Fatigue in Childhood Cancer Treatment

Patients often feel tired and weak during cancer treatment. Cancer-related fatigue is different from everyday tiredness. It does not go away with sleep or rest. Fatigue can make it hard to complete tasks or do normal activities. This can interfere with school or work, relationships, and emotional and physical health. For some patients, fatigue continues even after treatment ends.

Fatigue is one of the most common and distressing side effects of cancer and cancer treatments for patients and families. It is important for families to work closely with the care team to identify possible causes and develop a plan to address them.

Ways to help fatigue include:

• Have a regular sleep schedule.
• Plan extra rest, especially during and after cancer treatments.
• Eat a healthy diet.
• Be active, and get some exercise when possible.
• Increase exposure to natural light by spending time outside or opening blinds during the day.
• Work with the care team to treat any underlying causes of fatigue.

What is cancer-related fatigue?

Cancer-related fatigue is the feeling of low energy, tiredness, or exhaustion that is ongoing, not explained by other causes, and not relieved by rest. Fatigue has mental, physical, and emotional effects and interferes with daily life.

Causes of fatigue in cancer

Fatigue during and after childhood cancer is usually due to a combination of factors. These include cancer treatments, effects of the cancer itself, and other physical, behavioral, and emotional factors.

Chemotherapy and fatigue

Fatigue during chemotherapy can be up and down. Fatigue is usually worst in the days after a chemo treatment when blood counts are lowest. Energy levels may gradually increase until the next treatment. Targeted therapy and immunotherapy agents can also cause fatigue.

Anti-cancer medicines may cause fatigue in several ways. Physical changes that can contribute to fatigue include:

• Low blood counts and anemia
• Changes in hormones
• Effects on the central nervous system and changes in neurotransmitters

Radiation therapy and fatigue

Patients who receive radiation therapy also report fatigue. Fatigue with radiation often gets worse over time. It usually improves after treatment ends. Radiation to the brain is especially likely to cause fatigue.

Other factors that increase risk for cancer-related fatigue

• Medications including corticosteroids, pain medicines, anti-nausea medicines
• Anemia due to blood loss or low blood counts after cancer treatments
• Sleep problems
• Hormone changes
• Pain
• Infection
• Dehydration
• Stress, anxiety, or depression
• Decreased physical activity and low physical fitness
• Less exposure to natural (outdoor) light
• Poor nutrition or low calorie intake
• Heart, lung, or kidney problems

Assessment of fatigue

Ways to manage fatigue

It can help to know that the “no energy” feeling is normal during cancer and should get better. Families should work with the care team to identify and treat medical and emotional factors that contribute to fatigue. The reasons for a patient’s fatigue might not be fully known.

Ways to manage fatigue include:

• Healthy sleep habits – Sleep problems are common during cancer, especially when patients are in the hospital. Keeping to a sleep schedule, increasing exposure to natural light, and creating a comfortable sleep environment can lead to improved sleep and less fatigue.
• Exercise and physical activity – Even small amounts of physical activity can help increase energy and reduce fatigue. Exercise also improves strength and fitness to make it easier to do daily tasks with less effort. Fatigue can make it hard to exercise. But even when it feels difficult, it is important try to get some exercise, a little at a time.
• Good nutrition – It can be hard for patients to get enough calories and fluids during cancer. This can interfere with the body’s ability to meet energy needs. Weight loss and decreased muscle can also lead to fatigue. Healthy eating habits and clinical nutrition support can make sure that children get the nutrients they need.
• Psychotherapy – Mental health professionals can help see if fatigue is related to depression, anxiety, or stress. Talk therapy or counseling can teach patients self-care strategies to cope with fatigue.
• Light therapy – Exposure to natural light, especially in the morning can encourage healthy sleep and reduce feelings of fatigue. It can be hard for patients to get natural light, especially during hospital stays. Treatment with bright light therapy uses a controlled light source delivered for a specified time to help regulate the body’s internal clock.
• Complementary therapies – Patients may find help for fatigue through treatments such as music therapy, art therapy, relaxation techniques, massage therapy, and aromatherapy. The care team can help families identify techniques that might be most useful.

Fatigue in children and teens with cancer: tips for families

• Talk to your care team about fatigue.
• Keep a record of symptoms. Write down when fatigue occurs, what makes it worse, what makes it better, and any related factors such as pain, stress, or sleep problems.
• Keep a consistent schedule of sleep, rest, and activity.
• Make sure that food and fluid intake support good nutrition and hydration.

More resources on cancer-related fatigue

• Fatigue and Cancer Treatment (NCI)