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Fatigue (PDQ®)

Patient Version
Last Modified: 11/04/2011

Treatment

Psychostimulant drugs
Treatment for anemia
Exercise
Cognitive Behavior Therapy
Activity and rest
Patient education
Current Clinical Trials

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 cell transfusions or blood cell growth factors, diet supplementation 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 1 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 cancer survivors 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 psychological disorders. 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 outpatient chemotherapy, 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 2 and anemia 3 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 4.



Glossary Terms

abnormal (ab-NOR-mul)
Not normal. An abnormal lesion or growth may be cancer, premalignant (likely to become cancer), or benign (not cancer).
activities of daily living (ak-TIH-vih-teez…DAY-lee LIH-ving)
The tasks of everyday life. These activities include eating, dressing, getting into or out of a bed or chair, taking a bath or shower, and using the toilet. Instrumental activities of daily living are activities related to independent living and include preparing meals, managing money, shopping, doing housework, and using a telephone. Also called ADL.
advanced cancer (ad-VANST KAN-ser)
Cancer that has spread to other places in the body and usually cannot be cured or controlled with treatment.
anemia (uh-NEE-mee-uh)
A condition in which the number of red blood cells is below normal.
antidepressant (AN-tee-dee-PREH-sunt)
A drug used to treat depression.
anxiety (ang-ZY-eh-tee)
Feelings of fear, dread, and uneasiness that may occur as a reaction to stress. A person with anxiety may sweat, feel restless and tense, and have a rapid heart beat. Extreme anxiety that happens often over time may be a sign of an anxiety disorder.
blood (blud)
A tissue with red blood cells, white blood cells, platelets, and other substances suspended in fluid called plasma. Blood takes oxygen and nutrients to the tissues, and carries away wastes.
bone marrow (bone MAYR-oh)
The soft, sponge-like tissue in the center of most bones. It produces white blood cells, red blood cells, and platelets.
breast cancer (brest KAN-ser)
Cancer that forms in tissues of the breast, usually the ducts (tubes that carry milk to the nipple) and lobules (glands that make milk). It occurs in both men and women, although male breast cancer is rare.
cancer (KAN-ser)
A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is a cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is a cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is a cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord. Also called malignancy.
cell (sel)
The individual unit that makes up the tissues of the body. All living things are made up of one or more cells.
chemotherapy (KEE-moh-THAYR-uh-pee)
Treatment with drugs that kill cancer cells.
chronic (KRAH-nik)
A disease or condition that persists or progresses over a long period of time.
cognitive behavior therapy (KOG-nih-tiv beh-HAY-vyer THAYR-uh-pee)
A type of psychotherapy that helps patients change their behavior by changing the way they think and feel about certain things. It is used to treat mental, emotional, personality, and behavioral disorders. Also called CBT and cognitive therapy.
condition (kun-DIH-shun)
In medicine, a health problem with certain characteristics or symptoms.
cope (kope)
To adjust to new situations and overcome problems.
darbepoetin alfa (DAR-bee-POH-eh-tin AL-fuh)
A substance made in the laboratory that stimulates the bone marrow to produce red blood cells. It belongs to the family of drugs called antianemics.
depression (dee-PREH-shun)
A mental condition marked by ongoing feelings of sadness, despair, loss of energy, and difficulty dealing with normal daily life. Other symptoms of depression include feelings of worthlessness and hopelessness, loss of pleasure in activities, changes in eating or sleeping habits, and thoughts of death or suicide. Depression can affect anyone, and can be successfully treated. Depression affects 15-25% of cancer patients.
diet (DY-et)
The things a person eats and drinks.
disorder (dis-OR-der)
In medicine, a disturbance of normal functioning of the mind or body. Disorders may be caused by genetic factors, disease, or trauma.
dose (dose)
The amount of medicine taken, or radiation given, at one time.
drug (drug)
Any substance, other than food, that is used to prevent, diagnose, treat or relieve symptoms of a disease or abnormal condition. Also refers to a substance that alters mood or body function, or that can be habit-forming or addictive, especially a narcotic.
electrolyte (ee-LEK-troh-lite)
A substance that breaks up into ions (particles with electrical charges) when it is dissolved in water or body fluids. Some examples of ions are sodium, potassium, calcium, chloride, and phosphate. These ions help move nutrients into cells, help move waste out of cells, and help nerves, muscles, the heart, and the brain work the way they should.
epoetin alfa (ee-POH-eh-tin AL-fuh)
A substance that is made in the laboratory and stimulates the bone marrow to make red blood cells. It is a type of antianemic and a type of recombinant human erythropoietin.
euphoria (yoo-FOR-ee-uh)
A feeling of great happiness or well-being. Euphoria may be a side effect of certain drugs.
fatigue (fuh-TEEG)
A condition marked by extreme tiredness and inability to function due lack of energy. Fatigue may be acute or chronic.
fluid (FLOO-id)
A substance that flows smoothly and takes the shape of its container. Liquids and gases are fluids.
graft-versus-host disease (... dih-ZEEZ)
A disease caused when cells from a donated stem cell graft attack the normal tissue of the transplant patient. Symptoms include jaundice, skin rash or blisters, a dry mouth, or dry eyes. Also called GVHD.
growth factor (grothe FAK-ter)
A substance made by the body that functions to regulate cell division and cell survival. Some growth factors are also produced in the laboratory and used in biological therapy.
hospice (HOS-pis)
A program that provides special care for people who are near the end of life and for their families, either at home, in freestanding facilities, or within hospitals.
immunity (ih-MYOO-nih-tee)
The condition of being protected against an infectious disease. Immunity can be caused by a vaccine, previous infection with the same agent, or by transfer of immune substances from another person or animal.
infection (in-FEK-shun)
Invasion and multiplication of germs in the body. Infections can occur in any part of the body and can spread throughout the body. The germs may be bacteria, viruses, yeast, or fungi. They can cause a fever and other problems, depending on where the infection occurs. When the body’s natural defense system is strong, it can often fight the germs and prevent infection. Some cancer treatments can weaken the natural defense system.
iron (I-urn)
An important mineral the body needs to make hemoglobin, a substance in the blood that carries oxygen from the lungs to tissues throughout the body. Iron is also an important part of many other proteins and enzymes needed by the body for normal growth and development. It is found in red meat, fish, poultry, lentils, beans, and foods with iron added, such as cereal.
medication (MEH-dih-KAY-shun)
A legal drug that is used to prevent, treat, or relieve symptoms of a disease or abnormal condition.
nausea (NAW-zee-uh)
A feeling of sickness or discomfort in the stomach that may come with an urge to vomit. Nausea is a side effect of some types of cancer therapy.
nerve (nerv)
A bundle of fibers that receives and sends messages between the body and the brain. The messages are sent by chemical and electrical changes in the cells that make up the nerves.
outpatient (OWT-pay-shunt)
A patient who visits a health care facility for diagnosis or treatment without spending the night. Sometimes called a day patient.
paranoia (PAYR-uh-noy-uh)
A mental disorder in which a person has an extreme fear and distrust of others. A paranoid person may have delusions that people are trying to harm him or her.
physical therapy (FIH-zih-kul THAYR-uh-pee)
The use of exercises and physical activities to help condition muscles and restore strength and movement. For example, physical therapy can be used to restore arm and shoulder movement and build back strength after breast cancer surgery.
psychological (SY-koh-LAH-jih-kul)
Having to do with how the mind works and how thoughts and feelings affect behavior.
psychostimulant (SY-koh-STIM-yoo-lunt)
A drug that causes a sense of well-being, decreases fatigue and depression, and increases the desire to eat. These drugs can also cause mood changes and trouble with sleeping.
qigong (chee-gong)
A form of traditional Chinese mind/body exercise and meditation that uses slow and precise body movements with controlled breathing and mental focusing to improve balance, flexibility, muscle strength, and overall health.
quality of life (KWAH-lih-tee ... life)
The overall enjoyment of life. Many clinical trials assess the effects of cancer and its treatment on the quality of life. These studies measure aspects of an individual’s sense of well-being and ability to carry out various activities.
red blood cell (red blud sel)
A cell that carries oxygen to all parts of the body. Also called erythrocyte and RBC.
respiratory therapy (RES-pih-ruh-TOR-ee THAYR-uh-pee)
Exercises and treatments that help improve or restore lung function.
side effect (side eh-FEKT)
A problem that occurs when treatment affects healthy tissues or organs. Some common side effects of cancer treatment are fatigue, pain, nausea, vomiting, decreased blood cell counts, hair loss, and mouth sores.
social support (SOH-shul suh-PORT)
A network of family, friends, neighbors, and community members that is available in times of need to give psychological, physical, and financial help.
stress (stres)
The response of the body to physical, mental, or emotional pressure. This may make a person feel frustrated, angry, or anxious, and may cause unhealthy chemical changes in the body. Untreated, long-term stress may lead to many types of mental and physical health problems.
supplementation (SUH-pleh-MEN-TAY-shun)
Adding nutrients to the diet.
survivor (ser-VY-ver)
One who remains alive and continues to function during and after overcoming a serious hardship or life-threatening disease. In cancer, a person is considered to be a survivor from the time of diagnosis until the end of life.
symptom (SIMP-tum)
An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.
tai chi (ty chee)
A form of traditional Chinese mind/body exercise and meditation that uses slow sets of body movements and controlled breathing. Tai chi is done to improve balance, flexibility, muscle strength, and overall health.
therapy (THAYR-uh-pee)
Treatment.
transfusion (tranz-FYOO-zhun)
A procedure in which a person is given an infusion of whole blood or parts of blood. The blood may be donated by another person, or it may have been taken from the patient earlier and stored until needed. Also called blood transfusion.
tumor (TOO-mer)
An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancer), or malignant (cancer). Also called neoplasm.
vitamin (VY-tuh-min)
A nutrient that the body needs in small amounts to function and stay healthy. Sources of vitamins are plant and animal food products and dietary supplements. Some vitamins are made in the human body from food products. Vitamins are either fat-soluble (can dissolve in fats and oils) or water-soluble (can dissolve in water). Excess fat-soluble vitamins are stored in the body’s fatty tissue, but excess water-soluble vitamins are removed in the urine. Examples are vitamin A, vitamin C, and vitamin E.
yoga (YOH-guh)
An ancient system of practices used to balance the mind and body through exercise, meditation (focusing thoughts), and control of breathing and emotions. Yoga is being studied as a way to relieve stress and treat sleep problems in cancer patients.

Table of Links

1http://www.fda.gov/cder/drug/infopage/RHE/default.htm
2http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?Diagnosis=41390&tt=2&a
mp;format=1&cn=1
3http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?Diagnosis=41382&tt=2&a
mp;format=1&cn=1
4http://www.cancer.gov/clinicaltrials