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

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.

Although fatigue is one of the most common symptoms in cancer, few medications are effective in treating it. A health care provider may prescribe medication in low doses that may help patients who are depressed, unresponsive, tired, distracted, or weak. These drugs (psychostimulants) can give a sense of well-being, decrease fatigue, and increase appetite. They are also helpful in reversing the sedating effects of morphine, and they work quickly. However, these drugs can also cause sleeplessness, euphoria, and mood changes. High doses and long-term use may cause loss of appetite, nightmares, sleeplessness, euphoria, paranoid behavior, and possible heart problems.

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.

Treatment for anemia-related fatigue in patients undergoing chemotherapy may also include drugs, such as epoetin alfa, that cause the bone marrow to make more red blood cells. This type of drug may shorten survival time or may cause some tumors to grow faster. Patients should discuss the risks and benefits ¹ of these drugs with their doctors.

Exercise (including light- to moderate-intensity walking programs) helps many people with cancer. 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.

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.

Cognitive behavior therapy (CBT) is a method used by therapists to treat a variety of psychological disorders, including post- cancer treatment fatigue that has no physical cause. 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.

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.

Treating chronic fatigue in cancer patients 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.

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

Glossary Terms

A condition in which the number of red blood cells is below normal.

A drug used to treat depression.

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.

A term for diseases in which abnormal cells divide without control. Cancer cells can invade nearby tissues and can spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is 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.

The individual unit that makes up the tissues of the body. All living things are made up of one or more cells.

Treatment with drugs that kill cancer cells.

A disease or condition that persists or progresses over a long period of time.

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.

The things a person eats and drinks.

In medicine, a disturbance of normal functioning of the mind or body. Disorders may be caused by genetic factors, disease, or trauma.

The amount of medicine taken, or radiation given, at one time.

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.

A substance that breaks up into ions (electrically charged particles) when it is dissolved in body fluids or water. Some examples of electrolytes are sodium, potassium, chloride, and calcium. Electrolytes are primarily responsible for the movement of nutrients into cells and the movement of wastes out of cells.

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.

A feeling of great happiness or well-being. Euphoria may be a side effect of certain drugs.

A condition marked by extreme tiredness and inability to function due lack of energy. Fatigue may be acute or chronic.

GVHD. A reaction of donated stem cells against the patient’s tissue. Also called GVHD.

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.

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.

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.

A narcotic drug used in the treatment of pain.

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.

A patient who visits a health care facility for diagnosis or treatment without spending the night. Sometimes called a day patient.

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.

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.

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.

RBC. A cell that carries oxygen to all parts of the body. Also called RBC and erythrocyte.

Exercises and treatments that help improve or restore lung function.

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.

A network of family, friends, neighbors, and community members that is available in times of need to give psychological, physical, and financial help.

Adding nutrients to the diet.

An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.

Treatment.

The infusion of components of blood or whole blood into the bloodstream. The blood may be donated from another person, or it may have been taken from the person earlier and stored until needed.

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 cancerous), or malignant (cancerous). Also called neoplasm.

A key nutrient that the body needs in small amounts to grow and stay strong. Examples are vitamins A, C, and E.