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Fatigue
What Is Fatigue?
FAQs
Symptoms and Possible Causes
Assessment
Treatment
Resources
Fatigue Test
To
measure your level of fatigue and obtain helpful hints for
managing it, take our online fatigue
test.
What
Is Fatigue?
Acute
vs. Chronic Fatigue
Cancer-Related Fatigue
Fatigue
is a feeling of weariness, tiredness, or lack of energy that
varies in degree, frequency, and duration. Everyone has experienced
normal fatigue, which improves with rest. Chronic fatigue
associated with a disease or treatment of a disease does not
improve with rest and can seriously affect a person's ability
to function and quality of life. Fatigue can impact quality
of life in many different ways -- physically, emotionally,
socially, and spiritually.
Acute
vs. Chronic Fatigue
Acute fatigue has a recent onset and is temporary in duration.
It is usually related to excessive physical activity, lack
of exercise, insufficient rest or sleep, poor diet, dehydration,
increase in activity, or other environmental factors. Acute
fatigue can be a protective body function, alerting a person
to rest. It is anticipated to end in the near future, with
interventions such as rest or sleep, exercise, and a balanced
diet.
Chronic
fatigue persists, and recovery is not quickly anticipated.
Chronic fatigue may be associated with numerous illnesses,
such as cancer; AIDS; heart, lung or kidney problems; multiple
sclerosis; and other medical conditions. Fatigue can also
accompany psychological problems, such as depression, or result
from the use of medications.
Cancer-Related
Fatigue
Fatigue symptoms are common, yet underrecognized, in cancer
patients. Fatigue experienced by cancer patients can result
from the course of the disease, preexisting physical or psychological
conditions, effects of medication, or lack of exercise. Fatigue
may also result from treatment such as surgery, chemotherapy,
and radiation therapy.
Fatigue
from cancer surgery can last for weeks or months, and may
be caused by anxiety as patients prepare for surgery, as well
as the pre-admission testing for surgery. Pain after surgery,
the effects of anesthesia, sedatives, or analgesics may also
cause fatigue.
Fatigue
from chemotherapy affects most patients, lasting for one to
two weeks following treatment then decreasing gradually. Fatigue
as a result of radiation therapy affects almost all patients
and may worsen during the course of treatment, peaking at
4-6 weeks. Fatigue may lessen after radiation therapy is completed
but still continue for weeks or even months. Many patients
undergoing interferon or interleukin therapy also experience
fatigue.
Patients
may discuss adjusting therapeutic regimens with their doctors
to relieve fatigue symptoms. Delaying chemotherapy treatments
for 1 or 2 days to attend important life events, or changing
the time of their treatment, may be considered.
FAQs
Why
does my fatigue continue even after I rest or sleep?
Does chronic fatigue mean that my cancer has
worsened?
How can exercise benefit patients with fatigue?
Why
does my fatigue continue even after I rest or sleep?
While rest may lessen fatigue associated with a medical illness,
it often does not relieve it. Although patients with cancer
or other chronic diseases who experience fatigue may need
rest or naps during the day, they should recognize that these
activities will not eliminate the problem. Excessive bed rest
can promote weakness or decreased energy levels and eventually
increase fatigue. Mild to moderate exercise, such as walking
and stretching, can help to restore energy levels. (Whatever
the solution, it is advisable to check with your doctor before
starting an exercise program.)
Does
chronic fatigue mean that my cancer has worsened?
Cancer patients experiencing fatigue may not report
it to their doctors because they fear that fatigue symptoms
are associated with disease recurrence or spread. However,
fatigue can be related to cancer treatment, anemia, liver,
kidney, or lung function, inactivity, or a variety of other
causes. Treatment interventions that alleviate fatigue symptoms
are available to patients, and patients should report their
fatigue symptoms to their doctors.
How
can exercise benefit patients with fatigue? 
Moderate exercise has been found to relieve fatigue symptoms
in both healthy people and those with chronic diseases. Light
to moderate exercise, as recommended by a physician, can gently
energize a patient and increase functioning. Exercise differs
from casual, everyday activity in that a program of exercise
is controlled therapeutic activity used to maintain energy
and minimize fatigue.
Symptoms
and Possible Causes
Common
Fatigue Symptoms
Fatigue is generally defined in terms of symptoms that occur
over time, cause distress or impair function, or are likely
to result from disease or treatment of disease. The following
symptoms, which vary from patient to patient, are associated
with fatigue:
 |
Diminished
energy disproportionate to activity, causing distress |
|
Diminished
activity associated with lower physical or intellectual
performance, e.g., lack of focus, short attention span,
memory problems |
|
Diminished
motivation, interest in activities |
|
Exhaustion,
apathy, lethargy |
|
Generalized
(whole body) weakness or tiredness |
|
Sleep
abnormalities |
|
Irritability,
impatience, sadness, changes in mood |
Possible
Causes of Fatigue
Though little is known about fatigue prevention and treatment,
fatigue may be related to a variety of medical and physical
conditions and psychosocial factors. Fatigue can be caused by
anemia or associated with major organ dysfunction, including
severe heart or lung disease, kidney failure, or liver failure.
Hypothyroidism (insufficient production of thyroid hormone)
and adrenal problems, even if mild, can cause fatigue. Neuromuscular
disorders, malnutrition, infection, dehydration or electrolyte
disturbances can also be associated with fatigue, as well
as sleep disorders, immobility and lack of exercise, chronic
pain, or the use of centrally-acting drugs (e.g., opioids).
Psychosocial factors associated with fatigue are anxiety and
depression, stress, and those related to the reactions of others
to the fatigue.
Assessment
How
Health Care Providers Assess Fatigue
Assessment of fatigue begins with a detailed description of
its history, development,
symptoms, and causes. This information is acquired from the
patient's self-report, medical history, physical examination,
and review of laboratory tests such as a complete blood count,
thyroid function, and imaging studies (CT or MRI scan).
The
onset of fatigue, course of the symptoms, severity or intensity,
level of distress, and degree of interference with daily activities
(e.g., grooming, shopping) should be addressed. Factors that
relieve fatigue or make it worse should also be examined.
These factors may be emotional (moods, etc.), social (relationships
with family and friends), and psychological (effect on thought
process). These areas can be assessed using a verbal rating
scale: none, mild, moderate, and severe; or a 0 to 10 scale
(where 0 means no fatigue and 10 means the worst fatigue imaginable).
One scale is usually adopted and consistently used.
Treatment
Treating
Anemia
Adjusting Current Medications
Commonly Prescribed Medications
Non-Drug Interventions to Manage Fatigue
Patient/Caregiver Education
Exercise
Change in Activity and Rest Patterns
Stress Management and Cognitive
Therapies
Adequate Nutrition and Hydration
The
treatment of fatigue includes identifying and managing the
underlying cause and using a variety of interventions, including
medication; education; exercise; sleep hygiene; stress management,
and nutrition.
Treating
Anemia
Anemia (below normal levels of red blood cells) can be a major
factor in cancer-related fatigue. Lack of red blood cells
and oxygen in the body creates an energy deficit, causing
tiredness or fatigue. Blood transfusion therapy, as well as
recombinant human erythropoietin (a hormone produced by DNA
technology), is used to treat anemia. Erythropoietin stimulates
bone marrow to produce red blood cells, thereby increasing
the number of red blood cells in the body.
Adjusting
Current Medications
Patients on medication who complain of fatigue may need their
drug regimens reviewed or adjusted by their physicians. Centrally-acting
drugs that are not essential may be eliminated or reduced
(e.g., antiemetics, hypnotics or anxiolytics, antihistamines,
and analgesics). If opioids are taken for controlling pain,
dosage reduction is done cautiously to see whether fatigue
improves without making the pain worse.
Commonly
Prescribed Medications
Drug therapy for treating fatigue associated with medical
illness has not been evaluated through controlled studies.
Some doctors consider the use of psychostimulants such as
methylphenidate and pemoline. These drugs are often used to
treat opioid-related cognitive impairment and depression in
the elderly and medically ill.
Sometimes
low-dose corticosteroids
(e.g., dexamethasone or prednisone) are used in the treatment
of cancer-related fatigue.
Amantadine
has been used for many years in the treatment of fatigue due
to multiple sclerosis.
An
antidepressant drug may be used to treat fatigue due to clinical
depression, preferably one of the serotonin-specific reuptake
inhibitors, secondary amine tricyclics, or buproprion.
Non-Drug
Interventions to Manage Fatigue
In addition to medication, non-drug interventions may be used
to manage fatigue.
Patient/Caregiver
Education
Patients and caregivers can be helped to understand the nature
of fatigue symptoms, treatment choices, and expected outcomes
through education and counseling. Patients can be prepared
to anticipate fatigue as a normal part of the course of cancer
and its treatment. Patients can be taught energy
conservation and restoration strategies while undergoing
these treatments.
Exercise
Exercise may be beneficial in relieving fatigue. The exercise
program
should be tailored to the individual according to age, gender,
physical and medical condition. Exercises should involve rhythmic
and repetitive movement of large muscle groups (walking, cycling,
or swimming). These exercises should begin gradually, several
days a week, and not be performed to the point of exhaustion.
Some contraindications to low-intensity exercise include cardiac
abnormalities, recurrent or unexplained pain, and onset of
nausea with exercise.
Change
in Activity and Rest Patterns
Using a diary to assess fatigue may identify specific activities
that increase fatigue. Patients can record changes in energy
levels, and this information can help to modify, schedule,
or pace these activities throughout the day.
Naps
should be taken in the morning or early afternoon; late afternoon
or evening naps might interfere with sleep at night. Basic
sleep hygiene
principles, such as a specific bedtime and wake time,
noise and light reduction, diversional activities (e.g., music,
massage), avoidance of stimulants (e.g., caffeine, nicotine,
steroids, methylphenidate) and central nervous system depressants
(e.g., alcohol) prior to sleep should be employed. A specific
wake time helps to maintain a normal sleep-wake rhythm. Consistent
exercise tends to improve sleep and promote deeper sleep when
done at least six hours before bedtime.
Stress
Management and Cognitive Therapies
Using stress reduction techniques or cognitive therapies (e.g.,
relaxation, deep breathing, hypnosis, guided imagery, or distraction)
can promote coping skills and relieve stress.
Coping
skills such as seeking more information about the illness
and its interventions, planning and scheduling activities,
delegating tasks, and developing solutions to daily problems
associated with fatigue are helpful to patients.
Mental
fatigue may be relieved by activities that conserve and restore
mental capacity, such as decreasing noise and distractions
while trying to concentrate, walking outside, gardening, and
other environmental activities.
Adequate
Nutrition and Hydration
A balanced diet  that
combines adequate caloric intake, e.g., grains, green vegetables,
legumes, and iron-rich foods, can help maintain energy levels.
Adequate fluid intake can prevent dehydration and hypotension,
which can intensify fatigue symptoms. Regular exercise may
improve appetite and increase nutritional intake.
Credits:
Adapted from Assessment and Management of
Cancer-Related Fatigue by Russell K. Portenoy and Christine
Miaskowski.
Resources
For
more information see links below.
Cancer-Related
Fatigue
Nutrition
Guidelines
Online
Medical/Pharmacological Dictionaries
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