Fatigue in cancer: Just be tired?

Many people are familiar with the symptoms of exhaustion. However, exhaustion that occurs in connection with illnesses is referred to as fatigue. It can be long-lasting and even chronic, and many people suffer from it. The causes range from sleep disorders, stress and deficiencies to a number of different diseases such as cancer.

The term “fatigue” comes from the French language and literally means “tiredness” or “exhaustion”. In addition, fatigue syndrome is a common symptom in the population and in medical practice. It occurs in different clinical pictures and can be very pronounced. Sometimes so strong that patients feel seriously ill. Fatigue can have many causes. A specific cause cannot be identified. Therefore, the syndrome is not easy to explain and understand. Fatigue associated with chronic disease often improves with treatment of the disease itself.

Frequency and Symptoms

The disease occurs worldwide and has a prevalence of 0.2 — 0.4%, i.e. the proportion of people with the disease in the total population. According to consensus estimates, almost half a million people in Germany suffer from Chronic Fatigue Syndrome, or CFS for short. Doctors often speak of myalgic encephalomyelitis (ME). ME/CFS can lead to significant limitations in everyday life. The World Health Organization (WHO) classified ME/CFS as a nervous system disease in 1969. In the ICD (International Classification of Diseases) it is coded under G93.3 as a neurological disease.

Those affected often suffer from severe physical weakness, fatigue and lack of strength for years. There are also symptoms such as headaches and joint pain or cognitive impairments. For the majority of those affected, who are usually diagnosed at a young age between 20 and 40, CFS often means the abrupt end of their professional and/or social life. Many of those affected become unable to work, and some even require care. The quality of life of patients with CFS is often worse than that of advanced cancer patients. So what does it look like when fatigue appears parallel to a tumor disease.

Tumor-Associated Fatigue

An often leaden “fatigue” that impairs both physical and mental performance and cannot be explained by lack of sleep or heavy stress: This is fatigue that also differs from “normal” tiredness (lack of sleep) or exhaustion (due to severe load) differs. Fatigue is one of the most common and distressing symptoms of cancer that patients have to struggle with. Most cancer patients return to their original energy levels within a year of completing tumor treatment. However, more recent studies show that around 30% of patients continue to suffer from severe fatigue and the life restrictions it causes, even several years after treatment.

Since the causes of fatigue are multifactorial, COVID-19 disease can also be associated with the syndrome. CFS can develop after various serious viral infections, such as the flu or COVID-19. Infection can be the trigger, especially if you have cancer. A not insignificant proportion of our patients show the full picture of a CFS. Unfortunately, it is still not exactly known why about a third of patients develop this chronic fatigue. However, there are various therapy modules that can be used to improve the symptoms of fatigue. The grueling state of exhaustion often improves again after a few weeks or months.

Fatigue management in cancer — What happens in the consultation?

When you come to a fatigue consultation, the suspicion has arisen in advance through discussions and questionnaires that chronic tumor-associated fatigue exists. Perhaps you have been feeling less productive for a long time, often exhausted and weak, and you have not been able to regain your old energy level even after the end of the tumor therapy. In the following section you will learn how a typical fatigue consultation works.

During the consultation, your current (fatigue) symptoms will first be discussed together, and the course of the disease as well as reinforcing and relieving factors or therapies will be analysed. Your medical history and the diagnostics that have already been carried out will be assessed. In particular, to be able to rule out additional factors such as hypofunction of the thyroid gland, anemia and the like or to be able to treat them correctly. If a module is still missing in the diagnostics, it can be added if necessary. In the next step, your treating doctor would like to discuss with you how you assess your fatigue and offer you further information on chronic tumor fatigue in general and possible therapy strategies. This results in an individual therapy plan, which is made up of various components (e.g. sport, relaxation methods, medication, nutrition). Unfortunately, fatigue cannot be cured directly at the moment, only the symptoms can be treated, circulatory problems, pain, severe sleep disorders, deficiencies such as vitamin D deficiency, folic acid or selenium deficiency. It is also very important to avoid overexertion, which repeatedly leads to severe flare-ups, and to learn relaxation techniques, for example through breathing exercises. That’s easier said than done, because it’s mainly young people who want to work or have to look after children who are affected. But an important therapeutic principle at the beginning is that you first bring in peace.

Over a longer period of time (e.g. 1 year), you will receive a fatigue questionnaire about your course every three months in order to be able to assess the effectiveness of the therapies. After six and twelve months, you will come back to the fatigue consultation for an interview. There, the attending physicians would like to know how you are doing with regard to fatigue, which therapy modules have worked well or in which points we should change or adapt the therapy.

10 facts about fatigue in cancer

Fatigue is a common symptom during and even many years after a tumor disease
Fatigue is more than “simple tiredness”
There are many causes of fatigue
Careful medical history is important
Fatigue is often the symptom that affects people the most in everyday life
Therapy is based on several pillars of symptom relief
The therapy plan depends on the individual symptoms and the respective situation of the patient
Therapy should be adjusted over time
The cause of (tumour-related) fatigue is not yet well understood scientifically
It’s often easier together — self-help groups, therapy groups, cooperation between therapists