Treatments for Fatigue
Key Points for This Section
- Fatigue in cancer patients is often treated by relieving related conditions such as anemia and depression.
- Treatment of fatigue may include teaching the patient ways to increase energy and cope with fatigue in daily life.
Treatment of fatigue depends on the symptoms and whether the cause of fatigue is known. When the cause of fatigue is not known, treatment is usually given to relieve symptoms and teach the patient ways to cope with fatigue.
- Change in diet
- Transfusions of red blood cells
Transfusions work well to treat anemia. Possible side effects of transfusions include an allergic reaction, infection, graft-versus-host disease, immune system changes, and too much iron in the blood.
Drugs that cause the bone marrow to make more red blood cells may be used to treat anemia-related fatigue in patients receiving 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 or recur. The Food and Drug Administration (FDA) has not approved these drugs for the treatment of fatigue. Discuss the risks and benefits of these drugs with your doctor.
If pain is making fatigue worse, the patient's pain medicine may be changed or the dose may be increased. If too much pain medicine is making fatigue worse, the patient's pain medicine may be changed or the dose may be decreased.
Fatigue in patients who have depression may be treated with antidepressant drugs. Psychostimulant drugs may help some patients have more energy and a better mood, and help them think and concentrate. The use of psychostimulants for treating fatigue is still being studied. The FDA has not approved psychostimulants for the treatment of fatigue.
Psychostimulants have side effects, especially with long-term use. Different psychostimulants have different side effects. Patients who have heart problems or who take anticancer drugs that affect the heart may have serious side effects from psychostimulants. These drugs have warnings on the label about their risks. Talk to your 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).
- Mood changes.
- Loss of appetite.
- Paranoia (feelings of fear and distrust of other people).
- Serious heart problems.
The doctor may prescribe low doses of a psychostimulant to be used for a short time in patients with advanced cancer who have severe fatigue. Talk to your doctor about the risks and benefits of these drugs.
Exercise (including walking) may help people with cancer feel better and have more energy. The effect of exercise on fatigue in cancer patients is being studied. One study reported that breast cancer survivors who took part in enjoyable physical activity had less fatigue and pain and were better able to take part in daily activities. In clinical trials, some patients reported the following benefits from exercise:
- More physical energy.
- Better appetite.
- More able to do the normal activities of daily living.
- Better quality of life.
- More satisfaction with life.
- A greater sense of well-being.
- More able to meet the demands of cancer and cancer treatment.
Moderate activity for 3 to 5 hours a week may help cancer-related fatigue. You are more likely to follow an exercise plan if you choose a type of exercise that you enjoy. The health care team can help you plan 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 cancer treatment.
Mind and body exercises such as qigong, tai chi, and yoga may help relieve fatigue. These exercises combine activities like movement, stretching, balance, and controlled breathing with spiritual activity such as meditation.
Changes in daily routine make the body use more energy. A regular routine can improve sleep and help the patient have more energy to be active during the day. A program of regular times for activity and rest help to make the most of a patient's energy. A health care professional can help patients plan an exercise program and decide which activities are the most important to them.
The following sleep habits may help decrease fatigue:
- Lying in bed for sleep only.
- Taking naps for no longer than one hour.
- Avoiding noise (like television and radio) during sleep.
Cancer patients should not try to do too much. Health professionals have information about support services to help with daily activities and responsibilities.
Therapists use talk therapy (counseling) to treat certain emotional or behavioral disorders. This kind of therapy helps patients change how they think and feel about certain things. Talk therapy may help decrease a cancer patient's fatigue by working on cancer-related factors that make fatigue worse, such as:
- Stress from coping with cancer.
- Fear that the cancer may come back.
- Feeling hopeless about fatigue.
- Lack of social support.
- A pattern of sleep and activity that changes from day to day.
Fatigue is often a short-term side effect of treatment, but in some patients it becomes chronic (continues as a long-term condition). Managing chronic fatigue includes adjusting to life with fatigue. Learning the facts about cancer-related fatigue may help you cope with it better and improve quality of life. For example, some patients in treatment worry that having fatigue means the treatment is not working. Anxiety over this can make fatigue even worse. Some patients may feel that reporting fatigue is complaining. Knowing that fatigue is a normal side effect that should be reported and treated may make it easier to manage.
Working with the health care team to learn about the following may help patients cope with fatigue:
- How to cope with fatigue as a normal side effect of treatment.
- The possible medical causes of fatigue (not enough fluids, electrolyte imbalance, breathing problems, or anemia).
- How patterns of rest and activity affect fatigue.
- How to schedule important daily activities during times of less fatigue, and give up less important activities.
- The kinds of activities that may help the patient feel more alert (walking, gardening, bird-watching).
- The difference between fatigue and depression.
- How to avoid or change situations that cause stress.
- How to avoid or change activities that cause fatigue.
- How to change the surroundings to help decrease fatigue.
- Exercise programs that are right for the patient and decrease fatigue.
- The importance of eating enough food and drinking enough fluids.
- Physical therapy for patients who have nerve problems or muscle weakness.
- Respiratory therapy for patients who have trouble breathing.
- How to tell if treatments for fatigue are working.