According to a survey conducted by The Fatigue Coalition, a multidisciplinary group of medical practitioners, researchers, and patient advocates, and funded a grant from Ortho Biotech Products, L.P., 76 percent of cancer patients cite fatigue as the most commonly experienced side effect of their cancer.

A Whole Lot of Tired

Fatigue is often described as unusual or excessive whole-body tiredness, disproportionate to or unrelated to exertion. That means feeling as if you just walked up a long flight of stairs after walking down the hall or feeling as if you just went for a long run after doing your grocery shopping.

Fatigue can be short-term or long-term and can have a profound negative impact on your loved one’s quality of life. Fatigue can interfere in the ability to perform everyday activities such as dressing, food shopping, paying bills, housework, and walking up stairs.

Causes of Fatigue

So what causes fatigue in cancer patients?

Cancer itself causes fatigue, since the tumors use some of the body's energy.

Cancer treatments such as radiation therapy, surgery, or chemotherapy can rob the body of energy. Some treatments can cause anemia, which means a decrease in red blood cells. Red blood cells carry the oxygen the body needs to make energy and without enough of them, the body simply doesn’t have any energy!

Other causes of fatigue include:

• Side effects of cancer treatments such as nausea and vomiting
• Stress, depression, and anxiety
• Changes in activity or rest patterns
• Loss of weight and appetite
• Decreased nutritional status
• Neurotoxicities of cancer and its treatment
• Sleep disturbances
• Overactive or hypermetabolic state due to tumor growth

How Can Caregivers Help Manage Fatigue?

Be aware of the warning signs of fatigue including:

• Tired eyes
• Stiff shoulders
• Decreased or lack of energy
• Inability to concentrate
• Increased irritability
• Nervousness
• Anxiety
• Impatience

Keep a Diary

Help your loved one track their fatigue patterns, by keeping a diary for one week.

1. Identify the time(s) of day when your loved one is most fatigued or has the most energy.
2. Note any activities or situations that make the fatigue better or worse.
3. Use a 1-10 scale to assess levels of fatigue: 1 as the least amount of fatigue and 10 as the worst possible sensation of fatigue

After recording the patterns in a diary for one full week, discuss the symptoms and the patterns with your healthcare professional. He or she may have suggestions for coping with the fatigue—or even some ideas for treatment that could help.

Also, be sure to read our article on Tips for Managing Fatigue. This article contains practical tips and advice for your loved one—and for you—on managing fatigue.

Managing Other Symptoms

1. Pain
   Your loved one may experience pain with cancer. Pain is difficult to assess since it is a subjective process; only the person with the pain really knows how they feel.
   
   As a caregiver, you can help in the assessment and description of pain to your loved one by using a pain assessment scale. The most commonly used scale is a scale from 0 to 10, with 0 being no pain and 10 being the worst pain imaginable.
   
   Caregivers can also be helpful by helping to keep track of the pain medications the patient is taking and to monitor dosage and scheduling to make sure that the patient is taking medications correctly, to minimize adverse interactions and optimize effectiveness. Be sure to speak with your loved one’s doctor about all pain medications—and if your loved one changes the frequency of taking pain medications.
   
   
2. Depression
   Some degree of sadness is to be expected among loved ones with cancer and among family members caring for someone with cancer. This sadness comes from the many changes that are imposed by the illness and the unknown future that lies ahead.
   
   Clinical depression is different from the sadness that most families experience and it is critical to assess accurately whether the patient or caregiver is suffering from clinical depression, since depression is a treatable illness that can be managed by medication and/or psychotherapy.
   
   If depression is suspected, contact a mental health professional to assess for clinical depression. Have health care providers review all the medications the caregiver or loved one is taking for depressive side effects.
   
   
3. Skin Problems
   Cancer patients are at risk for numerous treatment and disease-related skin impairments including photosensitivity, rash, nail changes, bedsores, swelling, itching, and hair loss.
   
   Caregivers can help these skin problems by encouraging the use of sunscreen, helping to protect affected areas from trauma, encouraging meticulous hygiene (keeping skin clean and dry), and making sure their loved one’s eat healthy and drink enough water.
   
   Caregivers can also encourage the purchase of a wig prior to treatment, and can minimize hair loss by using baby shampoo, a soft hairbrush, and minimizing hair washing.
   
   
4. Bowel Changes
   Diarrhea and constipation are two common bowel changes in cancer patients.
   
   If your loved one is suffering from diarrhea, you can play an important role in helping your health care team by providing information on the following:
   
   Assessing normal bowel changes:

• Quantifying the number of stools per 24 hours
• Reviewing dietary intake and recent changes in die
• Evaluating nutritional supplements or tube feedings as a source of diarrhea
• Checking weekly weight
  
  If your loved one is constipated, you can assist the patient's health care team by:
• Assessing daily dietary fiber, calorie and fluid intake
• Reviewing current medications and treatments that may contribute to or cause constipation
• Assessing the frequency and consistency of stools