In part one, we covered some basics about cancer-related fatigue (CRF). We followed up with Dr. Kuiper to get specifics about how to manage CRF. Dr. Bram Kuiper is a clinical psychologist, scientific entrepreneur, and CEO of Tired of Cancer.

1. If I’m on a treatment that negatively affects my sleep, are there ways to combat the fatigue while remaining on my treatment schedule?

There are ways you can make adjustments that can improve your sleep. Setting a good sleep routine is key. Small changes can help you get a better night of sleep. Below are some tips:

  • Relax before bed with no television or device (smartphone, tablet, or computer) surfing to prepare your body for sleep.
  • Avoid looking at a clock in the middle of the night. Watching the minutes pass by can make you restless and keep you awake.
  • Remember that caffeine and alcohol should be avoided as they also interfere with sleep.
  • Exercising may also help you sleep better, but don’t exercise too close to bedtime.

2. What else, aside from treatment, could be affecting my fatigue?

Fatigue is often caused by a combination of several factors such as stress, sleep issues, sedentary lifestyle, low-immunity, pain, anxiety, and depression. It’s important to always talk to your doctor about fatigue before doing anything else. Your doctor can evaluate you for any medical causes or if other conditions like diabetes or cardiovascular disease that can be contributing to the fatigue.

3. Are there medications that can help manage my fatigue?

Although there are no drugs specifically FDA approved to treat cancer-related fatigue, you should talk to your doctor to determine if any other medications you are taking are potentially causing fatigue. They can also evaluate you for any other medical conditions that can be causing fatigue. For instance, if you have a thyroid dysfunction it can be causing additional fatigue, you can be prescribed medication to help address it.

4. I would rather not take another medication. What can I do to try to manage my fatigue that doesn’t require a prescription?

In 2017, the National Comprehensive Cancer Network (NCCN) published sound and well-considered ‘Standards of Care’ regarding the diagnosis and treatment of CRF. These included both pharmacological and non-pharmacological methods. Pharmacological interventions were found to be of limited effectiveness while better outcomes appeared to come from non-pharmacological interventions. In particular, there was positive evidence for behavior therapy, mindfulness-based cognitive therapy, exercise, and psycho-education.

Try looking at your energy every day like a vase of water. You only have so much in your vase to use. Daily tasks like errands or cooking dinner will take away energy. But there are things that can give you energy like chatting with a good friend or reading a book. It’s important to address the things in life that can be leaking energy like stress, anxiety, or sleep issues. Being able to better understand what impacts your energy will allow you to manage your fatigue levels. Even though you may be tired, things like taking a walk or meditating can help energy levels. Eating well and having good sleep habits are another important part of the energy equation. Fatigue is different for every person so listening to your body and not overdoing it is important.

5. Could cancer-related fatigue be associated with depression?

Medical factors have a one-way relationship with fatigue. For example, anemia leads to fatigue, but fatigue does not lead to anemia. However, there is an interaction between fatigue and psychosocial processes. For example, fatigue can lead to poor sleep and poor sleep leads to fatigue. This can become a vicious circle. Depression can be a component in that circle that then leads to poor sleeping and eating habits. When this happens, people end up in a cycle that is often difficult to break out of. They are trapped in a cycle of cause and effect and always return to the situation they want to leave. This phenomenon plays a role in long-term cancer-related fatigue.

6. What can I do to feel somewhat rested after a night (or many nights) where I cannot sleep?

Sleep is something that many cancer patients struggle with so you’re not alone. Almost 60% of cancer patients have some sort of sleep disorder. There are a few sleep tips that can help you cope with a lack of sleep and try to get a better night:

  • Start the day with enough light. Light tells your biological clock it’s morning and that it’s time to wake up. Light activates both your body and mind.
  • Make sure you move and stay active. Try going for a walk as fresh air and activity can help improve energy levels.
  • If you’re struggling to get through the day, take a break and rest, or lay down for a short (30 minute) power nap. Just make sure it’s not too long, not in your bed, or too late in the day (no later than 3 pm) or you may affect your night’s sleep.

7. Experiencing fatigue is affecting my work performance and attendance. How can I talk about fatigue at work in a productive way?

Reintegrating back to work is an important topic that isn’t talked about enough. One of the main problems of fatigued-cancer patients is that fatigue is invisible to others. Saying something is a good first step. It’s important to have a dialogue with your supervisor so that adjustments and accommodations can be made. Remember you have protections with the
Americans with Disabilities Act so know your rights.

It is hard for someone who has never experienced cancer fatigue to fully understand what you are going through. Remember, some days are harder than others and it’s not something they will know unless you speak up and share. When you are fatigued during the workday, try to take a small break, even just a couple minutes to take a few deep breaths (relaxation exercises) or getting up to walk for a few minutes can help give you energy.

8. What types of medical professionals can help me get better sleep?

Talking to your oncologist, general practitioner, or care provider can help you decide if you need to see a sleep specialist. Doctors that specialize in sleep disorders and treating sleep issues are board-certified in Sleep Medicine.

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