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Life After Cancer A Roadmap for Cancer Survivors

Ernest H. Rosenbaum, MD

The Management of Fatigue

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Fatigue is the feeling of being tired after resting or a good sleep. Fatigue is common when a person has any type of chronic disease, including cancer. Fatigue also affects up to 90% of cancer survivors, especially those under treatment. In addition to treatment effects, fatigue can also be caused by emotional stress, anxiety, depression, pain, sleeping problems, hormonal problems (for example, low thyroid function) or anemia (having too few red blood cells to carry oxygen) due to cancer or its treatment.

Anemia is a common cause of fatigue. Symptoms of anemia are tiredness, weakness, shortness of breath, dizziness, and possibly a decrease in heart function. The causes of anemia are common but can be complex and could be due to a deficiency in iron or vitamin B12 /folic acid, hemolysis (red blood cell destruction), an acute or chronic disease or bleeding. The treatment depends on the cause in each case. Anemia maybe treated with drugs (including iron, B12/folic acid, erythropoietin [Procrit® or Aranasp®]) when anemia is caused by chemotherapy/radiation therapy or with blood transfusions. Evaluating and treating the cause is essential to correct an anemia for symptom relief.

Fatigue affects quality of life, the ability to function, and the capacity to live a productive, satisfactory existence. An active program is needed to reduce fatigue. Both rest and exercise may help in controlling debility and fatigue problems.

The Management of Fatigue
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A daily exercise program can be very beneficial in building and maintaining muscles that will help you in your daily living functions.

Tips on managing fatigue include:
Eat frequent small meals, snacking on high protein foods.
Add nutritional supplements such as Ensure®, Boost®, and Scandi-shakes®.
Maintain good fluid replacement with liquids and electrolyte-positive drinks.
Plan your day's activities so that heavy activities are done when you are at optimal strength.
Try to be more organized, for example, plan your shopping trips with a list that is coordinated with the aisles in the store you use, and, if necessary, use a shopping service that delivers to your home.
Use relaxation techniques, such as biofeedback, meditation; find ways to relax with fun, easy activities such as movies, music, art, and family or friend enjoyment projects that require minimal energy.
Modafinil (Provigil®) has recently been reported to have positive effects by significantly reducing cancer related fatigue in women with breast cancer who had fatigue up to two years after treatment.

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First appeared December 14, 2007; updated August 2, 2008