You Can Manage Fatigue

By Resource Center at the Preston Robert Tisch
Brain Tumor Center at Duke

How would you rate your energy level during the past week? Your ability to do your daily activities? Your overall quality of life? If you answer "poor" or "below average," then you may be suffering from one of the most common medical conditions experienced by patients with brain tumors: fatigue.

Many of us think of fatigue as temporary—a condition that occurs after intense physical activity and that goes away after a good rest. But fatigue in patients with brain tumors can be chronic, meaning it does not go away, and can have a significant impact on physical, mental, and social well-being.

For the person receiving treatment for a brain tumor, fatigue can be more than just a feeling of being tired or weak. It can mean difficulty performing routine activities such as getting dressed or talking to friends. It can mean being short of breath after only light activity, like cooking or eating a meal or taking a short walk. Fatigue can also affect the way you think and feel. It can cause you to lose interest in your hobbies, make concentrating on school or work difficult, and lead to social withdrawal. As one patient expressed, "It’s like hitting a wall. It’s not only that I’m not able to do things— it’s also that I don’t even feel like doing things. Some days, I don’t even want to play with my children."

Patients with brain tumors can be exhausted as a result of a number of factors (see below for “Causes for Fatigue”).  Chemotherapy can lower the number of red cells, which carry energy-providing oxygen throughout your body. Patients who have nausea or vomiting may not eat enough to keep up energy levels. Cranial radiation can also cause fatigue. Studies have shown that patients generally describe fatigue as minimal at the beginning of radiation therapy, but that it increases as radiation therapy progresses. Many patients experience debilitating tiredness as long as 3 months after completion of radiation therapy. Somnolence syndrome, a short term but distressing event, has been observed in a smaller percentage of patients with brain tumors, and occurs most commonly 4 to 8 weeks following radiation to the brain. Its symptoms can range from mild fatigue to drowsiness, to sleeping up to 20 hours per day. It can be accompanied by headache, vomiting, anorexia, and depression. Most often, the symptoms resolve within several days to two weeks.

The location of the brain tumor itself, and its injury to the brain, may also be a factor. Results of one study reported that patients with lesions located more centrally in the brain, such as the ventral frontal cortex or temporal/parietal cortex, report higher levels of fatigue and lower levels of vigor following surgery.

Emotional stress, coping with anxiety and the many changes in your daily routine also contribute to fatigue. The fact is, your entire life is being turned upside down, and yet, so much is still expected of you. You still have to travel to and from treatments. You still have to function. You have to call upon your body to do so much more than it may want or be able to do.

Many think that fatigue just has to be tolerated – that it is, in fact, an expected part of having a brain tumor, not important enough to mention, and that nothing much can be done about it. However, according to Margaret Duncan-Brown, inpatient Nurse Clinician with The Brain Tumor Center at Duke, there are many things that can be done to fight and manage fatigue, instead of just enduring it. "It’s very important to talk to your health care provider about any symptoms of fatigue," she says. "Be prepared to describe in concrete terms just how tired you are and how the fatigue is affecting your life. Your healthcare provider can prescribe medications to treat any physical conditions, such as anemia, dehydration, electrolyte imbalances, or infection. We can also give you information to help you set reasonable activity goals, learn to use the energy you have as effectively as possible, and to regain control and balance in your daily life."

Causes of Fatigue for Brain Tumor Patients

• Anemia
• Dehydration
• Electrolyte Imbalances
• Pain
• Infection
• Chemotherapy
• Radiation Therapy
• Biotherapy
• Depression
• Role Changes
• Altered Self-image
• The Brain Tumor Itself