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Extreme Tiredness

Extreme tiredness is one of the most common side effects of cancer and cancer treatment. When you experience it, you may have an increased need for rest, an inability to regain energy after resting, difficulty concentrating, or a disinterest in activities or events.

Compared with side effects, such as nausea or pain, extreme tiredness can be very difficult to identify and discuss. Sensations, such as weakness, dizziness, difficulty thinking, and feeling tired may be part of the feeling. People sometimes think they are just being lazy or depressed. They may tell themselves, I can snap out of this if I really try. But treating extreme tiredness requires more than sheer will.

Many factors contribute to extreme tiredness, including chemotherapy-related anemia, unrelieved pain, depression, lack of exercise, side effects of some medications, poor nutrition, sleep disturbances and inadequate rest, anxiety, infection, low thyroid gland function, and other medical problems. Likewise, successful treatment may require several approaches.

Sudden changes in feelings of extreme tiredness may mean there is a serious problem. Slower, gradual development of fatigue may lead to a decreased ability to perform everyday activities. For these reasons, it is important to tell your health care team if you have extreme tiredness or if your tiredness is worsening, so that you have the best chance of getting a treatment plan that will work for you.

There are no medical tests to measure extreme tiredness, but it can often be treated. If you experience extreme tiredness, report it to your nurse or physician to determine whether a treatable cause exists and to develop a strategy to reduce the amount of extreme tiredness.

What causes extreme tiredness?

The reasons patients experience extreme tiredness are many and complex. In fact, extreme tiredness often results from more than one cause, and effective treatment may require many strategies.

All of the factors listed below can contribute to extreme tiredness by decreasing the body's ability to produce energy or by consuming the limited energy produced.

Anemia - Anemia is an inadequate supply of red blood cells, resulting in a decrease in the oxygen-carrying capacity of the blood. Cancer patients commonly experience anemia as a side effect of chemotherapy. Anemia is important because it may cause unwanted symptoms, such as fatigue, tiredness, or shortness of breath, and may exacerbate or cause other medical problems, such as a heart condition.

Fortunately, the blood growth factor erythropoietin can increase the production of red blood cells; it is an effective treatment for anemia that is less risky than blood transfusions. There are two commercially available forms of erythropoietin: Epogen® or Procrit® (epoetin alfa) and Aranesp® (darbepoetin alfa). Both are manufactured in the same facility in the same manner. Epoetin alfa has been in use for many years. Darbepoetin alfa, a unique, longer-acting form of erythropoietin, is more convenient because it allows patients to receive fewer injections than with epoetin alfa.

The most common side effects seen in clinical trials with darbepoetin alfa were fatigue, edema, nausea, vomiting, diarrhea, fever, and shortness of breath. No important differences in side effects were seen between groups treated with darbepoetin alfa and groups treated with the existing anemia treatment epoetin alfa. However, the FDA has issued warnings associated with the use of these drugs and therefore the risks/benefits should be discussed with your physician prior to use.

Infection - When you have an infection, the body uses extra energy to fight the infection, which can contribute to fatigue.
Cancer medications or medical treatments - Many drugs, including those used to treat nausea (antiemetics), pain (analgesics), anxiety (antidepressants), and other conditions, can cause extreme tiredness as a side effect.
Inadequate nutritional intake - Cancer or cancer treatments may also cause you to lose your appetite or feel full early (early satiety). Insufficient intake of calories and vitamins reduces the body's ability to produce energy and may cause anemia.
Imbalance between rest and activity - Since the 1950s, space program researchers have studied bed rest as a way to better understand the effect of a weightless environment on the body. These studies have shown that bed rest or even restriction of activity for 1 or 2 days can decrease the body's ability to produce energy. Researchers have not identified how much rest is required for recovery and how much rest contributes to low energy production. However, it appears that extended rest may contribute to extreme tiredness, and modest amounts of activity and movement can improve energy levels.
Stress - Pain, anxiety, or depression can cause stress or result in sleep deprivation, causing increased extreme tiredness.
Other medical conditions - Extreme tiredness may be a symptom of other medical problems. Diabetes, heart disease, kidney failure, thyroid dysfunction, and hypercalcemia are common medical problems that can cause extreme tiredness.

What are the symptoms of extreme tiredness?

Compared with symptoms, such as nausea or pain, extreme tiredness can be very difficult to identify and discuss. Symptoms may include:

Low energy level and an increased need to rest after normal (not strenuous) physical activity
Overall weakness with a heavy feeling in your arms and legs
Difficulty completing daily activities
Difficulty concentrating or thinking clearly

Symptoms usually start out mild and become progressively worse until you are unable to perform everyday activities. Sudden changes in feelings of extreme tiredness may mean there is a serious problem.

There are no medical tests to measure extreme tiredness, so it is important to report any new or worsening symptoms of extreme tiredness to your doctor or nurse.

How can extreme tiredness be managed?

Extreme tiredness has many different causes and patterns, and effective treatment may require many strategies. For these reasons, it is important to discuss your symptoms with your nurse or physician to devise an individual plan that will work. Although there are no standard medical treatments for extreme tiredness, new tools exist to evaluate and cope with extreme tiredness. The following suggestions may also help:

Treat anemia - Anemia is the most common cause of extreme tiredness in cancer patients. It is also very treatable. Learn more about the diagnosis and treatment of anemia.
Maintain good nutrition - Maintaining good nutritional intake during treatment is especially important because cancer treatments increase the nutritional demands of the body. However, treatments may also cause you to lose your appetite or feel full early (early satiety). Work with a dietitian or nutritional specialist to ensure that you are getting proper nutrition.
Conserve energy - Try to be realistic about how much energy you have and what you can and can't do. Do only the things that are most important, and ask friends or family for help. It is important to recognize which activities create the most extreme tiredness and also note the frequency, degree, and duration of fatigue so that you can report these to your doctor. If you're having difficulty managing extreme tiredness, you may wish to ask your nurse or doctor to help family members understand how they can help.
Rest enough - Maintaining normal rest and sleep patterns is important to ensure quality rest. Too much or too little sleep can cause fatigue. Plan your daily activities carefully, and schedule rest times between activities throughout your day. Limit any daytime naps to between 30 minutes and 1 hour. Avoid caffeine after dinner.
Evaluate medications - Review your medications with your doctor, pharmacist, or nurse to ensure that the medications are not causing or contributing to your symptoms.
Exercise - Although conserving energy is important, it is equally important to understand that too much rest or inactivity can actually decrease the body's ability to produce energy and can worsen fatigue. Moderate daily exercise, such as walking, may help increase your energy level. Discuss individualized exercises with your health care team.
Manage stress - Counseling, support services, and medications can all play a role in reducing stress and thereby alleviating extreme tiredness.

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