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Fatigue, sleep and cancer

Fatigue vs asthenia

Fatigue linked to cancer and cancer treatments is different from other types of fatigue. Usually, fatigue is the body’s physical manifestation of a need for rest, which usually occurs following mental or physical exertion. Sleep is, in this case, reparative.

Asthenia, a pathological fatigue caused by illness and/or treatments, is an abnormally intense fatigue not linked to any type of exertion, which may not be cured by sleep. Asthenia is observed in more than 2/3 of patients and can highly alter their quality of life.

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How can I recognise asthenia?

The symptoms of asthenia are different from those of physiological fatigue and include: 

A constant lack of energy despite rest

A fatigue disproportionate to the effort exerted

Moderate concentration and memory issues

Emotional exhaustion, irritability and/or depression

How is it caused?

Fatigue usually has multiple factors.

There are primary factors including the intensity, development and stage of the illness.

Secondary factors linked to cancer include weight fluctuation, chronic pain, anxiety/depression, anemia (inflammatory or induced by treatments), difficulty sleeping (insomnia), and malnutrition.

Fatigue is also caused by factors linked to treatments including surgery (usually shorter in duration), chemotherapy (which can sometimes last several years after the treatment has been completed) and cerebral radiotherapy. Sometimes, it is not the treatment itself, but the frequent visits to the hospital, with travel and waiting time, which cause excessive fatigue.

Physical deconditioning, comorbidities (neurological, cardiovascular, endocrinal - such as hypothyroidism) and the patient’s psychosocial state can also significantly impact fatigue levels.

How do I manage it?

The first step is to speak to your care team and describe your fatigue in detail.

Fatigue is managed on an individual basis depending on its causes. Fatigue linked to the illness itself may be due to the treatments’ efficacity.

Fatigue linked to treatments can be managed by:

  • Limiting the number of trips to the hospital by grouping appointments together
  • Treating reversible side effects like anemia (transfusion, iron supplementation, EPO treatment, etc.) and malnutrition

Most often, sleep quality does not require medical intervention, but it should be monitored. For example, regular physical activity (even low-intensity) and sleep help fight off fatigue. In the case of insomnia, the cause must be identified. It is often due to anxiety, in which case, consulting an (onco)psychologist can be useful. Support from close friends and family is essential. Patient associations may also help.

Lastly, management of chronic pain and/or other pathologies will help diminish asthenia.

In summary, fatigue should be managed by a multidisciplinary team including professionals (oncologist, treating doctor, psychologist, dietician, pain doctor, sophrologist) and those close to you. Again, the essential first step in combatting fatigue is to speak with your care team in detail. Consider keeping a journal of your symptoms.

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