Intro / Side Effects / Fatigue and Anemia

Patients who have chronic fatigue describe their state in many ways: they may say they lack ambition, feel down and miserable, cannot concentrate, can no longer do a full day's work, or have lost their desire to communicate with those around them. They report that everything is an effort, that they are working against gravity. These feelings affect not only patients' outlook on and quality of life but also their ability to combat their disease.

Among cancer patients, fatigue has many causes. Cancer itself can cause fatigue, as cancer cells divide more rapidly than normal cells and use a lot of energy and nutrients to do so. Cancer also causes biochemical and hormonal changes that can lead to fatigue. In fact, fatigue is one of the symptoms that people may experience before their diagnosis, especially people with blood and bone marrow cancers such as leukemia. These diseases affect the body's ability to produce the red blood cells that carry oxygen throughout the body. Patients with anemia experience not only fatigue, but often feel chilled and look pale.

Cancer treatment is another important factor in chronic fatigue. Patients who undergo surgical procedures, even minor ones, will need time and energy to heal and may experience fatigue as a result. More complex surgical procedures often involve a loss of blood, the need for pain medications, and periods when patients cannot eat or drink; these can all deplete the body of nutrients and energy. It can often take six months for a patient to feel normal following a surgical procedure.

Chemotherapy leads to fatigue because most therapeutic agents damage normal tissues in the process of destroying tumors. Damage to bone marrow can lead to anemia and low levels of white blood cells and platelets. These two fend off infections and promote healing, so reduced levels can increase the chances of infection and the length of the healing process. Symptoms of anemia include feeling cold, pale color, shortness of breath and rapid heart rate following little exertion, for example, walking short distances.

Almost all patients who undergo radiation therapy say they experience fatigue. Radiation can affect bone marrow and lead to anemia, especially if the hip area is the target of radiation, because bones in that region contain much of the body's marrow. Treatment in this area also often causes diarrhea, another cause of fatigue. And a treatment schedule that calls for a daily course of radiation over four to six weeks can add stress and strain.

Biological response modifiers such as interferon and interleukin commonly cause flu-like symptoms and severe fatigue. Following diagnosis, patients may try to simply add their rounds of treatment into their pretreatment schedule, and to keep up strenuous activities. Fatigue may result; this could be the body's way of saying "slow down." Various treatment regimens can also affect a patient's sleep patterns. Pain, nausea and vomiting, and urinary frequency can waken patients at night, and sleep and pain medications can leave patients feeling groggy and unrested. Patients may also experience anxiety about their condition and about consequences such as financial stress, leading to insomnia.

Fatigue may lead to feelings of helplessness and hopelessness, but in fact, there are many things that patients and their caregivers can do to alleviate its effects:

• Become aware of the specific causes of your fatigue so that you can address those problems directly.
  
  
• Keep a daily journal to track when you have the most and least energy, both during each day and during each treatment cycle. Once you discover these patterns, you can plan accordingly: schedule activities that require the most energy during your energetic times; during the periods when you tend to be most tired, plan rest periods.
  
  
• If you exercised regularly before treatment, tell your physician that you would like to get back on an exercise schedule as soon as possible. If you did not exercise, ask your physician if it would be appropriate to begin.
  
  
• Eat healthy, but stick to foods that you can chew, swallow, and keep down easily. Spread your meals out into smaller meals throughout the day. Drink lots of fluid to keep your body well hydrated.
  
  
• Conserve energy: take naps if you find them helpful. Go to bed early but don't stay in bed all day because this can lead to weakened muscles and further fatigue.
  
  
• Join a support group; take an active part in treatment. These may both help you feel energized and engaged.
  
  
• Avoid negative coping mechanisms such as smoking, drinking, drugs and caffeine.
  
  
• Investigate relaxation techniques such as music and massage therapy.
  
  
• If you are suffering from insomnia, one or more of these suggestions may be helpful: Avoid dealing with anxiety-producing activities such as finances right before going to bed. Take longer-acting pain medications before bed if you are awakened by pain at night. Ask your physician or nurse the optimal time to take antiemetics so that they will work best during the night. Drink all your fluids before 6 PM to avoid the need to urinate during the night. Try to avoid sleep medications; they lead to less restful sleep at night.
  
  
• If you are experiencing chemotherapy-related anemia, ask your physician or nurse if you are a candidate for erythropoetin, a drug that can lessen or prevent anemia.
  
  
• Have your physician or nurse assess your fatigue level if they have not done so already. They will be able to give you more specific information that will help you cope with fatigue.