| Q: |
What causes fatigue in cancer patients?
| | A: |
Various factors can contribute to fatigue in people suffering
from cancer. Physical factors include weight loss and increased
catabolism (tissue breakdown), problems with bone marrow function
(leading to anemia, for example), abnormalities in hormone secretion,
and salt and fluid imbalances. Psychological problems like depression
and anxiety can lead to fatigue. Sleep–and circadian rhythm–disruption
can also lead to fatigue and feelings of sleepiness. Treatments such as
chemotherapy and radiation therapy can cause significant fatigue.
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| Q: |
What is the difference between fatigue and sleepiness?
| | A: |
Since there is no single treatment for fatigue in cancer, it is
important to know the difference between these two descriptions for
problems that can impair quality of life so much. Fatigue is a term that
describes feelings of muscle weakness and lack of energy, but without
sleepiness. Sleepiness is associated with a desire to fall asleep or
unintended episodes of falling asleep in the daytime.
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| Q: |
How is sleepiness treated in cancer?
| | A: |
Sleepiness in cancer can be due to many factors, including a
primary sleep disorder existing before the cancer was diagnosed. If, for
instance, someone with cancer has sleep apnea, then the latter should
be treated just as in anyone without cancer. If a cancer drug or
chemotherapy has led to a sleep-related movement disorder (e.g. restless
legs), that disorder should be treated specifically. If depression has
developed, therapy should treat the mood disorder. In addition to drug
treatments, general sleep hygiene measures should be followed .
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| Q: |
How is fatigue treated in cancer?
| | A: |
Your doctor must try to determine whether there is a specific
cause for the fatigue. This includes making sure that your body’s
biochemical balance is in order, that any anemia is corrected, any
infection is treated, and any hormonal imbalance is brought under
control. Some of these disorders can develop as a result of cancer
treatment with various drugs. Nausea, vomiting, and pain need to be
treated as well. Physical activity often reduces the sensation of
fatigue. Mild exercise, such as a walk outdoors, can increase light
exposure, help fight depression, and train sleep-wake times. Cancer pain
must be controlled too. Drugs are also available to combat daytime
fatigue.
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| Q: |
Can better timing of cancer treatments help treat fatigue?
| | A: |
There is some new evidence to suggest that timing cancer
treatments to coincide with circadian rhythms of the body can help
decrease the feelings of fatigue, improve quality of life, and lead to
less nausea. If chemotherapy is timed to coincide with the rhythms of
the body, then sometimes even higher doses of medication can be used
with fewer side effects. Research in this area is continuing.
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| Q: |
Can drugs used in the treatment of cancer pain cause sleepiness?
| | A: |
Many different types of drugs are used in the treatment of cancer
pain, ranging from acetaminophen through nonsteroidal anti-inflammatory
drugs (NSAIDs), to morphine and its derivatives. Morphine can certainly
induce drowsiness, so if you are feeling sleepier than you would like
to be, then you must discuss the dose you are receiving with your
doctor. Sedative medication, such as the benzodiazepines, is commonly
used for the treatment of insomnia in cancer and can lead to a
“hangover” effect the next day. If you have any concerns, you must
discuss these with your doctor.
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