Nutrition & Cancer Coping with Treatment-Related Fatigue 

Summary: Treatment-related fatigue is a very real issue for patients going through cancer treatment, and treatments for other long-term medical issues. This type of fatigue holds no match to that of simple every day tiredness, and there is not always a remedy that can immediately lessen the heaviness and troublesome issues that arise with this increased fatigue. There are many things you can do to work to lessen your fatigue levels and learn how to live with what you’ve got.

Fatigue is one of the most common symptoms and side effects from cancer treatment, right up there next to nausea and vomiting. It is a recognized side effect of many medical procedures, surgeries, chemotherapy, radiation, biotherapy, and hormonal therapy. Many studies state that nine out of ten patients experience fatigue at varying levels throughout their treatment. The fatigue that occurs during cancer treatment is much different from the tiredness experienced from usual illness, or the tiredness you may experience from typical everyday life. This type of fatigue can occur randomly and quickly at any time. Cancer-related fatigue is generally not relieved by rest or sleep. These can be signs of this type of fatigue:

  – feeling irritable and impatient
  – lack of sexual desire
  – having difficulty concentrating
  – feeling tired even after sleeping during your usual nighttime rest period
  – lack of interest or changes in personal hygiene or appearance
  – not wanting to do normal activities
  – sleeping more than usual, either during the night or day
  – feeling like you have no energy at all

Once your cancer treatment ends, you may find yourself feeling less fatigued, although some individuals may feel this fatigue for several months or even years afterwards. Treatment-related fatigue can affect many aspects of your life.

What are some of the reasons cancer treatment-related fatigue happens?

Fatigue during treatment can be directly related to your type of cancer, or happens as a result of certain treatment types, or even anemia. It can be difficult to pinpoint the exact reasons for your fatigue. During your treatment, cells are rapidly growing and dying, and regenerating. Your treatment may cause fatigue in these ways:

  – Many chemotherapy drugs can cause fatigue because they destroy the rapidly growing cells, like those in bone marrow. When red blood cells are destroyed, you can quickly develop anemia. Once your anemia is resolved or controlled, your fatigued caused by this issue should lessen.
  – Neutropenia, a common side effect of chemotherapy, is a low white blood cell count that occurs due to treatment. As you slowly recover, this aspect of fatigue should also slowly resolve itself.
  – Fatigue is a common side effect of radiation therapy. The fatigue caused by radiation therapy will increase during your first month of treatment, and then begin to decrease when treatments begin to lessen. Radiation to any bony area in the body can also cause anemia.
  – When chemotherapy and radiation are given together, fatigue grows due to all of the aforementioned reasons. These treatments are often given together to increase the overall outcome of the treatment.
  – Chemotherapy induced menopause is associated with fatigue. This can be caused from the changes in hormones, changes in sleep patterns, or an increase in body fat.
  – Biotherapy, which is done to stimulate the body’s natural immune system, can lead to ongoing mental and physical fatigue.
  – Some types of hormonal treatment therapies cause short or long-term fatigue, which is related to the changes in the patient’s levels of estrogen, progesterone, or testosterone levels.

Certain side effects from your treatment can also trigger and contribute to fatigue.
  – Eating less and not getting enough nutrients causes weight loss, loss of appetite, nausea, vomiting, mouth sores, taste changes, diarrhea, or constipation. Any or all of these symptoms can cause the patient fatigue.
  – Dehydration, diarrhea and vomiting can lead to an imbalance of electrolytes, which can cause overall weakness. Electrolytes like sodium, potassium, magnesium, and calcium are involved in the body’s metabolism and help your cells to function normally.
  – Cancer cells may be competing with normal cells for nutrients, thusly slowing the growth of normal cells and causing fatigue, decreased appetite, and weight loss. “Starving” cancer does not work and is dangerous for anyone to try.
  – Chronic pain can disrupt sleep and mental focus, leaving your feeling more fatigued.
  – Medications for coping with treatment-related side effects like pain and nausea can also increase levels of fatigue.
  – Stress, depression or not sleeping enough can also contribute to fatigue.
  – Interrupted sleep, whether from frequent urination, insomnia, or other conditions like restless leg syndrome, can make treatments feel even worse.

How can I cope with fatigue?

After you have determined the cause of your fatigue, it is time to make adjustments to your life, daily activities, and work towards reducing stress. Other ways to cope with fatigue include:
  – Drink small amounts of caffeine-containing beverages, if your doctor approves
  – With your doctor’s approval, gradually incorporate a daily routine of light exercise, like walking
  – Do not force yourself to do more than you can manage
  – Let others help you where they can: meals, household chores, yardwork
  – Remember that fatigue due to anemia is temporary.
  – Ask your doctor for a sleep evaluation. Your fatigue may be related to sleep apnea or another serious breathing issue that needs to be treated.
  – Get a good night’s sleep, and work on a regular sleep schedule. This means at least six to eight hours of sleep a night.
  – Schedule your necessary activities and appointments at a time of day you will be fresh with enough energy to make things happen.
  – Use light stretching and exercise, like yoga, to help reduce fatigue.
  – Plan short resting periods to conserve energy for more important things.
If there is ever a time that you cannot get out of bed for more than twenty-four hours, contact your doctor or medical care team immediately.

What are the different ways I can use nutrition to my advantage?

Treatment-related fatigue can be made worse by poor nutrition choices but can be helped by choosing the right foods, packed with everything your body needs to thrive.

  – Get enough calories. Combating fatigue requires calories and proteins.
  – Include protein in your diet, because proteins are needed to help rebuild cells and muscles. These sources can come from animal protein, milk, eggs, or even plant-based foods like legumes and nuts.
  – Get enough vitamins and minerals. Absorbing these from your food intake is best, but do not hesitate to talk to your doctor about basic vitamin supplements to help to ensure you are getting the nutrients you need.
  – Staying hydrated means drinking at least eight cups of water or healthy liquids each day. If you are experiencing vomiting or diarrhea, you will need more fluid to help balance your body. Water, fruit juices, small amounts of milk, or broth can be good choices. Coffee and caffeinated beverages can further dehydration, thusly increasing overall fatigue.
  – Avoid sweets and sugary treats. Those sugars can rapidly increase your overall blood sugar levels, and then cause a crash hours later, which can be very confusing to your body.
  – Talk to a nutritionist or registered dietician to help you to identify the nutrients your diet is lacking. Balancing your diet can dramatically decrease symptoms of fatigue.
  – Ask for help when you need it. If you are so exhausted that eating is too tiring, reach out to your family and friends for help.

There are other ways to manage and work on decreasing your fatigue levels using non-food related therapies or diets. Being physically active and managing stress are the two most common ways, and also benefit each other. While you may not always feel up to being psychically active, slow, steady exercise can be very beneficial for your body. Managing your stressors and depression is also very necessary, and something many people avoid during the first months of their treatment. Cancer and treatment-related fatigue can easily cause depression and an unwillingness to want to try. If you are coping with stress or depression, consider these options to help you through it.

  – Talk with your cancer center’s psychosocial support personnel
  – Talk about your feelings and fears with your loved ones and friends
  – Remember that it is okay to feel worried, sad, or frustrated
  – Seek help and advice through private counseling
  – Use prayer or other types of spiritual therapy to help ease your mind
  – Try to be more physically active
  – Take part in activities that distract you and keep you engaged both in and out of the home
  – Try deep breathing and meditational exercises
  – Consider guided imagery and focused meditation like reiki, yoga, or Pilates
  – Consider music therapy to decrease anxiety and promote relaxation.
  – Talk with your doctor about the use of anti-anxiety or antidepressant medications.

Whatever method you choose to help to reduce your fatigue levels and control your stress and depression, do not hold your feelings inside. Your health care team can recommend someone to talk to, or a support group in your area that can provide support when you need it. Any sadness or heavy emotion that lasts for weeks or months, or gets in the way of your daily life, may be clinical depression and should be discussed with your doctor.

When should I call the doctor if my fatigue or depression will not go away?

If you have five or more of the below signs or symptoms that last for two weeks or longer or are severe enough to interfere with your daily activities, you may need to be evaluated by a professional.

  – thoughts of death and suicide
  – difficulty concentrating, remembering, or making decisions
  – feelings of guilt, worthlessness, or helplessness
  – Profound fatigue, almost every day
  – restlessness or feeling slowed down
  – inability to sleep, early waking, or oversleeping
  – significant weight loss or gain
  – loss of appetite or overeating
  – loss of interest or excitement in ordinary activities
  – persistent sad or “empty” mood almost every day, all day long

If you are struggling with fatigue beyond the suggestions in this article, do not wait to contact your doctor to work towards a treatment that can help to lessen your fatigue, and help level your mental state.

Resources Used:
Reclaiming Intimacy
American Cancer Society Guide to Nutrition, Barbara Grant, ISBN0944235786

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