“It’s been a year-and-a-half since my chemotherapy treatments for acute myeloid leukemia (AML). Is it normal to still get tired doing everyday chores like yard work?”
Fatigue is very common in patients with blood cancers. Cancer-related fatigue (CRF) is characterized by excessive and persistent exhaustion that interferes with daily activity and function. CRF often begins before cancer is diagnosed, worsens during the course of treatment and may persist for months—even years—after treatment ends. Fatigue can be difficult to assess because there are no objective measurements.
What is cancer related fatigue?
Unlike the fatigue that healthy people experience from time to time, CRF is more severe, often described as an overwhelming exhaustion that cannot be overcome with rest or a good night’s sleep. Some people may also describe muscle weakness or difficulty concentrating. Many patients with leukemia, lymphoma, myeloma, myelodysplastic syndromes or myeloproliferative neoplasms find CRF more distressing and disabling than other disease-related or treatment-related symptoms such as pain, depression or nausea.
Treating cancer related fatigue
There is no single effective treatment for CRF. The first steps are often to identify and treat any underlying causes of CRF (such as anemia or poor nutrition) and then to determine any other contributing health problems (like thyroid, heart, liver or kidney disease) that may make CRF worse. Although some clinicians, caregivers and people living with cancer consider CRF an inevitable part of this disease and its treatment, there are steps that patients can take to ease their fatigue. Regular exercise, good nutrition, psychological support, stress management and other lifestyle changes can help boost energy levels and the ability to cope with fatigue. Untreated CRF can negatively affect a person’s physical and emotional well-being and quality of life.
Fortunately, CRF awareness is growing and research is uncovering treatments to help minimize or relieve fatigue. In addition, leading health organizations such as the National Institutes of Health (NIH) and the National Comprehensive Cancer Network (NCCN) have called for better assessment and management of CRF as an integral part of quality comprehensive cancer care. As with any cancer-related symptoms or treatment side effects, individuals should continue to report their levels of fatigue or exhaustion to members of their oncology care team.
Taking care of yourself
Here are some suggestions that may help patients with CRF improve their own well-being.
Be Flexible. Do not measure yourself by prediagnosis energy levels. Set realistic goals. You may not be able to accomplish everything that you want to do every single day. Decide which tasks are most important for you to complete and focus on accomplishing those goals. When you are feeling fatigued, let others help you. Distract Yourself. Allow yourself to shift your focus from fatigue (and what you may not be accomplishing) by listening to music, reading a book, looking at pictures, meeting friends, watching a movie, going for a walk or enjoying time in nature.
Stay Active. Staying physically active may help some people ease fatigue. If you do not already have an exercise regimen, begin one gradually and aim to exercise at least three to five times a week. Adjust your exercise routine if you feel overly tired. Focus on activities that will help you gradually build strength but that do not deplete your energy level. Light exercise, such as walking, can also help you relax and sleep better. It’s important that you consult with your physician before beginning or changing your exercise routine.
Practice Good Nutrition. Patients with cancer are at risk for malnutrition and other problems resulting from either the cancer or the cancer treatment (loss of appetite, nausea, vomiting and inability to absorb nutrients). It is important for patients to eat a balanced diet that provides sufficient fluid, calories, protein, vitamins and minerals. Iron intake is vital, so try to consume iron-rich foods such as green leafy vegetables and red meat. Drink plenty of non-caffeinated liquids throughout the day. Adequate hydration is very important in preventing and treating fatigue.
Manage Stress. The effects of stress can be offset, in part, through exercise, relaxation techniques, mindfulness meditation, spiritual and/or religious practices, socializing and counseling.
Address Sleep Habits. The following suggestions may help improve sleep quality: engage in relaxing activities before bedtime such as taking a warm bath, reading, or listening to calming music; go to bed at the same time every night; use the bedroom for sleep only; keep the bedroom cool, quiet and dark; avoid caffeine, alcohol or high-sugar foods before bedtime; and forego daytime naps that may interfere with nighttime sleep. If you need to nap, do not sleep for longer than 30 minutes.
The Leukemia & Lymphoma Society (LLS) is the world’s largest voluntary health organization dedicated to funding blood cancer research, education and patient services. LLS offers free information and services for patients and families touched by blood cancers. For more information, please call: (800) 955-4572 (M-F, 9 a.m. to 9 p.m. EST) or reach out online.
Question answered by Meredith Barnhart, LCSW, Director, The Leukemia & Lymphoma Society Information Resource Center
Meredith Barnhart, LCSW, joined The Leukemia & Lymphoma Society (LLS) in 2016 and is currently the Director of the Information Resource Center - a toll-free call center staffed with master’s level oncology social workers, nurses and health educators who provide blood cancer patients and caregivers free personalized information and support. Prior to joining LLS, Meredith was employed for ten years as a clinical social worker in the Department of Pediatrics at Memorial Sloan Kettering Cancer Center. She holds a master’s degree in social work from Columbia University and is presently pursuing a PhD in social work at Fordham University.