Fatigue (Tiredness)

Definition

Fatigue is an overwhelming sense of exhaustion and a decreased capacity for physical and mental work, regardless of adequate sleep. It means less energy to do the things you normally want to do. This fatigue is different than the fatigue of everyday life, which is usually temporary and relieved by rest. Fatigue is one of the most common side effects of cancer treatment, whether the treatment is radiation, chemotherapy, biologic therapy or bone marrow transplant. It is more severe and distressing than everyday fatigue, and not always relieved by rest.

How do people describe fatigue?

People who experience fatigue often report having no energy for every day activities. You may feel like your arms and legs are heavy. Some people describe fatigue as feeling tired, weak, exhausted, worn-out or slow, and being unable to concentrate. You may have feelings of sadness, irritability or get easily frustrated. You may still feel tired even after napping or getting enough rest at night. In addition, fatigue can exist well beyond when treatment ends.

What causes fatigue?

Fatigue can result from cancer therapies, from spending too much time in bed, or from not getting enough exercise. Anemia (low red blood cell count) and infections can also cause fatigue. Fatigue can also occur from not eating a healthy diet.

How do people cope with fatigue?

• Plan rest periods to conserve energy for important activities.
• Plan exercise every day; take a 15-minute walk.
• Sit at the sink to brush your teeth, use a chair when showering.
• Drink 6-8 eight-ounce glasses of water or other decaffeinated fluids per day.
• Let others help you with housework, chores or meal preparation.
• Eat a nutritious diet with fresh fruits and vegetables, and lean meat/fish/chicken and milk products as recommended by your doctor.
• Set priorities to do important or fun activities first.
• Establish regular bedtime activities.
• Use meditation or prayer at bedtime.
• Keep as active as possible during the day so that normal fatigue sets in at night.
• Go to bed earlier when exceptionally tired.
• Keep track of how you feel by journaling in a diary. Each day “score” your fatigue on a 0-10 scale (0= no fatigue; 10= worst fatigue possible).
• If possible, make adjustments to your work schedule, consider decreasing your work hours, or taking time off during the weeks you have treatment.
• Save some energy for fun things such as: visiting a friend, listening to music or reading

What can family members and friends do to help me with fatigue?

• Ask family members or friends to help you with housework, chores, yard work or cooking.
• Ask family members or friends to take a walk with you and encourage you to walk every day.
• Ask family members and friends to offer you fluids throughout the day to increase your fluid intake.
• Ask family members and friends to help you set daily priorities.

How can I talk with my family members about my fatigue?

• Be open and honest about your feelings with your family members.
• Ask your family members for ideas to help with or manage your fatigue.
• Ask a family member or friend to walk with you every day.
• Ask your family members how your fatigue is affecting him/her.
• What should I report to my doctor or nurse?
  • Fever greater than 100.5.
  • Inability to get out of bed for 24 hours.
  • If you are unable to think clearly or focus on things such as TV, conversations or reading.
  • If you are unable to do any of your usual daily activities.
• When contacting your healthcare provider, know the following information:
  • When your fatigue started
  • How it’s progressed since the fatigue began
  • What helps or makes the fatigue worse
  • How the fatigue affects you usual activities or the activities that give meaning to your life.

What can I get more information?

• Contact your healthcare provider.
• Contact the American Cancer Society at 1-800-ACS-2345 or on the Internet at http://www.cancer.org/docroot/MBC/content/MBC_2_3X_Fatigue.asp?sitearea=MBC
• Contact the National Cancer Institute at 1-800-4-CANCER or through the Internet at: http://www.cancer.gov/cancer_information/coping/
• Visit the Family Care Research Program on the Internet at: http://www.cancercare.msu.edu/
• Visit the National Comprehensive Cancer Network on the Internet at: http://www.nccn.org/patient_gls/_english/_fatigue/1_introduction.htm
• Visit the University of Pennsylvania website on the Internet:
  http://www.oncolink.org/coping/

References

1. Stone, P. (2002) The measurement, causes and effective management of cancer-related fatigue. International Journal of Palliative Nursing. 8(3), 120-8.
2. Whitmer, K. & Barsevick, A. (2001) Patient resources for Cancer-Related Fatigue. Cancer Practice, 9(6), 311-13.