Fatigue

Louisiana’s Young Breast Cancer Survivor Network

Fatigue

The Most Common Side Affect

Fatigue, the feeling of extreme tiredness, is the most common side effect of cancer treatment. Symptoms include not being able to focus, forgetfulness, mood changes and an overall feeling of being tired. Cancer-related fatigue has many causes, including the cancer itself, medicines, anemia, sleeplessness, poor nutrition or lack of exercise.

Medicines

It’s probably no surprise to you that medicines can contribute to your feelings of fatigue and tiredness. Here are a few things you should know about them.

Medicines That Can Make You Feel Tired:

Medicines for pain
Medicines for depression or anxiety
Medicines for allergies
Medicines for blood pressure
Tamoxifen or Aromatase Inhibitors (Aromasin, Femara, Arimidex)

Tips To Eliminate Medicinal Fatigue:

If possible, take these medicines at night before bed. Doing so may help reduce daytime fatigue. Try to find the best time during the day to take medicines that will allow you to rest at night and not be as tired during the day.
Some medicines may keep you awake. For example, some women find they cannot sleep after taking their Tamoxifen, while others feel extremely tired. Another medication that can interfere with sleep is a water pill (diuretic). Since these medications make you have to go to the bathroom, it’s important to not take these at bedtime.
Pain medicine may cause drowsiness. Drowsiness should go away after about three days when your body gets used to the medicine, however, it may not. It’s important to judge how you react to these medications.
Some people find that drinks with caffeine such as coffee, tea, or sodas help them feel less drowsy, but be careful to keep caffeine intake at nighttime to a minimum.
Review both prescribed and over-the-counter pain medicines with your doctor to see if any changes can be made to decrease fatigue.

Anemia and Fatigue

Anemia occurs when the body does not have enough red blood cells (RBCs). The RBCs have a protein called hemoglobin, which carries oxygen from the lungs to the tissues in your body. When red blood cells are destroyed, your body may make fewer red blood cells and hemoglobin levels may fall, resulting in anemia. Anemia, in turn, can cause extreme tiredness or fatigue affecting your quality of life.

Fast heart rate
Light-headedness
Shortness of breath
Headaches
Dizziness
Faintness
Sensitivity to cold
Paler than normal
Lack of skin tone
Inability to do things you are used to doing do such as work, spend time with other people or have fun
Lack of iron

Simple Ways to Increase Iron in Your Diet. Know that iron from animal products is easy for the body to absorb. Iron from vegetables, fruits, grains and vitamins are harder for the body to absorb. Eat lean meat, fish or poultry with beans or dark leafy greens at a meal to help absorb the iron from vegetables up to three times more than alone. Foods rich in vitamin C also increase iron absorption.

Liver
Lean red meat (beef)
Poultry, dark meat
Tuna fish
Salmon
Lamb
Pork
Shellfish
Cereals with added iron
Dried beans
Whole grains, such as wheat, millet, oats and brown rice
Eggs (egg yolks are good)
Dried fruits (prunes, raisins, and apricots)
Dark leafy green vegetables
Legumes: lima beans, soybeans, dried beans and peas, kidney beans
Seeds such as almonds and Brazil nuts
Vegetables: broccoli, spinach, kale, collards, asparagus, dandelion greens

Sleep Problems (Insomnia)

Tips To Deal with Sleeplessness

Go to bed and wake up about the same time every day.Maintaining a regular schedule sets your body’s internal clock so it will be ready for sleep when you are, and you will feel more rested when you are awake. This can be difficult to do when you’re working and/or have kids, but sticking to a routine is helpful for everyone. If you nap, try to do it around the same time every day, but don’t do so in the late afternoon or early evening as too much sleep during the day can throw off your bedtime schedule.
Make your bedroom as pleasant, comfortable, dark and quiet as you can. Try using dark shades over the windows, using a fan to keep your room cool, and cutting off the television and other electronics off at least 30 minutes before you plan to sleep. This will help your mind to slow down and begin to go into a restful state. Use a white noise machine and/or an eye mask too. Use your bed only for sleep and sex to help make sure your bed is associated with sleep. Sometimes after treatment for breast cancer, women find it more comfortable to sleep while holding a pillow against their chest while lying on their side or propping up the arm on the affected side while lying on your back. These techniques can reduce pulling on the breast and increased swelling associated with lymphedema.
Exercise can help you boost energy and sleep better. Do it regularly. The morning or afternoon is best since exercise can cause a temporary rise in endorphins, which can keep you awake. However, even people who exercise at night can sleep better. Taking a brief walk when the sun is coming up or going down can help your body create its own sleep schedule by influencing melatonin (your body’s own sleep hormone) production.
Avoid drinking liquids right before bed, so that you don’t have to wake up to use the restroom.
Avoid caffeine, nicotine and alcohol in the late afternoon and early evening. Caffeine and nicotine can delay sleep and alcohol may interrupt your sleep later in the night.
Try relaxation techniques before going to bed, or just after lying down. Some people do breathing exercises, take a warm bath, listen to guided meditation recordings (you can find these on YouTube), and some people count backwards from 300 by threes. These can distract the mind, and help lull you into sleep. Reading can help you feel sleepy as well. Avoid exciting or stressful mental and physical activities close to bedtime. Think about pleasant experiences and repeat it to yourself over and over. Think positive thoughts following each letter of the alphabet, e.g. A is for Amazing, B is for Beautiful … through Z.
Therapeutic massage can help you sleep better, and has the added benefit of making you feel nice and relaxed as well.
Make sure you’re getting enough calcium and magnesium. These two minerals really help the body to relax. Talk to your doctor about adding a supplement if you feel you may need more. If you notice that your heart pounds at night when you lay down, these might help.
If you’re still awake 30 minutes after going to sleep, get up and sit in a chair in a dark room. Some people also find it helpful to read something until they feel sleepy again (but be sure to read something boring, and not something too exciting). Staying in bed and becoming frustrated can lead to you associating your bed with stress and anxiety, and make matters worse.
Take prescription pain medications as directed. Pain keeps you awake and fatigue worsens pain. You must break the cycle by taking your medicine before the pain gets too bad.
Don’t take over-the-counter medications, including natural herbs and remedies for sleep without talking to your doctor.
Cognitive Behavioral Therapy (CBT) has been shown to help. Ask your doctor if you need a referral for a practitioner.
Keep a sleep/wake journal if you have tried the above interventions without success. This may help identify things that are keeping you awake.

Lack of Energy

Here are tips on how you can conserve your energy:

Make an activities list every day, but only include the items that must be done that day. Keep a second list of things you’d like to do if you have the extra energy. Save your energy for the activities that mean the most to you. Schedule activities around high-energy times and days.
Check your goals. Being careful and realistic in what you choose to do will reduce both physical and mental fatigue.
Plan your day so that you have time to rest in between activities.
Learn to pace yourself. You can do more by spreading out what you need to do over the entire day. Take breaks between activities.
Change the way a tiring task is done in order to use less energy. For example, do your ironing sitting down.
Pass on hard, high-energy tasks to willing family or friends. Do not force yourself to do more than you can manage.
Don’t be afraid to ask for help. Ask for help with tasks like housekeeping, laundry, shopping and carpooling kids.
Take a short nap when waiting your child during carpool line.
Keep an activities journal. Write down what you do during the day and note your energy and tiredness levels. After a few days, review your entries to see if there are any patterns. This can help you to change, schedule, or pace these activities throughout the day.
Work on the hardest errands during the time of the day you feel you have the most energy.
Restore your energy with activities that you enjoy and make you feel good, such as reading, watching a movie or spending time with your family. Pamper yourself too!
Take short naps or breaks rather than one, long rest period. Do not nap in the late afternoon or evening because it may get in the way of your nighttime sleep. Try to keep naps less than 30 minutes.
Reduce stress with relaxation, deep breathing, hypnosis, guided imagery, or distraction to restore energy.
Try easier or shorter kinds of activities you enjoy.
Listen to your body and rest when you need to.
Eat well, and drink plenty of fluids. See “Nutrition to Fight Fatigue” on this site.
Exercise. Take short walks or do light exercises such as stretching if possible. Stay as active as you can. Many people find that light exercise, such as walking can actually decrease their fatigue.
Enjoy what you are able to do even small things like taking a walk or a shower without help.
Talk to your family about your fatigue. If your family does not understand your fatigue it can lead to communication problems, resentment, and feelings of guilt.

Fatigue In The Workplace

There are a number of ways to deal with fatigue in the workplace, as well as resources to deal with workplace issues.

Work with your boss to set sensible goals for yourself and what you can manage now. Tell your boss about how tired you feel. Be sure he/she knows that you are doing all that you can so that you will have more energy. Also make sure he/she knows that you would like to remain a useful worker.
Ask for a change in your current job duties. Things that your boss can do to help include:
- Change your hours. It may be that you can go to and from work at less busy times (outside the rush hour), or perform some of your duties from home.
- Ask others to help with some of your work.
- Find a close place to park.
- Take a short break every now and again to lie down and rest if needed.
- Work from home, if that is an option.
- Learn a new job skill that might be less stressful on your body and mind.
- Plan your workload to use your high energy times wisely.
- Try to set up your work area so that you are close to the things that you use a lot.
Talk openly with your boss and fellow workers about feeling tired because of cancer or treatment. This may help them to better understand about your change in energy level or work schedule. The more they know, the better they can support you.
Do not feel embarrassed about asking others for help. Keeping others in the loop about how you feel and what help you need prevents confusion, mistrust and anxiety.
Eat well; drink fluids and exercise (take short walks) as you feel that you can. This will help you to keep energy through the workday. Keep snacks and water available at your work station. Take a multivitamin daily to help gain the nutrients you need.
Talk to your company’s human resources department to find out if your health plan provides referrals that can assist you in dealing with your fatigue. They might include a nutritionist, physical or occupational therapist, exercise physiologist, mental health or alternative health practitioner.
Get to know your own company’s rules about sick leave, disability, flexible work times, and options to retrain.
Know the provisions of the Americans with Disabilities Act and the Family Medical Leave Act so that you know your rights in the workplace.
If you are self-employed, it can be useful to talk to the Department of Social Security about benefits that you may be able to claim.
For More Information:
- Job Accommodation Network: 800-ADA-WORK (800-232-9675) (The Job Accommodation Network is a free service that helps employers makes special plans like flexible hours for workers who need them)
- The Cancer Resource Center: (415) 885-3693 (The Cancer Resource Center can give you more facts about your legal rights.)

Nutrition and Fatigue

A poor diet and or not eating enough calories aren’t the only reasons for fatigue or tiredness, but a good diet can improve your fatigue. Think of food as a needed part of your healing. Remember, you need to eat enough food so that your body can have the energy to heal itself.

The National Cancer Institute recommends eating the following types of foods:

A variety of foods every day.
Fruits and vegetables—raw or cooked. These give you vitamins, minerals and fiber.
Grains – whole grains such as cereal, bread, and pasta. These give you vitamins, minerals and fiber.
Low-fat dairy products—milk, cheese, yogurt, and ice cream. These supply protein, calcium, and several vitamins.
Lean meats - poultry, such as turkey or chicken or lean cuts of beef or pork. These supply protein.

Eating to Increase Your Energy

Start your day with a good breakfast. Try to include at least 1/3 of your protein requirements in this meal, such as eggs or lean meats. Unlike carbohydrates (toast, cereal), proteins provide you with long- lasting energy and will help you keep your energy throughout the day.
Increase protein food sources such as lean meat, fish and low-fat dairy products.
Eat plenty of iron-rich foods like lean red meats, poultry, dark green vegetables and dried fruits.
Eat several small meals rather than three large meals.
Exercise lightly prior to meals to improve your appetite. Some people find that a walk before meals is a good way to improve the appetite.
Drink plenty of liquids (8-10 glasses of fluid/day). Lack of fluids will increase your feelings of fatigue. But don’t drink with your meals—fluids can make you feel full faster. Instead drink most of your fluids between meals.
Eat when you are hungry. Try to take advantage of the times when your appetite is best.
Eat what you like, within reason. You can’t expect a diet of milkshakes alone to make you feel better. Try to keep a well-balanced diet, but pick the foods you like from each food group.
Avoid caffeine and white or refined sugars (cookies, cake or candy). While these products are alright in moderation (they may even give you a quick boost!), they tend to cause a rapid rise and fall in your blood sugar and will leave you more tired.
Limit foods high in fat, salt and sugar.
Limit alcohol intake, particularly close to bedtime. Alcohol can cause waking during the nighttime and not allow you to get the deep sleep that you need.
Limit foods that are smoked or pickled.
If you are losing weight, try a nutritional supplement such as Ensure between meals (not in place of them).
Try lower fat cooking methods, such as broiling, steaming and poaching.
Make mealtime an enjoyable activity. Share meals with family and friends. Put flowers on the table. Candles or soft music can make mealtime more pleasant.
Vary your diet/try new recipes. Some people find foods taste differently after cancer treatment— trying new foods or different seasonings may make foods tastier.
If you find you are not eating because you are too tired to prepare your meals:
- Consider pre-packaged/frozen meals at least once a week.
- Ask friends and family for help with meals.
- Prepare larger amounts when you do cook and freeze the extra food in single serving containers for easy reheating.
- Use paper plates and cups to cut down on cleanup.

Exercise To Fight Fatigue

After breast cancer treatment, many women have fatigue and are told to get more rest. But too much rest can result in more fatigue and exercise has been shown to improve fatigue, sleep and mood. So even if you’ve never exercised before, this may be a good time to start. Just be sure to talk with your health care team to find out if there are any safety measures you should take and remember the following!

Exercise within your own limits and set realistic goals.
Start with regular, light exercise such as walking. Begin with 5-10 minutes, once or twice every other day. Over time, increase how long you walk.
Try new kinds of exercises, then choose those that help to keep or increase your energy.
Do something that you like to do. Decide on something that you enjoy, that will work your heart, and make you stronger and more flexible. Walking can work your heart. Lifting weights will make you stronger. A stretching program will make you more flexible. No one says exercise has to be boring, so make it something you look forward to.
Keep a diary of your activity. Include how you felt during and after your exercise sessions as well as how your sleep was affected.
Drink plenty of liquids before, during and after exercise. Dehydration or thirst will increase feelings of fatigue.
On days you feel good, exercise a little longer; on days you feel tired, shorten your exercise schedule or select an easier activity, such as stretching or a gentle movement program.
Build up slowly, but be steady. Try to do a little something each day. If you feel very tired, take the day off. But if you just feel a little tired, go ahead and exercise.
Wear comfortable clothing, such as a loose-fitting cotton shirt and sweat pants, shorts, or a full skirt. Try to avoid tight outfits especially those with elastic in the sleeves.
Do not bounce or jerk your arms when doing any exercise. Your movements should be slow and smooth.
If exercise is not possible, try to plan some gentle activity in your daily schedule and slowly increase it at your own pace.
Include stretching and relaxation practices at the end of each exercise session.
Stop exercising if you have nausea, feel dizzy, have an irregular heartbeat, have pain or any shortness of breath during exercise.
Lie on your bed to stretch if you can’t get down on the floor. Choose a bed with a firm mattress.
Find an exercise partner who will help keep you motivated. Sometimes a spouse or partner is willing, or a friend with similar exercise goals can make it more fun. Playing with your kids can also be a fun way for the whole family to get moving together! Go to the park and walk, run, swing and explore.
Staying healthy means making exercise a part of your routine. Exercise should include both aerobic and strength training exercises, so change it up with different exercises for different days of the week, and create new routines every few months. Your health will thank you!

When Do You Need to Seek Help?

You should talk to your health care team for help in dealing with any of the above, including telling them about any and all medications you are taking and any recurring symptoms.

If you have anemia, a simple blood test called a complete blood count (CBC) can easily determine that. If you are continually feeling tired, keep a fatigue diary and show it to your health care team to help them determine a remedy.

If you are unable to eat for a day or more, lose more than five (5) pounds, experience pain while eating, vomit for more than 24 hours, are unable to urinate for 24 hours or if your urine is bad smelling, rare or very thick, contact your health care team immediately.

And always talk to your health care team before starting an exercise program. Ask if there are any measures you should take based on your health or treatment. Also let your doctor or nurse know if you feel nauseous or dizzy, have an irregular heartbeat, pain or any shortness of breath while exercising. If you keep an exercise diary, bring it with you when you consult with your health care team.