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.
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.
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 .
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.
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.
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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