Fatigue is one of the most common states experienced as a result of cancer or its treatment. Since it is a “technical term” that is also a word that we use in everyday communication, there is sometimes a misunderstanding of fatigue and what we can do about it.

We all get a little – or a lot – tired at times. We stay up too late, travel from place to place, don’t sleep well or tire ourselves out. It is a universal part of the human experience. That is different from the fatigue connected to cancer. The word fatigue does not adequately represent the degree of tiredness experienced, even when modified by an adjective like severe or pervasive or overwhelming. Cancer-related fatigue can last weeks or months, and it is not fully blunted by getting restorative sleep or rest. A nap or vacation is generally not as helpful to reverse cancer-related fatigue as they are in general fatigue.

Understanding Cancer-Related Fatigue
We know more about cancer-related fatigue over the last few years than we had previously understood. As cancer grows, it preferentially re-directs the body’s energy to support cell growth in tumors, diverting it from our vital organs such as muscle and brain tissue, among others. It is estimated that growing cancers use many thousands of calories a day in excess of what we could eat even when overeating, which also uses energy (shopping, cooking, cleaning, smelling, chewing, swallowing, digesting, and eliminating through stool and urine). This heightened metabolic state can be reduced with a good response to treatment but often remains for weeks to months after successful treatment is completed. Many other factors contribute to this state: worry and sadness, poor sleep, inadequate nutrition, an underactive thyroid, infection, poor circulation of the blood due to an underperforming heart, shortness of breath, blockages in the lungs, anemia, kidney or liver problems, and lack of activity.

We have also learned that fatigue is easier to prevent, at least in part, than fix after it has set in. Although it is counter-intuitive, too much rest or too much activity can lead to heightened fatigue. It is believed that optimal prevention and management of fatigue involves some basic tasks, as well as specialized ones. Correcting many of the factors listed above wherever possible is a good place to start, but is it only a starting point rather than a total plan. Making sure that one is not anemic and having all major systems functioning at their best is essential. Those parameters can and need to be checked by your cancer specialists, and most are routinely monitored throughout and after treatment. Monitoring thyroid function is sometimes an afterthought, and should be part of the routine follow-up for patients who have had radiation therapy to any area above the mid-chest.

Tips to Keep Cancer-Related Fatigue in Check
Patients and their families and friends have a few things to take charge of as well. Even though one may think or say, “I am too tired to do all of this,” experience shows that proper nourishment, a certain amount of physical activity, and good but not an overabundance of rest and sleep are basic to keep fatigue in check. Maintaining weight as close to your ideal body weight is helpful to keep lean muscle in proper proportion and optimal strength. A proper amount of physical activity for you is also essential, although our first preference may be to avoid activity. The amount and kinds of activities are based on many personal and physiologic variables as well as the kind of cancer diagnosed and treatment plan. Cancer specialists know how to estimate the scope of those activities, and should make a formal consultation request to a cancer-smart Physical Medicine and Rehabilitation specialist (Physiatrist or Physical Therapist) to refine those suggestions. Although treatment may preclude muscle building exercises, some mild aerobics and/or flexibility activities can be done by anyone, even if bed-bound. The proper balance of nutrition, exercise and rest/sleep is the most winning combination to prevent or reverse-cancer-related fatigue.

What Type of Fatigue Do I Have?
Distinguishing fatigue from the expectable sadness that comes with cancer or the less usual depression can be tricky, especially when it involves someone you love. In general, it’s more likely fatigue when one has the desire to do more but just can’t muster up the stamina. It is more likely depression if motivation is compromised more than the ability to carry out a task. Family members and close friends often over-estimate symptoms that they cannot extinguish.

Developing the proper diet, activity level and sleep habits along with sorting out the function of vital organ systems is a partnership between patients, families and the cancer treatment team. Describe how tired you are from the start so that the process is ongoing rather than a reaction to tiredness that could have initially be prevented. Be serious about preventing fatigue with the multi-dimensional program described, as guided by your cancer specialists.

It is too tiring not to do so.