Coping with cancer and cancer treatments can be hard, especially if an individual feels tired all the time. Fatigue is a very common side effect of cancer and its treatment, occurring in approximately 70 - 99% of individuals. Patients describe fatigue as an overwhelming feeling of exhaustion or tiredness.

Why does this happen?
Although we do not have all the answers, we do know that the fatigue of cancer is associated with many different circumstances. Factors such as the cancer itself, cancer treatments (surgery, chemotherapy, radiation), anemia, poor nutrition, inactivity, sleep problems, pain, stress, depression and some medications contribute to fatigue.

Fatigue is a very real side effect and should not be ignored. Managing fatigue requires a team effort. This means that the patient and the health care providers must work together to combat fatigue. There are certain things that you can do to reduce your fatigue and there are interventions that your healthcare team can utilize to help you feel better.

How can the healthcare team help?
Treatments are available to help manage anemia, nausea, vomiting, diarrhea, pain, depression and other side effects from cancer. All of these conditions will make fatigue worse if they are left untreated. In particular, anemia has been shown to add significantly to fatigue.

What is anemia?
Anemia is a condition that occurs when there is a shortage of red blood cells (RBCs). Red blood cells carry oxygen from the lungs to the other tissues and organs in the body. Our cells and tissues need oxygen to produce energy and function normally. When there are not enough red blood cells to transport needed oxygen, the end result can be feelings of weakness, fatigue, dizziness, irritability, difficulty concentrating, shortness of breath and decreased ability for exercise or activity. The diagnosis of anemia is established with a blood test (Complete Blood Count) primarily to look at hemoglobin and hematocrit. Anemia is a side effect associated with many different chemotherapy drugs.

What are symptoms associated with anemia?
Symptoms of anemia can range from mild to very severe. That dragging, tired feeling that makes it more difficult to get through the day can be a manifestation of anemia. So can the lack of concentration that makes it harder to read a book or newspaper. However, some symptoms are fairly clear-cut signals of more-than-mild anemia. Watch for shortness of breath or headaches caused by exertion, palpitations or a racing pulse and light-headedness. Any of these problems should raise a red flag that says, "call your healthcare provider." A good clinician who hears any of these complaints will do a blood count to check for anemia.

Should I be concerned about anemia?
Anemia can have a significant impact on a person's physical functioning as well as adversely affecting quality of life. During exercise or even routine activities, muscles and tissues demand more oxygen. If you have mild-to-moderate anemia, it may be difficult for your body to meet this increased demand for oxygen. The result is a feeling of becoming "easily fatigued" or "short of breath" with little exertion. You might manage to gather up enough energy to walk the dog or go to the market, but then you're too tired to cook or too exhausted to meet friends for an evening out. As the anemia gets more pronounced, the symptoms get worse and your ability to do even simple things (like making your bed) can be compromised. Severe cases of anemia place significant burden on your heart and all the organs in your body.

Can anything be done to treat anemia?
The answer is YES! First, it is important to discuss your symptoms and feelings with your healthcare provider. Open communication is key to helping make the right diagnosis and making sure all of your concerns and quality of life issues are being addressed. Some symptoms may be caused by conditions other than anemia. It's just as important to know what isn't the cause as what is. If the culprit is anemia from chemotherapy, it can most likely be treated with Erythropoietin (e-rith-ro-poy-e-tin). There are several brand names, i.e. Procrit, Epogen. Erythoproietin stimulates red blood cell production, resulting in an increase in your hemoglobin and hematocrit. In clinical trials, patients who responded to this drug for their anemia reported increases in energy, activity and overall feelings of well being. Blood transfusions can also be given to treat anemia. Transfusions are used most often as an emergency measure when severe anemia needs immediate correction, but may be useful in other situations when a rapid in HgB is desired.

How can I help myself manage fatigue?
In addition to treating any existing anemia, pain, nausea, vomiting etc., there are many things that patients can do to help themselves. Here are some helpful strategies for fatigue management:

Tips to Manage Fatigue

• Plan your day and prioritize what needs to be done. Make a list and include only the most important things. Plan activities you can look forward to.
• Set realistic goals. Don't overload yourself.
• Stay as active as you can and plan for frequent rest breaks.
• Daily walks or light exercise (stretching, yoga, and tai chi) can help you feel more energetic. Talk to your doctor about what is right for you.
• Identify the things that really tire you out, and ask someone else to help with those. Save your energy for the most important things.
• Eat as nutritiously as possible and try to maintain your usual weight. Consult with a dietitian to learn tips on how to maximize your nutrition.
• Learn to say "No!" (I really can't do that right now; it would tire me out too much.)
• Learn to say "Yes!" (It would be very helpful if you could pick up some groceries for me!)
• Keep a diary of how you feel each day; discover if there is a particular time of day when you feel your best/worst. Plan activities accordingly.
• Talk to your healthcare providers if you are not sleeping well or are having difficulty coping. They can suggest strategies to help meet your needs.
• Get "connected" with other cancer survivors -- Join a support group.

By Pat Kramer

More information about cancer related fatigue can be found in the Alta Bates Comprehensive Cancer Center, Patient Resource Center.