Cancer-related fatigue is one of the most common side effects for people with cancer. This type of fatigue is not always resolved by rest, and it can interfere with daily activities. In this video, Dr. Richard T. Lee, breast cancer survivor Kate Zickel, and caregiver Brian Zickel discuss what people with cancer should know about cancer-related fatigue, including its causes, how it can affect quality of life, and ways to manage and cope with it.
View Dr. Lee’s disclosures. Kate and Brian Zickel have no relevant relationships to disclose.
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Coping with Cancer-Related Fatigue
Voiceover: Cancer-related fatigue is one of the most common side effects for people with cancer, and can happen at any time during the course of cancer, its treatment, and after treatment is complete. 80-90% of newly diagnosed people with cancer experience this type of fatigue at some point.
Richard T. Lee, MD; Medical Oncologist; Member; American Society of Clinical Oncology: It's generally a feeling of physical, mental, or emotional exhaustion, even though you're getting enough rest and sleep. And so some patients may describe it as feeling worn out, or heaviness or slowness, or not having the energy to do things. I think the key aspect of cancer-related fatigue, as opposed to more regular fatigue, is that it's not really completely resolved with rest or sleep, and it can interfere with daily activity, and it may last for a long time, even after treatment finishes. Patients will report that their daily activities are affected, things like simple hobbies, or other daily routines, even their job performance may decline. Other things patients may note during the day is that their mood or emotions may feel different, their hope for the future, or how they relate to their family members or friends, and their ability to cope with the treatment is harder. And so sometimes it can make some of the other side effects worse.
Kate Zickel; Breast Cancer Survivor: I would say cancer-related fatigue feels like you're tired all the time, but not just tired like, "I need a nap," but tired like "I can't focus on daily tasks, it's difficult to get out of bed, it's hard to do all of those day-to-day things like walking the dog, or making breakfast." Those things that would normally take a regular amount of energy tend to take a large amount of energy, or it feels like they take a larger amount of energy. And so those activities that would normally feel molehills will suddenly feel like mountains.
Voiceover: Cancer-related fatigue is complex, and has many causes that can often be difficult to pinpoint.
Dr. Lee: Most commonly, it's probably related to the cancer diagnosis itself, but many times the treatments that we provide for patients, the surgery, the chemotherapy, radiation, can also cause fatigue. And there can be other medicines that we're providing that may worsen the fatigue symptoms. Other conditions that patients should be aware of are uncontrolled pain. Oftentimes, people don't realize that the pain is not allowing them to sleep, it's making them feel exhausted, so that contributes to their fatigue. Other things can be their psychological state, so depression, anxiety, stress, can also make patients feel tired. It's that mind-body connection. And when patients are very stressed, they often have trouble sleeping at night. So we have a disrupted sleep cycle, they're not waking up well-rested, so sleep can be another area that can be a cause, or contribute to these symptoms. Other things that we sometimes see is that when patients have poor nutrition, in part because of the surgery they had, or the side effects from the chemotherapy, they're not eating as well, and so poor nutrition can contribute fatigue. Another thing that we need to check for are low blood counts, specifically red blood cells, also contribute to fatigue. Patients should also keep in mind that their other medical conditions can worsen while they're going through cancer treatments, so diabetes or hypothyroidism, heart, lung or kidney issues.
Voiceover: If you are feeling fatigued while you are going through cancer treatment, it is important to tell your health care team. Once they are aware of your fatigue, they can work to determine the cause, so they can help you manage it, and help you feel better.
Dr. Lee: That way, your health care team can help evaluate and treat the potential causes. So one of the things they may do is some bloodwork or other simple tests. Sometimes we may find a simple, reversible cause, such as hyperthyroidism, low blood count, we can give you a blood transfusion, if it's really related to nutrition, having you meet with a dietitian, and addressing those malnutrition needs. Something as simple as a multi-vitamin may be helpful. Other times, we may find that you may be B12-deficient, or iron-deficient, and providing a supplement to address those deficiencies will also help with your fatigue. Other things that the health care team may consider is a physical activity program. So if you're really debilitated, they may recommend something as simple as physical therapy, they may recommend seeing a personal trainer to work on an exercise program. And there have been studies that show that exercise in itself can help improve fatigue. Counseling can also be helpful, cognitive behavior therapy has been helpful for fatigue, and it may help reframe your thinking about how you're addressing your fatigue and how you're thinking through it. And sometimes mind-body strategies can be helpful as well. So things as simple as meditation, music therapy, massage, other activities might be helpful in addressing your symptoms. And lastly, you may want to talk to your medical team about any medications or supplements that might be helpful, but I think you always need to check with your medical team first before starting any new medications or supplements.
Brian Zickel; Husband and Caregiver: When you're tired, sometimes the solution or part of the solution is to go outside and you know, play fetch with the dogs for a minute, get a little sunlight, move around. Obviously, there's a balance to that, but the idea, and this gets to what I try to bring to the table or offer for Kate, do what you can to give yourself the best shot at a full day, or a satisfying day. Even if you need a nap, that's fine, your body is telling you something.
Kate Zickel: I would say the best piece of advice I could give someone dealing with cancer-related fatigue would be to know your body well enough to allow for rest when you need to rest, and allow for productivity when you know you have the space to do it. So knowing your body, knowing when it's time to take a break, and allow yourself to do that, so that you can come back and be productive later, is really important.
Voiceover: Many people with cancer want to know how long it takes after treatment ends for the fatigue to subside.
Dr. Lee: I do tell patients that the more treatment you're on, the probably longer it's going to take to recover, so if it's just a minor surgery, then you might be able to recover within weeks to months, but if you've been on chemotherapy for 6 months or 12 months, then it may take 6 to 12 months to really find a new plateau or a new baseline. And so I think for every patient, you want to listen to your body, work with your health care team, figure out what makes sense in terms of a recovery period.
Kate Zickel: I think managing expectations has been hugely helpful for both of us, and just learning to not place too much weight on each other, as much as we can, and to understand that sometimes things don't get done during the day, and that's okay.
Voiceover: For more information on cancer-related fatigue and other side effects of cancer and its treatment, please visit Cancer.Net.
Dr. Lee: Cancer.Net is a great website, it's expert-reviewed, it provides a lot of information, specifically in the area of supportive care, including symptoms of fatigue. So it's a great resource specifically made for patients, and I highly recommend that as a resource to learn more about cancer-related fatigue.
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