Cancer Fatigue Was More Than Being Tired

Have you said "I'm tired" and felt that the word was far too small? You are describing something the National Cancer Institute treats as a medical condition in its own right. Cancer fatigue is a condition caused by cancer or cancer treatment. In it, you feel exhausted or extremely tired.

One line separates it from ordinary tiredness. Cancer fatigue is not completely relieved by sleep or rest. It may happen after no activity, or only minimal activity. Everyday tiredness has a cause you can point to and a fix you can take. This does not.

It is also very common. More than 80% of people receiving chemotherapy or radiation therapy experience fatigue. That makes it one of the most common side effects of cancer treatment.

NCI describes cancer fatigue as a cluster of specific experiences rather than one sensation:

• Having no energy; feeling extremely tired, drained, or lethargic
• Having difficulty moving; feeling heavy or slow
• Having difficulty thinking, remembering, or paying attention
• Having a sense of physical, emotional, and/or mental exhaustion
• Not feeling rested, even after sleeping

Trouble thinking sits on that list alongside the physical symptoms. Has your concentration slipped along with your energy? That is part of the same picture.

The cancer itself can be part of it. Cancer cells use up nutrients your body needs for energy. The body releases cytokines, substances that fight infection. At high levels these cause fatigue. Cachexia, a loss of muscle and weight, may develop. Blood cancers can impair the production of red blood cells. That reduces the oxygen carried to your tissues. Hormone-sensitive cancers such as breast and prostate cancer can disrupt hormone levels. Gastrointestinal cancers affect how the body processes nutrients.

Treatment adds its own causes. Surgery causes fatigue while you heal. Chemotherapy destroys healthy cells along with cancer cells. How radiation therapy causes fatigue is still not completely understood. Hormone therapy, immunotherapy, and targeted therapy can all cause fatigue, with different timing.

Then the side effects stack on top:

• anemia
• appetite loss
• diarrhea and dehydration
• hot flashes that interrupt sleep
• infection
• pain and pain medicines
• sleep problems
• nausea and vomiting

Emotions count too. A major illness such as cancer can leave you anxious, worried, or fearful. High levels of distress can lead to physical problems of their own, such as fatigue, insomnia, and appetite loss.

Fatigue can begin before, during, or after cancer treatment. It can be an early symptom of the cancer itself. Or it can grow out of the stress of being diagnosed.

The pattern often tracks the treatment. After radiation therapy begins, fatigue usually increases until midway through the course. Then it stays about the same until treatment ends. Chemotherapy is less uniform. Some people feel the most tired after each chemotherapy treatment. Others have worse fatigue halfway through their course of treatment.

Fatigue does not show up on a scan. So your team assesses it by asking. Expect a series of standard questions about how tired you feel and how it is affecting your daily life. They repeat the questions over time, so the pattern becomes visible.

Your team may also give you a chart, log, or fatigue diary. You record your energy level and fatigue each day. That converts a vague complaint into something specific enough to act on.

You may have a physical exam and blood tests as well. Those look for causes that can be treated on their own, such as anemia or infection.

Anemia is a condition in which the number of red blood cells is below normal. Red blood cells carry oxygen through your body. So anemia can leave you very tired, short of breath, and lightheaded. Other signs include feeling dizzy or faint, headaches, a fast heartbeat, and pale skin. You will have blood tests to check for anemia. Tell your doctor if you are extremely tired or have other signs of anemia.

Tell your health care team if you feel very weak and tired. Tell them especially if you are not able to do your normal activities, or if you are still very tired even after resting or sleeping.

It is also reasonable to ask your doctor directly: what problems should I call you about?

• How would you expect fatigue to behave with the specific treatment I am on?
• Could anemia, infection, pain medicines, or sleep problems be adding to it?
• Would a daily fatigue log help you see what is happening?
• What level of tiredness should prompt me to call rather than wait?

• Call 911 or go to an emergency department if chest discomfort that lasts more than a few minutes settles in alongside the exhaustion, or you are suddenly struggling for breath while sitting still. Discomfort spreading to an arm, the jaw, the neck or the back counts too.
• Call your care team the same day if the tiredness arrives with breathlessness on small efforts, dizziness or feeling faint, a fast heartbeat, headaches, or skin that has turned pale. That is the anemia picture described above, and it is checked with a blood test.
• Call your care team within a day or two if you can no longer get through your normal activities, or a full night of sleep leaves you no better than before.

• National Cancer Institute: Fatigue and Cancer Treatment. https://www.cancer.gov/about-cancer/treatment/side-effects/fatigue
• National Cancer Institute: Fatigue (PDQ) — Patient Version. https://www.cancer.gov/about-cancer/treatment/side-effects/fatigue/fatigue-pdq
• National Cancer Institute: Anemia and Cancer Treatment. https://www.cancer.gov/about-cancer/treatment/side-effects/anemia
• MedlinePlus, U.S. National Library of Medicine — Heart Attack: https://medlineplus.gov/heartattack.html