how to handle fatigue during cancer treatment

One of the most common side effects of almost any type of chemotherapy is fatigue. And because the effects on the body from chemotherapy are cumulative, the fatigue often builds, worsening as treatment progresses. Fatigue from chemotherapy often happens during that first week or two after receiving the treatment, but as time goes on, the symptom may last longer and longer.

For many people, it can be disabling.

Feeling tired or weak during cancer treatment can be related to several things — sadness or depression, poor nutrition or not eating enough, disrupted sleep or not enough sleep, pain medications (especially narcotic medications), or anemia (decreased hemoglobin, which is carried by red blood cells). If any of these are occurring, it’s important to take care of these issues first to see if the fatigue improves. Sometimes the fatigue is related to the cancer or the treatment itself, however. That kind of fatigue is harder for us, as oncologists, to help with.

The one big thing that patients can do that can help? Stay active.

People undergoing cancer treatments are usually concerned about whether it’s okay for them to exercise, to go to the gym, to continue playing tennis or going for their morning runs. If there are no other health reasons — like a recent surgery — that would prohibit exercise, my advice is always to continue staying active during chemotherapy.

Here are all of my tips to combat fatigue during chemotherapy, once any treatable conditions have been dealt with appropriately:

  1. Get moving. Whether it’s walking or swimming or going to the gym, do something on a daily basis if possible. Not only will the exercise help with fatigue, but it helps to improve appetite and quality of life.
  2. Take time to relax. Schedule some rest in your day so that you conserve energy when it’s not needed.
  3. Eat well. Keeping up with your nutrition is important on so many levels. Even if you can’t eat three big meals a day, snacking or grazing throughout the day on healthy snacks can keep things going in the right direction.
  4. Practice good sleep habits. Taking simple steps, such as limiting naps to short periods of time (maybe 45 minutes to 1 hour), turning off the television or computer during the hour before bedtime, and avoiding caffeine in the afternoon, will help nighttime sleep be more restful. With better rest at night, you might feel more energized for more physical activity the next day.

photo credit: Caitlin Regan, 2008

i’m on chemo and can’t keep my weight up…what can I do?

I have joked sometimes that I wish I had this problem, but truthfully, losing too much weight can be problematic for someone undergoing cancer therapy. Weight loss during chemotherapy is not a guaranteed phenomenon. In fact, most women undergoing breast cancer and ovarian cancer chemotherapy actually put on some weight during their treatment and in the period of time following treatment. When too much weight loss does happen, though, we oncologists typically don’t like to see it.

Losing too much weight can lead to undernutrition – or even frank malnutrition. In addition to loss of body fat, patients often lose lean muscle mass. Too much involuntary weight loss (or voluntary, for that matter) can increase health risks and lead to an increased risk of mortality.

That’s not a good thing.

The reasons for weight loss can be multiple, and your physician should ensure that any treatable causes are identified. Some of the more common – treatable – reasons for weight loss are diabetes, hyperthyroidism, some infections, and even certain medications. Nausea and vomiting from treatment, or from the cancer itself, are also a potential cause of weight loss, and these symptoms can hopefully be treated — and prevented next time around.

If weight loss is because of poor appetite, and if nothing else is working to keep the weight up, there are prescription medications that can be prescribed to stimulate the appetite. These can be helpful in the right situation, especially if forcing yourself to eat just isn’t working.

Before I try a prescription appetite stimulant, I usually recommend other interventions first. To put on weight, I usually recommend relaxing any diet restrictions that a patient may have put on himself or herself in order to eat “healthier” during chemotherapy. Eating a healthier diet — with whole grains, lean proteins, plenty of vegetables and fruits – is a wonderful thing, whether you have cancer or not. But, if one’s diet modifications have restricted calories too much, I’m not a happy doc. The cancer treatment time is generally not a time for dieting, and it is possible to make lifestyle changes in one’s diet while still maintaining an appropriate weight.

Here are some other tips for keeping weight loss to a minimum:

  • Eat more eggs. One large egg contains 6 grams of high quality protein that is easily digestible and inexpensive, especially when compared to the much pricier protein supplements. Not only are eggs a conveniently self-packaged protein source, but they contain 10 to 20% or more of choline (important for cell metabolism), selenium (an antioxidant), riboflavin, vitamin B12, and phosphorus.
  • If nut allergies are not a problem, incorporate more nuts into your diet. Just one ounce of pistachios or almonds contains 6 grams of protein.
  • Protein shakes (such as Ensure or Boost) are an easy solution, but these supplements can be financially taxing if you’re on a limited income. Finding a flavor that you like is important, and if you really want to increase calories as well as protein, blend a scoop of ice cream into the supplement and make a milkshake out of it.

Since eggs are the cheapest way to up protein in the diet, I’m a big fan of eggs. These easy-to-prepare recipes won’t steer you wrong:

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