Psychostimulant drugs
Treatment for anemia
Exercise
Cognitive Behavior Therapy
Activity and rest
Patient education

Most of the treatments for fatigue in cancer patients are for treating symptoms and providing emotional support because the causes of fatigue that are specifically related to cancer have not been determined. Some of these symptom-related treatments may include adjusting the dosages of pain medications, administering red blood cell transfusions or blood cell growth factors, diet supplementation with iron and vitamins, and antidepressants or psychostimulants.

Although fatigue is one of the most common symptoms in cancer, few medications are effective in treating it. A healthcare provider may prescribe medication in low doses that may help patients who are depressed, unresponsive, tired, distracted, or weak. These drugs (psychostimulants) can give a sense of well-being, decrease fatigue, and increase appetite. They are also helpful in reversing the sedating effects of morphine, and they work quickly. However, these drugs can also cause sleeplessness, euphoria, and mood changes. High doses and long-term use may cause loss of appetite, nightmares, sleeplessness, euphoria, paranoid behavior, and possible heart problems.

Treatment for fatigue that is related to anemia may include red blood cell transfusions. Transfusions are an effective treatment for anemia; however possible side effects include infection, immediate transfusion reaction, graft-versus-host disease, and changes in immunity.

Treatment for anemia-related fatigue in patients undergoing chemotherapy may also include drugs, such as epoetin alfa, that cause the bone marrow to make more red blood cells. This type of drug may shorten survival time or may cause some tumors to grow faster. Patients should discuss the risks and benefits of these drugs with their doctors.

Exercise (including light- to moderate-intensity walking programs) helps many people with cancer. People with cancer who exercise may have more physical energy, improved appetite, improved ability to function, improved quality of life, improved outlook, improved sense of well-being, enhanced sense of commitment, and improved ability to meet the challenges of cancer and cancer treatment. Findings from a study of breast cancer survivors suggest that patients may be able to lessen fatigue and pain and function better in daily activities if they take part in moderate to vigorous recreational sports after cancer treatment.

Exercise may also help patients with advanced cancer, even those in hospice care. More benefit may result when family members are involved with the patient in the physical therapy program.

Cognitive behavior therapy (CBT) is a method used by therapists to treat a variety of psychological disorders, including post-cancer treatment fatigue that has no physical cause. CBT aims to change a patient's awareness (the cognitive) in order to change the way he acts (the behavior). CBT sessions may be helpful in decreasing a patient's fatigue following cancer treatment by focusing on factors such as:

• Stress from coping with the experience of having cancer.
• Fear that the cancer may come back.
• Abnormal attitudes about fatigue.
• Irregular sleep or activity patterns.
• Lack of social support.

Any changes in daily routine require the body to use more energy. People with cancer should set priorities and keep a reasonable schedule. Health professionals can help patients by providing information about support services to help with daily activities and responsibilities. An activity and rest program can be developed with a health care professional to make the most of a patient's energy. Practicing sleep habits such as not lying down at times other than for sleep, taking short naps no longer than one hour, and limiting distracting noise (tv, radio) during sleep may improve sleep and allow more activity during the day.

Treating chronic fatigue in patients with cancer means accepting the condition and learning how to cope with it. People with cancer may find that fatigue becomes a chronic disability. Although fatigue is frequently an expected, temporary side effect of treatment, other factors may cause it to continue.

Since fatigue is the most common symptom in people receiving outpatient chemotherapy, patients should learn ways to manage the fatigue. Patients should be taught the following:

• The difference between fatigue and depression



• Possible medical causes of fatigue (not enough fluids, electrolyte imbalance, breathing problems, anemia)



• To observe their rest and activity patterns during the day and over time



• To engage in attention-restoring activities (walking, gardening, bird-watching)



• To recognize fatigue that is a side effect of certain therapies



• To participate in exercise programs that are realistic



• To identify activities which cause fatigue and develop ways to avoid or modify those activities



• To identify environmental or activity changes that may help decrease fatigue



• The importance of eating enough food and drinking enough fluids



• Physical therapy may help with nerve or muscle weakness



• Respiratory therapy may help with breathing problems



• To schedule important daily activities during times of less fatigue, and cancel unimportant activities that cause stress



• To avoid or change a situation that causes stress



• To observe whether treatments being used to help fatigue are working

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