If I Wasn't So Tired

I am so tired — a phrase that I often hear from cancer survivors. Do they just need to take it easy and take a few more naps? How is it possible to be so tired that putting one foot in front of the other takes every bit of energy out of you or just a simple task seems so impossible? Could it be cancer-related fatigue (CRF)?

“Cancer-related fatigue is a distressing, persistent, subjective sense of physical, emotional, and/or cognitive tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning¹.” Studies have shown that 70-90% of patients will have CRF at some point in their cancer journey. It can be one of the most debilitating side effects from cancer treatment. Are you talking and listening to your patients about their fatigue?

Often, we tell our patients the most logical thing we can come up with - rest often and don’t overdo it. Despite rest, cancer-related fatigue may not improve. CRF can be attributed to multiple causes, such as anemia, decreased nutrition, hypothyroidism, medications, pain, stress, depression, and/or insomnia. As a healthcare provider, we need to treat CRF using a multidisciplinary approach.

Simple lifestyle modifications can help improve management of CRF, such as exercise, diet, improving sleep, managing stress and getting support. First and for most, patients need to understand their treatment didn’t happen overnight, and their body needs time to build back stamina. Doing a little bit each day, and adding to when possible, can help with CRF.

Giving your patients the following simple suggestions can help them manage their cancer-related fatigue better:

• Exercise Decrease in physical activity can lead to tiredness and lack of energy. It is recommended that cancer survivors exercise at least 150 minutes per week doing moderate intensity exercise — which means sweating a little and elevating their heart rate. 150 minutes can be an overwhelming number, but breaking that time down into smaller time frames is important for those that suffer from CRF. Don’t do too much too soon! Encourage them to find a workout buddy to keep them motivated. Remind patients they need to check with their physician before starting an exercise program.

• Diet Good nutrition is good fuel for the body. With the proper nutrition patients can feel better and have more overall energy. Treatment can pose challenges with eating — taste changes, feeling of fullness, swallowing difficulties and smells that can trigger nausea make it hard to find the proper food to fuel the body. Many health organizations have dietitians available to talk with patients to help make suggestions on nutrition. If one is not available there are many good websites with helpful information, such as www.aicr.org. Grocery shopping can also bring its own challenges. Patients need to plan ahead and go shopping when it’s a good time for them. If the patient doesn’t have the energy to go encourage them to ask for help. Another good idea is to see if their local grocery store offers delivery. Smaller meals and snacking throughout the day can help fuel the body. Most importantly, have them keep things simple and well balanced, and make sure to drink enough fluids to help cope with their fatigue.

• Manage stress This is a hard one for anyone, but can be more difficult for cancer patients. It’s easier said than done - let go of the worries! Having a range of emotions is normal, but patients need to remember to be gentle with themselves. Having them be mindful of what they can control versus what they can’t, will help alleviate some of the stressors. Another great tool is mindfulness meditation. Meditating can help patients learn to be in the present, and not think about the future or the past. Some patients find meditation to be difficult. However, the more they practice meditating, the easier it gets. Sleep can be another factor in managing stress. Taking long afternoon naps can make going to bed at night harder. Have patients try to get into a healthy bedtime routine. Trying things that can relax them before bedtime can be beneficial, such as gentle yoga. Finally, if something is bothering your patient, they need to know that it is ok to ask. With a diagnosis of cancer, life doesn’t stop. Patients can become overwhelmed and may need to seek professional help, such as a licensed professional counselor or attend a support group.

• Pace yourself Life isn’t a marathon! Pace, plan, and prioritize. Patients need to know their limits and do the best they can each day. Have them keep a journal to see if they can find a pattern with their fatigue. This might help them understand how to plan each day and be able to see what may trigger their fatigue. Deciding what activities are most important to them that day, can help make planning the day easier. Slow and steady is better than fast and furious!

• Ask for help It is human nature to be so hard on ourselves that we think we ‘should’ be doing this or that. Patients need to give themselves permission to be where they are in their journey. Asking for help does not make them weak. Many times, family and friends will ask what can they do for the patient. Now is the time for them to take advantage of the extra help that is offered. Also, patients should be specific when asking for help. Don’t be afraid to tell someone how they can help you. Allowing others to help can ease the burden and help patients conserve energy.

• Talk with your healthcare provider It is key that patients be honest and open with their healthcare providers about their fatigue. There might be an underlying medical issue making the fatigue worse. Ask your patient what activities they would like to be doing that they aren’t able to do? Try to grasp how the fatigue is affecting the patient can help healthcare providers have a better understanding of the severity of the problem. Do they have sudden weakness in one extremity, dizziness, light headedness, sudden falls, new onset of shortness of breath, chest pain, or bleeding? Some of the symptoms may not be related to CRF and my need further testing.

The first thing about helping patients suffering from cancer-related fatigue is knowing the problem exists. CRF can start pretreatment, last through treatment, and beyond. It is impeccable that we understand the severity of the fatigue our patients are suffering from. Many patients don’t bring the topic up because they believe it’s a normal thing. Be an advocate for your patients by starting the conversation and listening to them.

¹ National Comprehensive Cancer Network (NCCN). NCCN clinical practice guidelines in oncology: cancer-related fatigue V.2; 22017. Available at: https://www.nccn.org/professionals/physician_gls/PDF/fatigue.pdf . Accessed August 22, 2017.

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