FATIGUE
Online Education Module

Learning Objectives
What is Fatigue?
Why Fatigue occurs during treatment
Managing Fatigue
Medical Fact
Glossary

Learning objectives

  1. Identify the symptoms of fatigue
  2. Recall why fatigue occurs during treatment
  3. Demonstrate self care steps to manage your fatigue

What is fatigue?
Fatigue is a feeling of tiredness that might keep you from doing things you normally do or want to do.  Fatigue is very common in people who are getting treatment for a brain tumor.  Fatigue can be caused by the brain tumor itself, or it can be a side effect  of your treatment.  You may feel tired or exhausted.  You may feel weak, or your arms and legs may feel heavy.  You may have less desire to do your usual daily activities, or you may find it hard to concentrate or think clearly.  The fatigue experienced by a person with a brain tumor can be mild or severe.  You can have fatigue before, during, or after treatment.  For some patients, fatigue gets better after they have completed their treatment.  For others, fatigue may last long after treatment is finished. 

Why fatigue occurs during treatment for a brain tumor
You are likely to feel more tired than usual if you have surgery, radiation treatment, chemotherapy, or take certain medications for your brain tumor.   The exact cause of fatigue in people with brain tumors is not known, but there can be many causes for fatigue, such as the tumor itself, low blood counts, changes in body chemicals, infection, pain, problems sleeping, changes in diet, anemia , and depression. 

Medical Fact:
Despite extensive effort to identify the mechanisms responsible for fatigue and direct interventions at these mechanisms, the underlying biological nature of fatigue is poorly understood.   Fatigue that is related to cancer treatment is generally attributed to the accumulation of products of cell death or to an imbalance between energy expenditure and energy products.  Fatigue continues in some people following completion of their treatment, however, risk factors for persistent fatigue have not been identified.
 
 
Managing fatigue
There are some things that you can do to help manage your fatigue. 
  • Keep track of the way you feel.    A diary is good way to record the side effects that you are having, how severe each side effect is, and the day of week and time of day when you are having problems.  This information will help the physicians, nurses (and others who take care of you), treat your problems. 
  • Tell the people taking care of you how fatigue is affecting your life.   Fatigue from a brain tumor is real. It should not be ignored.    For example, saying things like “I have to rest halfway up the stairs to catch my breath” or “I’m spending most of my time in bed” will help your caregivers understand what fatigue is like for you.
  • Keep track of any difficulty with sleep that you are having.  This includes problems falling asleep, staying asleep, and waking up too early.  Be sure to tell your caregivers if pain, frequent need to get up to go to the bathroom, or some other problem is causing you to have trouble sleeping.
  • Treatments that lower your blood cell counts will probably make you feel tired.  Keeping track of the results of your blood tests can help you understand and manage your fatigue.  If your red blood cell counts are low, your blood is delivering less oxygen to your brain and muscles, and this can make you feel tired.  If your white blood cell counts are low, you might feel tired because you have an infection.  Your physician may order a blood transfusions to replace red blood cells, or you might get medications to help increase your red or white blood cells.
  • Eat a healthy, nutritious diet and drink plenty of fluids.
  • Plan to take a nap (or lie down just to rest) at the same time each day.   Set an alarm clock so that you nap only for an hour or two. 

Medical Fact:
While it is important to eat a balanced diet to stay healthy, there is no published research linking specific nutritional deficiencies, foods, vitamins, or supplements to fatigue.
  • Pacing yourself – sometimes call “energy conservation” –helps some people to better handle fatigue.   Plan time for rest breaks, give yourself permission to do less or do things differently, and ask others for help with household activities. 
  • If you have found a pattern for your fatigue, plan activities for when you tend to have the most energy.  For example, some people have found that places with lots of stimulation (such as lots of people, lights and noise) increase fatigue, and that activities that challenge you to use your brain (such as paying bills or reading) increase fatigue.  Plan tiring activities for the time of day when you have the most energy.

Medical Fact:
There are no published randomized control trial studies of the pure effect of energy conservation on fatigue in any illness.   Pilot studies have shown promising results in patients receiving chemotherapy and radiation treatment and a randomized controlled trial is now underway.
 
  • Stay as active as you can.   Increased rest is not always the answer for fatigue.   Sleep and rest are important, but too much rest can actually decrease your energy level.  Regular moderate exercise, like walking, has been shown to reduce fatigue in patients with various types of cancer.  Talk to your physician or nurse before starting an exercise program or changing the way you exercise.

Medical Fact
Most of the research related to exercise during cancer treatment studied women with breast cancer who were receiving treatment.   Studies have looked at different types and duration of exercise, different study eligibility criteria, and different types of cancer treatment.  A consistent finding across these studies is that exercise decreases fatigue.  Aerobic conditioning exercises are the ones that have shown the effect.  Walking was the most common conditioning exercise reported.
  • Communication is important.   People who have not had a brain tumor, treatment for cancer, or other physical illness may not understand your fatigue.  Lack of understanding about fatigue can lead to resentment and feelings of guilt.   Share this information with your family so that they understand that tiredness caused by fatigue is not the same as the tiredness that healthy people have.  Your fatigue does not mean that you are doing too much or that you are lazy.  It is not the same as depression.  It may not be relieved by sleep and rest.
  • Be sure to tell your physician or nurse about any change in your fatigue or other medical problems that you are having. 

Remember to call your physician or nurse if your symptoms change for the worse, or if you have a question about how to manage your fatigue.


GLOSSARY

anemia – deficiency of red blood cells

antibiotic – a drug used to treat a bacterial infection.   It may be given by mouth or through a vein (IV).

blood cells – cells that make up the blood.   These cells are made in the bone marrow and include white blood cells, red blood cells, and platelets.

blood count – the number of white blood cells, red blood cells, and platelets.

bone marrow – the soft, spongy center of the bone where most of the blood cells are made before they enter the bloodstream.

chills – a feeling of being cold.   This often happens with fevers and may include shaking.

cognitive, cognitively – relating to perception, learning, and reasoning

depression – a mental state characterized by feelings of sadness, inadequacy, despondency, and/or hopelessness

intravenous – giving fluid or medicine into a vein through a needle.   Also called an IV.

constipation – occurs when unable to move bowels.   Narcotic pain medications, some chemotherapy drugs, antinausea medicines, and changes in diet can cause constipation.

diarrhea – a change in stool consistency or form (bowels are loose, watery, or move more frequently).   May be accompanied by stomach cramps.

fatigue – weakness, exhaustion, lethargy, inability to concentrate, malaise, sleepiness, and lack of motivation

fever – body temperature above 98.6  F.

flu-like symptoms – includes muscle aches, fever, chills, shakes, weakness, headache, upset stomach, and diarrhea.   These may be a symptom or sign that you are ill or may be a side effect of chemotherapy drugs.

immunization – a vaccine to protect us from disease (such as measles and chicken pox).   It is important for patients having chemotherapy to avoid children who have recently had immunizations because the vaccines are sometimes made from the actual bacteria.

infection – occurs when a germ/bacteria enters the body and the person is unable to fight it off.   This can happen when a person is undergoing treatment for a brain tumor.  Signs of infection include fever, fatigue, chills, muscle aches.

injection – giving medicine using a needle into the muscle, under the skin, or into the vein.

intravenous – giving fluid or medicine into a vein through a needle.   Also called IV.

nadir – period after chemotherapy treatment when blood counts are their lowest number.

neutropenia – a condition when the number of neutrophils in the blood counts are low.

neutropenic – a term used to describe a patient when the number of neutrophils in the blood counts are low.

neutrophil – a type of white blood cell that kills bacteria.

platelet – a type of blood cell that helps the blood to clot.   Chemotherapy can lower platelet count.

red blood cell – the cells in the blood that carry oxygen to the organs and tissues and take carbon dioxide away.

side effect – a symptom or a reaction that a person may have to brain tumor treatment.

swelling – when fluid fills the spaces between the cells in parts of the body.   Swelling (also called edema) often occurs in the ankles and feet and may be a sign of infection.

subcutaneous – under the skin.

symptom – any change in the body’s function that would indicate disease or a reaction to treatment.

temperature – how hot the body gets.  Normal body temperature 98.6  F (Fahrenheit).

thermometer – a tool used to check body temperature.   There are various types available.

urination or to urinate – emptying of urine from the bladder (“passing water”).

vaginal discharge – fluid or mucus that leaks from the birth canal or vagina and may have a strong odor which is a sign of infection.

white blood cell – cells in the blood that fight infection or germs.   Neutrophils are one type of white blood cell.

References

Lovely, M.  (2004).  Why am I so tired?  Search, 58; Oakland, CA: National Brain Tumor Foundation.

Yarbro, C.H., Frogge, M.H., and Goodman, M. (2004) Cancer Symptom Management, 3rd edition, Sudbury, MA: Jones and Bartlett.

Oncology Nursing Society and PRISM (Priority Symptom Management).  (2004). Ways to manage your cancer symptoms. www.cancersymptoms.org