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Fatigue (Patient) (cont.)

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.

The use of drugs that cause the bone marrow to make more red blood cells may be considered for treating anemia-related fatigue in patients undergoing chemotherapy. Epoetin alfa and darbepoetin alfa are two of these drugs. 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.

eMedicineHealth Public Information from the National Cancer Institute

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

This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.

Some material in CancerNet™ is from copyrighted publications of the respective copyright claimants. Users of CancerNet™ are referred to the publication data appearing in the bibliographic citations, as well as to the copyright notices appearing in the original publication, all of which are hereby incorporated by reference.






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