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Fall 1999 Volume 3, Issue 6:
By Kassy McGourty
What to do if you're tired of being tired
Between doctor visits, lab tests, treatments, and the time and mental energy you exert learning about your condition, you have good reason to be tired! But it’s important that you don’t confuse a normal amount of fatigue resulting from what you’re going through with a more serious fatigue that can be brought on by anemia associated with myeloma and its treatment.

Cancer fatigue is often described as a total lack of energy or debilitating exhaustion that can last days, weeks or months. It is the most common side effect of cancer and its treatment, affecting more than three-quarters of people undergoing therapy. Even though it is so prevalent, cancer fatigue is often still overlooked, under-recognized and undertreated.

Cause and Effect

As discussed in the last issue of Myeloma Today, the causes and effects of fatigue are complex, and there is no established method to assess it. Individuals with myeloma and other cancers may not report it and clinicians may be focused on other indicators.

However, one of the most common causes of cancer-related fatigue is anemia. Anemia is a condition in which decreased numbers of red blood cells prevent sufficient oxygen from reaching body tissues. Anemia is a common complication of cancer and treatments, such as chemotherapy and radiation therapy, which can interfere with the supply of red blood cells by inhibiting the production in the bone marrow. Anemia can also result from blood loss during surgery.

Two lab tests reflect the level of anemia. The first is “hematocrit” or “HCT”, which is the volume of red blood cells in the blood, usually expressed as a percentage of total blood. The second is “hemoglobin”, often abbreviated as “Hb”, which is the iron-containing protein present in red blood cells that transports oxygen and carbon dioxide to nourish a person’s body tissues.

The ranges of HCT and Hb vary, depending on your age and whether you’re a man or a woman. For example, the normal Hb count is between 14.0-18.0 for men, and 12.0-16.0 for women.

Recognize the Effects of Anemia

While the symptoms of cancer fatigue are often reported as feeling tired – weak, worn out, drained, "wiped out" – there are other important ones to identify as well, including shortness of breath after light activity, difficulty climbing stairs or walking short distances and difficulty performing ordinary tasks, such as cooking, cleaning, taking a shower or making the bed.

Cancer fatigue can also have mental and emotional effects: difficulty concentrating, trouble thinking clearly and making decisions. The condition may also underlie feelings of low self-esteem and frustration, often resulting in feelings of helplessness or despair. Changes in sleep, daily activity or eating patterns can cause fatigue, as can anxiety, depression or stress.

Furthermore, cancer-related fatigue may make it increasingly difficult for individuals to cope with cancer and can sometimes prevent them from reaping the full benefits of available treatments. Because the condition can significantly interfere with a person’s sense of well-being, it may limit the number of chemotherapy cycles that could be administered, which may hinder the effectiveness of treatment altogether.

There is Help

The good news is that the known causes of cancer-related fatigue can be treated and possibly relieved, at least to some degree. Proper nutrition, vitamin and mineral supplements, anti-depressant and anti-anxiety medications, lifestyle modifications and even psychological counseling can help to alleviate the problem.

To treat the anemia that contributes to fatigue, oncologists have traditionally relied on blood transfusions to raise red blood cell levels and help restore energy, if only temporarily. Although transfusions can bring quick but temporary results, many physicians try to avoid them because of potential risks, such as fever, allergic disorders, infections and suppression of the immune system in about 20% of cases.

An alternative that is gaining in use is a drug commonly called EPO or by the brand name PROCRIT®. The medication is a genetically engineered version of the body’s natural hormone, erythropoietin, that stimulates the bone marrow to produce red blood cells. Given by injection, the medication may reduce the need for transfusion, and may improve a person’s ability to engage in everyday activities and cope with their disease.

Other tips for coping with fatigue:

  • Plan your day so you have time to rest;
  • Take short naps and breaks;
  • Eat nutritious foods;
  • Drink plenty of fluids;
  • Take short walks or do light exercise when possible;
  • Keep a diary of how you feel each day to help you plan your daily activities;
  • Save your energy for the activities that are most important to you;
  • Ask for help if you need it;
  • Join a support group;
  • Talk to your nurse or doctor about treat ment for fatigue.

Resources are also available to help you. For example, you can visit the Oncology Nursing Society’s new Web site: www.cancerfatigue.org. This interactive site provides information about fatigue in English and Spanish, and allows you and your caregivers to ask an oncology nurse confidential questions about cancer-related fatigue and receive quick answers.

As you search for information and help, remember you aren’t alone. Talk with your doctor or nurse, who may be able to provide treatment and help you to return to the active lifestyle you remember. Learning more about cancer anemia and fatigue is the first step to overcoming it.

"Fatigue: The more you know..." published in the Summer 1999 issue of Myeloma Today appeared courtesy of the Cure For Lymphoma Foundation.

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