatigued following diagnostic tests, surgery, and the emotional distress of coping with a cancer diagnosis.

Causes

Most of the causes of fatigue in patients with cancer are poorly understood, and patients are likely to be coping with many possible causes of fatigue at the same time. Fatigue commonly is an indicator of disease progression and is frequently one of the first symptoms of cancer in both children and adults. For example, parents of a child diagnosed with acute lymphocytic leukemia or non-Hodgkin lymphoma frequently seek medical care because of the child's extreme fatigue. Tumors can cause fatigue directly or indirectly by spreading to the bone marrow, causing anemia, and by forming toxic substances in the body that interfere with normal cell functions. People who are having problems breathing, another symptom of some cancers, may also experience fatigue.

Fatigue can occur for many reasons. The extreme stress that people with cancer experience over a long period of time can cause them to use more energy, leading to fatigue. However, there may be other reasons that patients with cancer suffer from fatigue. The central nervous system (the brain and spinal cord) may be affected by the cancer or the cancer therapy (especially biological therapy) and cause fatigue. Medication to treat pain, depression, vomiting, seizures, and other problems related to cancer may also cause fatigue. Tumor necrosis factor (TNF), a protein made mainly by white blood cells, can cause necrosis (death) of some types of tumor cells and may be given to a patient as a cancer treatment. TNF may cause the loss of protein stores in muscles, making the body work harder to perform normal functions and causing fatigue. There are many chemical, physical, and behavioral factors that are thought to cause fatigue.

Assessment

To determine the cause and best treatment for fatigue, the person's fatigue pattern must be determined, and all of the factors causing the fatigue must be identified. The doctor will look for causes of fatigue that can be treated. The following factors must be included:

1.Fatigue pattern, including how and when it started, how long it has lasted, and its severity, plus any factors that make fatigue worse or better.
2.Type and degree of disease and of treatment-related symptoms and/or side effects.
3.Treatment history.
4.Current medications.
5.Sleep and/or rest patterns and relaxation habits.
6.Eating habits and appetite or weight changes.
7.Effects of fatigue on activities of daily living and lifestyle.
8.Psychological profile, including an evaluation for depression.
9.Complete physical examination that includes evaluation of walking patterns, posture, and joint movements.
10.How well the patient is able to follow the recommended treatment.
11.Job performance.
12.Financial resources.
13.Other factors (for example, anemia, breathing problems, decreased muscle strength).

Underlying factors that contribute to fatigue should be evaluated and treated when possible. Contributing factors include anemia, depression, anxiety, pain, dehydration, nutritional deficiencies, sedating medications, and therapies that may have poorly tolerated side effects. Patients should tell their doctors when they are experiencing fatigue and ask for information about fatigue related to underlying causes and treatment side effects.

Anemia evaluation

There are different kinds of anemia. A medical history, a physical examination, and blood tests may be used to determine the kind and extent of anemia that a person may have. In people with cancer there may be several causes.

Treatment

Most of the treatments for fatigue in cancer patients are for treating symptoms and providing emotional support because the causes of fatigue that are specifically related to cancer have not been determined. Some of these symptom-related treatments may include adjusting the dosages of pain medications, administering red blood celltransfusions or bloodcellgrowth factors, dietsupplementation with iron and vitamins, and antidepressants or psychostimulants.

Psychostimulant drugs

Fatigue in patients who have depression may be treated with antidepressant or psychostimulant drugs. Psychostimulants may help some patients have more energy and a better mood, and may help them think and concentrate. The use of psychostimulants for treating fatigue is still under study. The doctor may prescribe low doses of a psychostimulant to be used for a short time in advanced cancer patients with severe fatigue.

Psychostimulants have side effects, especially with long-term use. Different psychostimulants have different side effects. Patients who have heart problems or are taking anticancer drugs that affect the heart may have serious side effects from psychostimulants. These drugs have boxed warnings on the label about their risks. It is important to talk with a doctor about the effects these drugs may have and use them only under a doctor's care. Some of the possible side effects include the following:

  • Trouble sleeping.
  • Euphoria (feelings of extreme happiness).
  • Headache.
  • Nausea.
  • Anxiety.
  • Mood changes.
  • Loss of appetite.
  • Nightmares.
  • Paranoia (feelings of fear and distrust of other people).
  • Serious heart problems.

Treatment for anemia

Treatment for fatigue that is related to anemia may include red blood cell transfusions. Transfusions are an effective treatment for anemia; however possible side effects include infection, immediate transfusion reaction, graft-versus-host disease, and changes in immunity.

Treatment for anemia-related fatigue in patients undergoing chemotherapy may also include drugs, such as epoetin alfa, that cause the bone marrow to make more red blood cells. This type of drug may shorten survival time, increase the risk of serious heart problems, and cause some tumors to grow faster. Patients should discuss the risks and benefits of these drugs with their doctors.

Exercise

Moderate activity for 3 to 5 hours a week may help cancer-related fatigue. Choosing a type of exercise that will be enjoyed makes an exercise plan more likely to be followed. The health care team can help with planning the best time and place for exercise and how often to exercise. Patients may need to start with light activity for short periods of time and build up to more exercise little by little. Studies have shown that exercise can be safely done during and after active cancer treatment.

People with cancer who exercise may have more physical energy, improved appetite, improved ability to function, improved quality of life, improved outlook, improved sense of well-being, enhanced sense of commitment, and improved ability to meet the challenges of cancer and cancer treatment. Findings from a study of breast cancersurvivors suggest that patients may be able to lessen fatigue and pain and function better in daily activities if they take part in moderate to vigorous recreational sports after cancer treatment.

Exercise may also help patients with advanced cancer, even those in hospice care. More benefit may result when family members are involved with the patient in the physical therapy program.

Mind and body exercises such as qigong, tai chi, and yoga may also help relieve fatigue. These exercises combine activities like movement, stretching, balance, and controlled breathing with mental exercise such as meditation.

Cognitive Behavior Therapy

Cognitive behavior therapy (CBT) is a method used by therapists to treat a variety of psychologicaldisorders. CBT aims to change a patient's awareness (the cognitive) in order to change the way he acts (the behavior). CBT sessions may be helpful in decreasing a patient's fatigue following cancer treatment by focusing on factors such as:

  • Stress from coping with the experience of having cancer.
  • Fear that the cancer may come back.
  • Abnormal attitudes about fatigue.
  • Irregular sleep or activity patterns.
  • Lack of social support.

Activity and rest

Any changes in daily routine require the body to use more energy. People with cancer should set priorities and keep a reasonable schedule. Health professionals can help patients by providing information about support services to help with daily activities and responsibilities. An activity and rest program can be developed with a health care professional to make the most of a patient's energy. Practicing sleep habits such as not lying down at times other than for sleep, taking short naps no longer than one hour, and limiting distracting noise (TV, radio) during sleep may improve sleep and allow more activity during the day.

Patient education

Treating chronic fatigue in patients with cancer means accepting the condition and learning how to cope with it. People with cancer may find that fatigue becomes a chronic disability. Although fatigue is frequently an expected, temporary side effect of treatment, other factors may cause it to continue. Learning the facts about cancer-related fatigue may help patients cope with it better and improve their quality of life. For example, some patients in active treatment worry that fatigue is a sign that the treatment is not working. They may feel that reporting fatigue is complaining. Anxiety over this can make fatigue even worse. Knowing that fatigue is a normal side effect that should be reported and treated may make it easier to manage.

Since fatigue is the most common symptom in people receiving outpatientchemotherapy, patients should learn ways to manage the fatigue. Patients should be taught the following:

  • The difference between fatigue and depression
  • Possible medical causes of fatigue (not enough fluids, electrolyte imbalance, breathing problems, anemia)
  • To observe their rest and activity patterns during the day and over time
  • To engage in attention-restoring activities (walking, gardening, bird-watching)
  • To recognize fatigue that is a side effect of certain therapies
  • To participate in exercise programs that are realistic
  • To identify activities which cause fatigue and develop ways to avoid or modify those activities
  • To identify environmental or activity changes that may help decrease fatigue
  • The importance of eating enough food and drinking enough fluids
  • Physical therapy may help with nerve or muscle weakness
  • Respiratory therapy may help with breathing problems
  • To schedule important daily activities during times of less fatigue, and cancel unimportant activities that cause stress
  • To avoid or change a situation that causes stress
  • To observe whether treatments being used to help fatigue are working

Current Clinical Trials

Check NCI's list of cancer clinical trials for U.S. supportive and palliative care trials about fatigue and anemia that are now accepting participants. The list of trials can be further narrowed by location, drug, intervention, and other criteria.

General information about clinical trials is also available from the NCI Web site.

Posttreatment Considerations

This section is for patients who have had no cancer treatment for at least 6 months. The causes of fatigue are different for patients who are receiving therapy compared to those who have completed therapy. Also, the treatment for fatigue may be different for patients who are no longer receiving treatment for cancer.

Fatigue in people who have completed treatment for cancer and who are considered to be disease-free is a different condition than the fatigue experienced by patients receiving therapy. Fatigue may significantly affect the quality of life of cancer survivors. Studies show that some patients continue to have moderate-to-severe fatigue for up to 18 years after bone marrow transplantation. Long-term therapies such as tamoxifen can also cause fatigue. Fatigue can cause poor school performance years later in children who were treated for brain tumors and cured. Long-term follow-up care is important for patients after cancer therapy. Physical causes should be ruled out when trying to determine the cause of fatigue in cancer survivors.

Get More Information From NCI

Call 1-800-4-CANCER

For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 8:00 a.m. to 8:00 p.m., Eastern Time. A trained Cancer Information Specialist is available to answer your questions.

Chat online

The NCI's LiveHelp® online chat service provides Internet users with the ability to chat online with an Information Specialist. The service is available from 8:00 a.m. to 11:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.

Write to us

For more information from the NCI, please write to this address:

NCI Public Inquiries Office
Suite 3036A
6116 Executive Boulevard, MSC8322
Bethesda, MD 20892-8322

Search the NCI Web site

The NCI Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. For a quick search, use the search box in the upper right corner of each Web page. The results for a wide range of search terms will include a list of "Best Bets," editorially chosen Web pages that are most closely related to the search term entered.

There are also many other places to get materials and information about cancer treatment and services. Hospitals in your area may have information about local and regional agencies that have information on finances, getting to and from treatment, receiving care at home, and dealing with problems related to cancer treatment.

Find Publications

The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237).

Changes to This Summary (07 / 25 / 2011)

The PDQcancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

Editorial changes were made to this summary.

Questions or Comments About This Summary

If you have questions or comments about this summary, please send them to Cancer.gov through the Web site's Contact Form. We can respond only to email messages written in English.

About PDQ

PDQ is a comprehensive cancer database available on NCI's Web site.

PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.

PDQ contains cancer information summaries.

The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.

The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.

Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.

PDQ also contains information on clinical trials.

A clinical trial is a study to answer a scientific question, such as whether one method of treating symptoms is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. Some patients have symptoms caused by cancer treatment or by the cancer itself. During supportive care clinical trials, information is collected about how well new ways to treat symptoms of cancer work. The trials also study side effects of treatment and problems that come up during or after treatment. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients who have symptoms related to cancer treatment may want to think about taking part in a clinical trial.

Listings of clinical trials are included in PDQ and are available online at NCI's Web site. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237).

Last Revised: 2011-07-25


If you want to know more about cancer and how it is treated, or if you wish to know about clinical trials for your type of cancer, you can call the NCI's Cancer Information Service at 1-800-422-6237, toll free. A trained information specialist can talk with you and answer your questions.


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