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Fatigue Associated with Medical Therapy: Causes and Solutions
Ernest H Rosenbaum, MD; Barbara F. Piper, RN, OCN, DNSc.; Marilyn Dodd RN, PhD; Kathleen Dzubur, MS; Michael Glover, Pat Kramer, RN, MSN, AOCN; RoseAnn Kurshner, RN, BSN, MEd; Francine Manuel, RPT

Fatigue: What a Patient Needs to Know
Facts on Fatigue
Problems of Fatigue

What Causes Fatigue
What Physicians Need to Know
Tips For Reducing Fatigue

Fatigue Reduction Program for Improved Quality of Life
Fatigue Diagram

The best way to combat fatigue is to treat the underlying cause. Unfortunately, it is not always easy to know what the exact cause is. Many factors may be involved and require treatment, particularly if the fatigue has become chronic. All possible causes must be thoroughly assessed. If fatigue is related to anemia or hypoxia (low blood oxygen), for example, blood transfusions, supplemental oxygen, and medications - epoetin alfa, designed to increase red blood cell production, may be prescribed. Other causes can be managed on an individual basis. This management may include physical therapy and strength training, changes in nutrition, and emotional support and psychological counseling.

The Causes and Solutions of Fatigue

1. Fatigue Post Therapy: as a result of therapy or surgery, fatigue may persist for a prolonged period of time even after the cancer therapy is completed
Surgery and anesthesia can lead to post-operative fatigue.

Fatigue is more related to treatment than to the cancer - and it may persist after therapy.

There can be a hyper-metabolic state from tumor growth (tumors may draw nutrients from the body).

Cellular disintegration from therapy (release of cytokines-interferons, tumor necrosis factor) may cause fatigue.

Other factors include electrolyte imbalance such as potassium, sodium and magnesium deficiency.

2. Stress
The initial support a person receives following a cancer diagnosis often dissipates with time as each support person returns to their own way of life and problems. It is often difficult to function post therapy when there is less support. People assume and treat you like life is normal, but anxiety about your health and your future may still persist.

Unfortunately, with increased needs, patients often lack the continued needed support from family and friends and must therefore rely on themself for strength and stability. Continued mental support with meditation, relaxing exerted self-hypnoses, bio-feedback helps to decrease stress and improve coping skills.

Anxiety also can contribute to sleeplessness, increased energy demands, and fatigue.

Use antidepressant drugs for symptoms of depression.

Women who become menopausal secondary to therapy may have additional stress because of hot flashes, sleeplessness, impact on sexuality, and self-image.

3. Nutrition
Nutritional dysfunction may be related to fatigue. If possible, have a registered dietitian (RD) do a nutritional analysis. A nutritionist (RD) can help plan meals and give guidance about proper nutrition. Because efforts to improve appetite, reduce weight loss, and control symptoms and side effects of nausea, vomiting and diarrhea may help reduce fatigue, a healthy diet can yield more energy.

4. Lack of Exercise
Exercise can help maintain muscle strength and flexibility. On an emotional level, it helps to reduce depression by increasing endorphins.

Changes in the patterns of activity and rest can play a significant role in the prevention of fatigue. Unnecessary inactivity, prolonged bed rest, and immobility contribute to the loss of muscle strength and endurance. Muscle that is not exercised loses its ability to use oxygen, so more effort and more oxygen is required for the same amount of work when performed by conditioned muscles. This is one of the reasons that aerobic endurance exercise, such as walking three or four times a week for 20 to 30 minutes, is often prescribed for patients and family members. Stretching exercises are also helpful and can be done even when a person is not very mobile.

The exercise time daily can be accumulated time from various activities (gardening, chores etc) to equal 20-30 total minutes per day.

5. Reduced Activities of Daily Living
Attention to self-care and daily living skills, such as brushing your teeth, shaving, combing your hair, getting dressed, etc., serves three purposes: it increases your ability to perform these activities, provides overall muscle toning and increases your range of motion.

Performing as many self-care tasks as possible will also help you develop independence and self-esteem. Feeling dependent on others can be defeating, and a certain satisfaction can be gained from setting objectives in life and accomplishing them. Recovering from an illness or injury is certainly one of these accomplishments.

Consider the degree of physical effort required for self-care tasks in terms of graduated levels based on how much mobility and energy each activity requires. Feeding yourself requires the least amount of effort. When you are stronger, you will be able to graduate to the activities of hygiene and grooming; still later, you'll be able to bathe and dress yourself. Your overall goal is to return to your former activities as fully as possible. Keep a Self-Care Progress Chart or make a list of all the activities you perform daily in caring for yourself, and then add each new accomplishment to the list along with the date on which you achieve it.

Many assistive devices or gadgets are available to help you retrain yourself, making certain tasks easier to accomplish. You must conserve energy, using it appropriately to achieve both short-term and long-term goals. In addition, you should consider safety in the home. When you are tired and weak, it is all too easy to have an accident that could slow your recovery or even reverse your physical status dramatically.

6. Pain Problems
Fatigue is often related to pain and is worse when there is inadequate pain control. The drugs used for pain control may have sedative proliferative effects and contribute to fatigue.

Depression has multiple causes and plays a major role in fatigue. Use of antidepressant drugs can be of help as well as psychological counseling. Support groups can be extremely helpful.

8. Sleep Problems
Lack of restful or adequate sleep at night can cause increased fatigue and napping during the day. (Sleep disturbances such as insomnia, multiple awakenings and early waking are common symptoms of depression.) It is important to correlate sleep patterns with eating habits, pain control and depression with fatigue.

9. Anemia
Anemia can occur as a result of the cancer or the cancer treatment. When there is a decrease in the number of circulating red blood cells, the oxygen carrying capacity of the blood is diminished. Patients feel tired due to the inadequate supply of oxygen to muscles and other organs. When patients received treatment to correct anemia, they reported significant improvements in energy, activity and quality of life. Treatment for anemia may include red blood cell (RBC) transfusions and/or the use of epoetin alfa, erythropoetin (EPO) injections to stimulate blood production.

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