Fatigue

Are You Sick and Tired of Feeling Sick and Tired?

It’s normal to feel tired after we’ve had cancer. In fact, cancer fatigue is the most common side effect. More than 80 percent of people get fatigue at some point during their journey. But we don’t all experience it the same way.

Cancer fatigue can feel like:

  • A feeling of heaviness, exhaustion or a lack of motivation
  • Irritability or sadness
  • Difficulty concentrating or focusing
  • A sense that you just can’t get your energy back

What causes fatigue?

Cancer treatments cause changes to our bodies that lead to fatigue, like:

  • A low red blood cell count (anemia)
  • Side effects of our treatments and medications
  • Post-surgery healing
  • Hormone changes

Certain lifestyle factors can add to fatigue. For example:

  • A poor diet
  • Not enough sleep or poor-quality sleep
  • Too much rest or inactivity

Fatigue may also stem from the emotions we’re dealing with, like stress, anxiety and depression. It’s normal to have a wide range of emotions surrounding diagnosis and treatment. When we’re already tired from what cancer is doing to our body, it’s an even bigger drain on our energy.

Why it’s important to treat fatigue

Cancer fatigue can be extremely debilitating and affect so many areas of our lives. It may:

  • Lower our quality of everyday life
  • Interfere with relationships with friends and loved ones
  • Make going to work or caring for children much more difficult
  • Make it more challenging to follow the advice of our healthcare team
  • Slow down or interfere with recovery
  • Put us at risk for suicide

Fatigue is treatable, but many of us don’t report these symptoms to our healthcare team. Maybe we think it’s just a natural or non-negotiable part of having cancer. But it’s not. There are many things that we can do to help manage fatigue.

Practical steps you can take right now

First, talk to your medical team so they can test and treat possible physical causes like low red blood cell counts (anemia). Next, try these lifestyle tips.

Food is Mood

A poor diet lowers our physical and emotional energy and leaves our body without the fuel it needs to heal. Try these tips to boost your nutrition:

  1. Stay hydrated. Fatigue is a common symptom of dehydration.
  2. Cut down alcohol intake by ½ or eliminate it entirely. Alcohol is a depressant and can make fatigue worse. Plus, it makes it harder to get a restful night’s sleep.
  3. Try high-quality supplements. The right supplements can provide essential micro-nutritional support to convert food into energy. Here’s one we like that helps.
  4. Start your day with a nutrient-dense plant-forward breakfast. Our medical advisors recommend a high-quality protein shake, green juice with turmeric and ginger, and steel-cut oatmeal to give a surge of morning energy.
  5. Eat more at breakfast and lunch to deliver more energy throughout the day. Even though many of us make dinner the biggest meal, we need calories during the day to combat fatigue. If you don’t have an appetite, try eating smaller, more frequent meals.
  6. Bump up your intake of fiber through vegetables, fruits, whole grains and beans. Even though it may feel hard right now, eating more of these foods provide nutrients that boost our energy levels. Now might be a good time to try out a new recipe. Here are some cookbooks we love that have unexpected options.
  • Right now, focus on adding in healthy (like fruits) versus cutting out unhealthy (like sweets).
  • Add duos or trios of veggies to each meal. Instead of a side of green beans, mix it up with a trio of green beans, tomatoes and edamame or a combination of other veggies you like.
  • Remember this: The darker the vegetable, the more nutrients it has. Prioritize purple, dark green and red vegetables over light green and yellow veggies. But all choices are good choices! Any vegetable is better than no vegetable.
  • Ethnic cuisines, like Mediterranean and Asian, offer flavorful and healthful dishes.
  1. Simplify food prep. It’s overwhelming to prepare healthy food when we have low energy. When friends and family offer help, take it! Invite them over to cook or let them bring over a meal—and don’t forget to ask for a salad.
  2. Learn from a pro. A registered dietitian or nutritionist can help you learn more about foods that boost energy and reduce fatigue. Talk to someone on staff at your hospital or find an expert with experience in cancer recovery. What’s the difference between a nutritionist and a registered dietician? Both are trained in nutrition and diet, but a registered dietitian has advanced clinical training. We suggest working with a dietician.
  3. Connect with a Mend Recovery Coach. Our coaches have specialized training and can create a plan to incorporate more healthy foods into our everyday diet.

Rest vs. Activity

When we’re tired, it may seem best to rest as much as possible. But a lack of activity can actually make fatigue worse. The trick is to establish the right pattern.

If we have anxious, sleepless nights and lethargic days (also known as “excessive rest syndrome”), the goal is to break the cycle and replace it with healthful activity during the day and restful sleep at night. Here’s how:

  1. Sleep well (at night). If you have trouble falling asleep, staying asleep or waking up too early try some of these products.
  2. Limit naps. At the start of recovery, we might need to take a nap during the day. Try to limit it to less than an hour or you may have trouble falling asleep at night and returning to normal routine.
  3. Prioritize. Don’t deplete energy with things that don’t really matter. Use your energy to take care of the most important things in life first.
  4. Get help. Accept help from friends or loved ones with day-to-day tasks like cleaning, shopping or watching children. Use the extra time to go for a walk or try that yoga class. Remember, people like to help and it’s a gift to let them play a role in our recovery.
  5. Get moving. “A sedentary lifestyle is a bad idea no matter what, but it is a really bad idea for cancer patients,” advises Dr. Keith Block, medical director of the Block Center for Integrative Cancer Treatment. While we may think cancer earns us a break from physical activity, it can actually get in the way of recovery. Inactivity leads to muscle loss and may compromise our immune system. Bed rest doesn’t save our energy, it depletes it. For every hour you’re awake, try to move for at least five minutes, even if you’re very sick.
  6. Try yoga. It gives us double bang for our buck. We get the benefits of being active while also reducing stress, both of which help manage fatigue. One of our favorite types of yoga is Bikram (or hot) yoga. For those of us who enjoy warmer temperatures, it’s particularly healing (and addictive). Find a place to practice by searching for a Bikram or Original Hot Yoga studio.

Even tiny improvements in our habits can make a difference. Walking as little as 10 minutes at a time or lifting very light weights can develop more resistance to fatigue.

Emotions

  1. Seek Counseling. Fatigue is a common symptom of depression. Many of us benefit from talk therapy with a licensed certified social worker (LCSW), psychologist or psychiatrist.
  2. Be open to an anti-depressant. Your mental health counselor may suggest an antidepressant. Antidepressants can help turn chronic sad days into sunny ones. Ignore any social stigma you may feel about anti-depressants—they can be life-changing if you are clinically depressed. There are also natural supplements that can help regulate mood.
  3. Experiment as needed. It often takes some trial and error to find the right antidepressant for you. There are many formulations with different strengths and side effects. If you start this process, muscle through it with your practitioner until you find a solution that works for you.

Many people find a combination of therapy and medication to be most effective.

How can friends, family and colleagues help?

If our friend or loved one is suffering from fatigue, here’s how we can help.

  1. Provide support. Listening and validating our friend can mean a lot to him or her. Also, symptoms of fatigue are not always predictable, and some days are worse days than others. Asking “How are your spirits?” is a great way to check in.
  2. Offer specific, not general, help. If our friend or colleague has young children or a critter, offer to help for an hour or two. Maybe we can organize a group to provide some meals or pay for a house cleaner. Know that it’s often hard for patients to ask for help, so don’t wait for a request. Reach out with specific chores we’re willing to do and let him or her choose.
  3. Attend a class together: We know being more active can help with feelings of fatigue, but sometimes it’s hard to find motivation. Suggest going for a regular weekly walk or offer to join her or him at an exercise class or yoga session. This sort of support can be critical and is even better if you make it a regular part of both your routines.

A little goes a long way

Cancer fatigue can feel debilitating, but small, inspired steps can raise energy levels. Watch the difference it makes.

 

Errol J. Phillip has a PhD in Clinical Psychology from Notre Dame and is a former Clinical Research Psycho-Oncology Fellow at Memorial Sloan Kettering Cancer Center.
Lisa Lefebvre is the Founder of Mend After Cancer. She has experience recovering from 8 cancer-related surgeries, chemotherapy treatments, radiation protocols and hormone suppression therapy.

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