WHAT IS FATIGUE?

Fatigue may be attributable to cancer itself or to the side effects of treatment. You experience fatigue when you feel very tired or exhausted either part or all of the time. Nine out of ten cancer patients have fatigue, although every patient's case is different. The effects may be very slight in some, while others may be seriously effected by fatigue. Patients with fatigue may tire easily and not feel better after resting or sleep. The condition can affect all aspects of life. Even reading or watching television can be exhausting. This can be frustrating and overwhelming.

Cancer-related fatigue generally subsides following treatment, although it prolongs for months or years in some patients. It may be useful for you to keep a fatigue diary so you can discuss your condition with your doctor. One of the best things you can do to manage your fatigue is to stay physically active.

WHAT CAUSES FATIGUE?

Fatigue may be caused by a number of things. These include:

• The cancer itself.
• The tests you may require.
• The treatments for cancer, including chemotherapy, radiotherapy, hormone therapy, guided therapy, and surgery. Fatigue tends to get better once the treatment is over, although it sometimes turns into a long-term problem.
• Low levels of red blood cells (anemia) due to cancer or cancer treatment. Patients may receive blood transfusions to help increase their number of red blood cells.
• The emotional effects of cancer, such as anxiety or depression. These emotions are common when patients are first diagnosed, although cancer-related anxiety and depression normally can be managed with time.
• Loss of appetite due to cancer or the side effects of treatment.
• The symptoms that cancer may cause, such as pain, dyspnea, or fluid retention.

ADVICE FOR MANAGING REST

Regulate sleep.

Maintain a normal sleep pattern even if you feel like sleeping all the time. This regularity can help you feel better. There are different things you can do to improve your sleep and rest. You may want to try some of these:

• develop a routine for going to bed
• reduce the light and sound in your bedroom
• keep a journal of your worries so that you can note down any thoughts that keep you from sleeping
• get some exercise - this may help you sleep better over the long term.

It is a good idea to have a light snack or a warm drink before going to bed. But try to avoid caffeinated beverages such as coffee in the hours before bedtime. You may also wish to try some mental exercises if you cannot fall asleep. For example, try to remember song lyrics, make alphabetically ordered lists, or write a letter in your head.

Your doctor or nurse can give you more advice to manage your fatigue.

MANAGING THE SYMPTOMS OF FATIGUE

There are things you can do to help control the symptoms of fatigue.

Eating well and drinking plenty of fluids can increase your energy level. Your doctor or nurse can give you advice on proper diet.

Physical exercise can increase your energy level and increase your appetite. Start slowly and gradually increase the amount of exercise you do. Try to set small, attainable goals for yourself, such as walking to the door. Even in small doses, a bit of exercise is better than doing nothing at all. It is important to ask your doctor for advice before starting any new type of exercise.

You may feel more stressed during your treatment. This may make you feel more tired. Try to set time aside for relaxation. There are certain relaxation techniques that you can use to alleviate tension and increase your level of energy. Complementary therapy can also help you deal with fatigue and relax more.

MANAGING YOUR TASKS WHEN YOU FEEL FATIGUED

It is important to plan ahead if you are experiencing fatigue. Be realistic about what you can and can't do, and make a plan of things to do when you feel less tired.

Some of these suggestions may help you cope with tasks of daily life:

• Spread out housecleaning tasks throughout the week and ask for help if you can.
• Try to shop over the Internet, buy things that can be sent to your home, or ask a family member to do your shopping.
• Cook simple foods and eat small meals and snacks throughout the day.
• It can be worthwhile to take baths rather than showers. Also, try to wear clothes that are easy to take off.
• Listen to the radio or an audiobook instead of watching television.
• If you have children, explain to them that you feel tired. Plan activities in which you can sit while spending time with them.
• Try to avoid driving when you feel tired. Family or friends can help.

Remember that you should ask for help if you need it. Family members, friends, neighbors, social workers, and occupational therapists may be able to help you handle your tasks.

CAREGIVERS FOR PEOPLE WITH FATIGUE

What these individuals can do:

• Understand the different ways of coping with fatigue. Read the information in this section.
• Encourage your family member or friend to write down how fatigue is affecting his or her life.
• Use the fatigue journal to figure out the moments when the person you're caring for may have more energy to do things such a go shopping or have guests over. Plan effectively to make the most of these moments.

You can accompany your family member or friend when he or she goes to the hospital and bring the fatigue journal with you. Discuss the following with doctors and nurses:

• how fatigue is affecting the both of you
• what could be causing the fatigue
• which techniques have been tried to reduce fatigue, and what has and has not worked