WHAT IS FATIGUE?
Fatigue is not like ‘normal’ tiredness, the tiredness you feel after you have been busy, working hard or exercising. It is extreme tiredness that doesn’t go away when you rest or after sleep. People have described fatigue as ‘being drained of energy’ or that ‘sitting up was sometimes too much of an effort’. Fatigue is the most common symptom experienced by cancer patients. Many studies have found that while the majority of patient’s experience fatigue, it is one of the most overlooked and under-treated side effects of cancer. There are many factors, including physical, mental and emotional, which can cause fatigue. These include the lymphoma itself, treatments, medications, pain, nutritional deficits, anxiety and depression.
WHO GETS CANCER-RELATED FATIGUE?
Fatigue is a difficult thing to measure but research suggests that up to 9 out of 10 people with cancer are affected. It is one of the most common symptoms that people with lymphoma report. Cancer-related fatigue can be mild or it can be severe. It isn’t known why some people suffer from fatigue more than others.
WHY DOES CANCER CAUSE FATIGUE?
There are many reasons why you can feel fatigued if you have a cancer like lymphoma. Fatigue can be caused by:
- The emotional upheaval of the diagnosis and treatments
- The lymphoma itself putting a strain on the body
- Lymphoma symptoms such as pain or breathlessness
- Lymphoma treatments such as surgery (and having a general anaesthetic), chemotherapy, radiotherapy and antibody therapy
- Other co-existing medical problems
Fatigue will be worse if:
- You are having more than one kind of treatment
- You have other medical conditions
- You are older
- You are anxious or depressed
- You are overdoing it – perhaps having hospital appointments and going for treatments while you are still working or looking after your family, house and garden
- You have difficulty sleeping
- You have symptoms such as pain, nausea or anaemia
- You have a decreased appetite
SYMPTOMS OF FATIGUE
Fatigue affects people in different ways but it can make you feel that you don’t have enough energy. Fatigue symptoms can be:
- Extreme weariness, lack of energy even after sleeping
- Leg pain, difficulty climbing stairs or walking short distances
- Shortness of breath
- Difficulty performing simple tasks, such as cooking, cleaning, making a bed or taking a shower
- Difficulty concentrating, remembering things or making decisions. You can find you have trouble holding a conversation, watching TV or reading
- Moodiness, frustration, and/or irritability which can make you more emotional and tearful than usual
- Waking up tired after a full night’s sleep
- Your tiredness disrupts your work, social life or daily routine
It is important that you inform your health care team about your fatigue, so it can be evaluated. Although not all causes of cancer-related fatigue are well understood, the doctor may want to perform tests to try to determine what might be causing the fatigue. Try and be as specific as possible about your level of fatigue and when it occurs (such as in the morning, after treatment, etc.), as well as the activities that cause the most difficulty. As with other aspects of cancer and its treatment, fatigue varies from person to person. Fatigue can have an extremely negative impact on one’s quality of life. The severity of fatigue and how long it lasts depends on many factors including the type and length of cancer treatment and a patient’s overall health status.
HOW LONG DOES CANCER-RELATED FATIGUE LAST?
If you are having chemotherapy, you might notice a pattern of peaks and troughs, with fatigue often being worst after each treatment. With radiotherapy, fatigue tends to get worse over time. Sometimes it doesn’t start until the radiotherapy has finished.
Fatigue usually starts to improve a few weeks after the end of a course of treatment, gradually getting less severe over the next few months. It has been found that around a quarter of people have fatigue for longer than a year and a few people continue to have fatigue for several years after their cancer has been successfully treated. It is important to know that having fatigue after your treatment has finished doesn’t mean that the treatment hasn’t worked. If this is worrying you, talk to your Doctor about how you feel.
PATIENT TIPS FOR MANAGING FATIGUE
Although fatigue may not be completely preventable, the following tips may help patients manage or minimize this troublesome symptom.
- Keep a diary to help identify which times of the day or times related to treatment cycles you have the most energy. Document which activities make you feel fatigued or energized.
- Ask family or friends for assistance with your most energydraining activities or chores that must be done during your lowest energy times.
- Make sure you schedule appropriate time to rest between your daily activities. Prioritize tasks so your energy is used to accomplish your most important tasks or those that cannot be delegated.
- Organize your surroundings. Keep the items you need most frequently in an easily accessible location.
- Consider if you are experiencing any specific symptoms that may be related to fatigue. Treating or managing symptoms such as nausea, vomiting, pain, fever or lingering depression can help increase your energy supply.
- Avoid food and drinks that may not provide you with sustainable energy. For example, drinking too much caffeine can cause fatigue.
- Try to identify any causes of stress. You may feel that you would like to speak with a counsellor or social worker to help you cope with the stress of your illness and incorporate relaxation or other stress-relieving techniques into your routine.
- Regular light exercise such as walking has been shown to help fatigue and improve quality of life. Try to exercise up to three times a week if you can and increase what you do gradually, depending on how your body is coping. Exercise will probably make you more tired than you are used to, so make sure you rest afterwards.
- Eat a healthy, well-balanced diet and drink plenty of water each day. Review your diet with your doctor or a dietitian. Treatment and recovery often put extra demands on your body for calories, nutrition, and fluids.
- Maintain a regular sleep schedule. If you are having trouble sleeping, consult your healthcare team about possible solutions. In addition, napping can be a quick refresher, but avoid spending too much time in bed.
- People often find that listening to music or relaxation tapes, having a massage or taking a bath can help with fatigue.
- Others find complementary therapies helpful. Techniques that have been shown to help some people with cancerrelated fatigue include acupuncture, hypnosis and mindfulness-based meditation techniques.
RESOURCES AND SUPPORT
QUESTIONS TO ASK YOUR DOCTOR
- Is my lymphoma treatment likely to cause fatigue?
- What can I do to improve or manage my fatigue?
- How long might my fatigue last?
- Who can I speak to for advice about managing my fatigue?
- What other support is available to me?
