NEW YORK--Fatigue related to cancer or its treatment does not go away
after a good nights rest, and may last a month or longer. In
the cancer setting, there may be many reasons for chronic fatigue,
Lois Almadrones, RN, MPA, clinical research associate, Memorial
Sloan-Kettering Cancer Center, said at a Cancer Care teleconference
for cancer patients.
Ms. Almadrones gave a vivid description of what cancer-related
chronic fatigue is like: "Youre exhausted. Its a big
effort to do anything. You have no ambition. Your mood might change
so that if youre usually talkative, you dont want to
talk. A usually bubbly person is miserable. You cant
concentrate. You may be so run down, you dont feel like putting
your clothes on. Everything sort of has a cloud hanging over it.
There is a constant sense of working against gravity."
She reminded her audience that even a small medical procedure can
take its toll. "Maybe it was a bone marrow aspiration or the
taking of blood or a small biopsy that didnt require general
anesthesia," she said. "But you still had to come into the
hospital. You still had to have some kind of local anesthetic or mild
sedation. And if you had tissue removed for a biopsy, that caused damage."
Ms. Almadrones noted that virtually all patients who have radiation
treatments report fatigue, and that radiation of the large bones in
the upper legs, pelvis, and lower abdomen is known to cause the
The increased activity of showing up for regular medical treatments,
and sometimes having to get up earlier than usual for the
appointments, adds to the debilitating effects of treatment, and so
does trying to maintain ones precancer schedule of activities.
The result may be chronic fatigue. "Your body is telling you
that you really need to stop and make priorities about how to spend
your day," Ms. Almadrones said.
Not getting a good nights sleep only adds to the fatigue, and
there are many reasons why cancer patients cannot sleep. Ms.
Almadrones advised patients to "make sure that any pain
medication you take when you go to bed is long acting. If your sleep
problems are due to gastro-intestinal symptoms, perhaps the
medication for the GI symptoms can be taken closer to bedtime. If you
have been told to drink two quarts of liquid a day and urinary
frequency is interfering with your sleep, try drinking the liquid by
Sleeping pills are no panacea, she warned. "Although it helps
you to get sleep, it leaves you groggy and its not the same as
natural sleep. If you can, wean yourself off it."
Avoid Anxiety Before Bedtime
Engaging in activities that raise ones anxiety level before
going to bed does not help either, she said. Someone who is worried
about money should not work on their checkbook before going to bed,
for example. Rather, people should continue to observe the sleep
rituals that worked for them before their diagnosis, like taking a
warm bath or reading a magazine before retiring or taking a walk in
the evening, she said.
Just because a health care provider fails to inquire about a
patients energy level is no reason for a patient not to bring
it up, Ms. Almadrones said. "If youre feeling fatigued,
you definitely need to talk about it with your doctor or nurse on
your next visit," she said.
She also noted several things that patients can do to help assess the
causes of their fatigue. Keeping a daily journal of when one feels
tired or energetic will help tease out some of the causative factors,
as well as some of the anxious thoughts that may be interfering with
sleep. Discovering the ups and down of energy can also help patients
schedule activities so that they are less draining.
Proper nutrition and taking lots of fluids are also key and so is
getting adequate rest throughout the day. Ms. Almadrones encourages
patients to take short naps. She also encourages them to detach
themselves from any personal problems that family members are having.
"They can be an emotional drain. You need to conserve your
energy for your own body and use it to cope with your own
problems," she said.