Leukaemia, myeloma, lymphoma, myeloproliferative neoplasms and myelodysplastic syndromes are some blood cancers that have cancer related fatigue symptoms.
Fatigue or extreme weakness is common in patients suffering from cancer. Cancer related fatigue (CRF) causes persistent and excessive exhaustion that can interfere with a patient’s daily activities. Fatigue can often be difficult to assess, as there are no objective ways to measure it.
It is usually described as a feeling of overwhelming exhaustion that does not reduce even after rest or sleep. Some people describe it as muscle weakness and difficulty in concentrating..
CRF usually begins before the diagnosis of cancer and can worsen during the course of therapy. It may persist for a few months to several years, even after the treatment has ended.
Regular exercise, adequate nutrition, stress management, psychological support, and healthy lifestyle changes may boost energy levels and improve the patient’s ability to cope with CRF. Untreated CRF, on the other hand, may affect a person’s physical and emotional health negatively.
Fortunately, the awareness regarding CRF is growing, and research studies are uncovering treatments to reduce it.
CRF may occur due to several factors, such as:
When cancer patients start receiving treatment, most of them are already tired due to medical tests and surgery, as well as the emotional stress of dealing with the cancer diagnosis. Once the treatment begins, fatigue may become worse and lower a patient’s energy level further.
CRF may be caused by other factors such as:
Anaemia or a low red blood cell count may occur in blood cancers as the cancer cells accumulate in the bone marrow. These cells start interfering with the production of normal red cells that carry oxygen to all the tissues resulting in fatigue.
Anaemia may also be worsened or caused by cancer therapies. Most cancer treatments kill cancer cells. However, they can also destroy the normal blood-forming cells in your bone marrow, thus reducing the ability of the bone marrow to form new red cells.
Abnormal activation of the immune cells may worsen cancer related fatigue. Natural chemicals such as “cytokines” typically released by white cells in response to infections cause inflammation in the body. Cancer and cancer treatments can disrupt cytokine levels and worsen inflammation in the tissues, thus causing fatigue..
A high level of cytokines may also disrupt the secretion of serotonin, a hormone that affects a person’s sense of well-being and regulates moods and sleep. Very high or low production of serotonin might also contribute to CRF.
The effect of cancer and cancer treatments on the hypothalamus, pituitary gland, and adrenal gland can result in the release of a stress hormone, cortisol. Cortisol can influence the regulation of cardiovascular functions, blood pressure, immune functions and carbohydrate metabolism.
Cancer and cancer treatments, especially those using corticosteroids, might reduce cortisol levels released in the body and thus, cause fatigue.
Cancer and cancer treatments may disrupt the circadian rhythm and hence affects the sleep-wake cycles.
Cancer treatments may destroy healthy cells. The body needs to use extra energy to make more cells in order to heal tissues damaged during treatment. This extra energy consumption can contribute to feeling fatigued. Additionally, cancer treatments may cause a build-up of toxins in the body which will also make the patient feel more tired.
Several factors may predispose a person to develop CRF. Some of them include:
Patients with CRF usually feel physically and mentally drained..
The common signs of fatigue include:
Cancer related fatigue may also be reflected in the patient’s cognition, moods, and changes in social interactions in various ways, including:
CRF is often caused by more than one factor. Therefore, the physical or psychological symptoms must be treated by one or a combination of the following treatments at the same time.
Treating anaemia helps to reduce weakness in patients with CRF. The treatment for anaemia may include:
Exercises that increase blood circulation may reduce inflammation in healthy tissues and prevent fatigue. Patients who exercise can derive benefits such as:
Exercises, which have a mind-body component, including yoga, qigong, and tai chi, may be more effective for reducing fatigue. These exercises include physical elements such as stretching, movements, controlled breathing, and balancing as well as spiritual practices and stress management techniques such as meditation. This may help to improve the patient’s overall sense of well-being. Other physical activities such as walking, yoga, riding a stationary bicycle, water exercises, swimming, and strength training may also alleviate CRF and increase energy levels.
Patients diagnosed with moderate to severe depression may benefit from specialised therapies, including medications and counselling. Stress management training and support groups may help patients deal with CRF associated with depression, thus improving the quality of life.
Psychosocial interventions that relieve stress and improve psychosocial support such as counselling, coping strategies, and stress management may also help to reduce fatigue and raise energy levels.
Cognitive-behavioural strategies, including progressive muscle relaxation and relaxation breathing, can also relieve cancer related fatigue and it may also be useful for improving sleep behaviours and preventing sleep disturbances.
It is common for cancer patients to develop loss of appetite, diarrhoea, nausea, and vomiting due to cancer or cancer treatments. They can seek the advice of a dietitian to ensure that they are getting adequate calories, nutrients, and fluids needed for supporting the body’s functions and staying as active as possible.
Avoid measuring yourself by your pre-diagnosis energy levels and set realistic goals. Accept that you may not be able to carry out all the activities that you want every single day. You can decide which tasks are more critical to complete and focus on accomplishing them daily. Also, when feeling too tired, allow others to help you.
Shift your focus from CRF by listening to music, looking at beautiful pictures, reading a book, meeting friends, going for a walk, watching a movie, and enjoying time in nature.
Staying physically active often helps patients to avoid fatigue. You can exercise at least 3 to 5 times a week to prevent severe fatigue. You can adjust your exercise program if you feel too tired. Light exercises, such as walking, may help you to feel relaxed and allow you to sleep better. Focus on physical activities that help to build strength gradually but do not deplete your energy levels.
Patients with cancer have a higher risk of malnutrition due to nausea, vomiting, loss of appetite, and the reduced ability of the intestine to absorb nutrients due to cancer itself or cancer treatments. This can be avoided by eating a balanced diet that provides sufficient proteins, fluids, calories, vitamins, and minerals to the body..
Here are some dietary interventions that will help you avoid CRF:
Mental stress can be offset, to some extent, through exercises, mindfulness meditation, relaxation techniques, religious and spiritual practices, counselling, and socialising.
Practise relaxing activities such as meditation, taking a warm shower or bath, writing in a journal, reading a book, yoga, and listening to soothing music before bedtime..
Here are some simple tips to improve sleep and reduce Cancer Related Fatigue:
Don’t hesitate to ask for help with your routine tasks such as cooking, shopping, housekeeping, driving, and laundry. Take rest whenever you feel tired.
Try to schedule your cancer treatments when it will have the least effect on your routine activities, including your job.
Keep a journal to track your symptoms of fatigue. Make notes related to the symptoms such as:
Make a note of daily activities, treatments, medications, sleeping and eating habits, emotional stressors, and weight changes in the journal. Write down the strategies that worked to reduce fatigue.
A detailed journal of your symptoms will help you when you discuss the possible causes, coping strategies, and treatments with our doctors and nurses
Leukaemia, myeloma, lymphoma, myeloproliferative neoplasms and myelodysplastic syndromes are some blood cancers that have cancer related fatigue symptoms.
Changing your diet to incorporate foods rich in iron and vitamins can treat anaemia, which is a cause of fatigue. Exercising also helps increase blood circulation to improve energy levels and strength.
Leukaemia patients may sleep a lot more or sometimes, too little. They may also experience a lack of motivation, difficulty concentrating, and mood swings. Fatigue can also affect moods and increase anger and irritability or anxious feelings.
Patients diagnosed with Lymphoma often describe fatigue related to the condition as feeling weak, listless, and drained. Some may even feel too tired to eat or visit the bathroom. If you are suffering from lymphoma fatigue, speak to your medical care team at CFCH as to how you can better manage these symptoms.
Low levels of haemoglobin in MPN patients usually causes fatigue symptoms such as dizziness, difficulty concentrating, headaches and general weakness.
MDS patients that suffer from impaired function of the blood may experience fatigue symptoms like persistent weakness, tiredness and unusual paleness of the skin from low red blood cell count.
The information on the Centre For Clinical Haematology website is intended for educational use. It should not be considered or used as a substitute for medical advice, diagnosis or treatment from a qualified health professional.
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