Fatigue is one of the most common and toughest side effects of cancer treatment. It is more than just being tired. Fatigue is feeling physically, emotionally or mentally exhausted. You may have trouble finding the energy for even the simplest tasks, and this feeling does not go away with rest.
It is important to tell your health care team if your energy is low. Fatigue usually lessens over time, but it is sometimes caused by anemia or blood loss that can be treated with medication. Sometimes fatigue is confused with depression, a psychological condition treatable with counseling or medication.
Prepare to talk with your doctor by keeping track of your fatigue. Write down when you feel fatigue. Note the time of day, how tired you feel on a scale of 0-10 (with 10 being the most tired), how long the feeling lasts and anything you do that makes it better or worse. This information will help your doctor understand what you are going through. Be sure to bring up fatigue when you talk with your doctor or nurse, even if they do not ask about it.
Tips for Fighting Fatigue
- Plan your day so that you use your best times for activities that are important to you, like getting work done or paying attention to your children.
- Get enough sleep. Wake up and go to bed at the same times each day.
- Eat healthy foods.
- Take on less. Cut back on responsibilities, volunteer commitments and even favorite hobbies.
- Stay physically active. Consult these tips to get started.
- Make changes to your normal activities to suit your energy level.
- Ask for help and allow others to help you. This may be hard if you are used to being the one who handles things in your family, workplace or community. But it is an important part of feeling and getting healthy.
- Talk with a doctor to find out about and treat other conditions that can cause fatigue such as anemia, depression, anxiety, medication use and pain.
Getting enough rest is an important part of staying healthy. Cancer and cancer treatment can play havoc with sleep patterns. You may find that you feel healthier and your routine is getting back to normal, but sleep is still a problem.
There are three main ways sleep can interfere with your life:
- Hypersomnia: You sleep for long periods of time (10 or more hours at a time), have trouble staying awake during the day or constantly feel tired, even after a nap.
- Insomnia: You struggle to fall asleep or stay asleep.
- Nightmares: Your sleep is disrupted by scary, vivid dreams that feel real.
All three of these conditions can make it harder to function during the day, and may worsen other side effects or health concerns. Try these tips to help manage sleep problems.
Tips for Managing Hypersomnia
- Try to exercise every day, preferably in the morning or early afternoon. Develop a sleep routine so that you go to bed and wake up at the same time every day. When it is time to get up, get out of bed.
- Avoid naps. If needed, adjust your regular bedtime or wake-up time to give yourself extra sleep time.
- Spend time on activities you enjoy that take your full attention.
- Watch your diet. Avoid eating heavy foods or meals that might make you feel drowsy during the day.
- Avoid alcohol and caffeine.
Tips for Managing Insomnia
- Work with your health care team to address underlying sources of insomnia, such as pain, anxiety or medication.
- Develop a sleep routine. Go to bed and wake up at the same time each day.
- Start a bedtime ritual, such as reading or taking a bath, to signal to your body that it is time for sleep.
- Avoid caffeine, alcohol and tobacco, especially at night.
- If you are hungry at bedtime, eat a light snack.
- Exercise regularly, preferably more than two to three hours before bedtime.
- Sleep in a quiet, dark room that is not too hot or cold.
- Medications are sometimes used to treat insomnia in the short-term if other approaches do not work.
Tips for Dealing with Nightmares
- Discuss your fears and feelings with a close friend or family member. Have these conversations early in the day rather than the evening.
- Talk about the nightmares with a trusted family member or friend.
- Write in a diary or draw pictures to express the content or themes of the nightmares.
- Imagine different endings or storylines to the nightmares.
- Remind yourself that nightmares aren’t real.
Cancer and cancer treatment can affect your thinking, memory, concentration and behavior. These “cognitive changes” can interfere with your ability to work or perform everyday tasks. It can be very upsetting to realize that your cancer has been successfully treated, but you still do not feel like your old self.
Not everyone will experience cognitive changes. For those who do, changes can be mild or more severe, and often improve with time or treatment. Pay attention to any changes you notice. Ask your family or friends to watch for changes as well. Talk with your doctor or a member of your health care team about these symptoms. Some changes are caused by an underlying condition, which may be treatable.
People often use the expression “chemo brain” to describe mild changes in their ability to think, concentrate or remember during and after cancer treatment. Symptoms may include:
- Difficulty concentrating
- Inability to think clearly or find the right words
- Difficulty multitasking
If you think you may have chemo brain, talk with a health care provider about the problems you are experiencing. It is also a good idea to tell the people around you what is going on so that they can support you. Use the tips provided on this page to help you feel more on top of things.
Radio Show Episode: Lifting the Fog of Chemo Brain
Tips for Managing Chemo Brain
These tips can help you cope with mild cognitive changes. Be sure to talk with a health care professional in case there is an underlying condition that can be treated.
- Tell a family member or friend. Let people know what’s going on so they can support you.
- Write things down. Carry a notebook or use your phone or tablet to make lists and help yourself remember things.
- Try to focus on one thing at a time. Whenever possible, avoid having conversations or working in an environment with distractions.
- Develop routines to stay on top of things.
- Get enough rest.
- Eat a healthy diet.
- Keep moving. Even a few minutes of exercise can be helpful.
Mental Confusion or Delirium
Delirium refers to the state of being very confused. It can come and go throughout the day. Some people with delirium act tired or withdrawn, while others seem agitated or hyper. Delirium is a side effect of certain medicines and generally improves when you stop taking the medicine. Get in touch with your health care team right away if you think that you or a loved one may be experiencing delirium.
Lymphedema is swelling in the arms, legs or middle part of the body, sometimes referred to as the trunk. The swelling is caused by a buildup of fluid beneath the skin. Cancer and cancer treatment can result in blocked or damaged lymph nodes, which lead to lymphedema. Lymphedema can develop soon after treatment, or weeks, months or even years later.
Who Gets Lymphedema?
Anyone who has had cancer or cancer treatment is at risk for lymphedema. Lymphedema is most common among people who have had breast cancer, melanoma, lymphoma, head and neck cancer or cancers affecting the pelvic area including gynecologic, urinary tract and prostate cancers. Procedures that put you at greater risk for developing lymphedema include:
- Lumpectomy or mastectomy
- Surgery that affects the groin or armpit area, including surgeries for prostate and gynecological cancers and melanoma
- Radiation therapy
- Procedures to find cancerous lymph nodes that use dyes and radioactive substances
Other factors such as obesity, skin that is slow to heal, diabetes and the use of certain medications such as steroids may also increase your risk of lymphedema.
Symptoms of Lymphedema
Talk with a doctor or other member of your health care team if you suspect you have lymphedema. Watch for these signs:
- Swelling in any part of the body
- Tingling feeling in the arms or legs
- Changes in the color, feeling or texture of your skin
- Muscle weakness or difficulty bending or moving
- Itchiness, burning sensation or heavy feeling in the arms or legs
Lower Your Risk of Lymphedema
There is no sure way to prevent lymphedema, but it can help to take special care of the part of your body that is at risk. Talk with your doctor to find out if there are any treatments that can help. Follow these precautions:
- Maintain a healthy weight.
- When possible, avoid shots, needles, finger sticks, blood pressure checks or blood draws in the arm or leg that might be at risk for lymphedema (the post-surgery side).
- Keep the skin of the at-risk limb clean and gently moisturized.
- Make sure the at-risk arm or leg gets proper circulation. Avoid sitting or standing in the same position for long periods of time.
- Lift the arm above the heart occasionally.
- Wear loose-fitting clothing. Avoid tight clothing and jewelry around the affected area.
- Avoid heavy lifting, rigorous movements or too much pressure on the affected limb.
- Exercise. Work with a lymphedema specialist or physical therapist to develop a safe exercise program.
- Limit time in extreme temperatures, such as very hot showers. Avoid saunas, hot tubs and the use of ice or heating pads in affected areas.
- Try to avoid injury and infection to the affected area.
- If a prosthetic is needed, choose one that is lightweight.
- Take special precautions when traveling—ask for guidance from a lymphedema specialist.
Watch for even a slight increase in size or swelling of the arm, hand, fingers, chest wall, trunk or legs. Contact your doctor if you notice these symptoms.
Treatment of Lymphedema
Follow the suggestions listed above under “lower your risk of lymphedema” and talk with a member of your health care team to find out if there are treatments that can help relieve any discomfort you are experiencing or improve your symptoms.