Fatigue

Fatigue | Mood | Cognition | Epilepsy

Fatigue is a lack of energy, where you feel you are unable to carry out normal tasks at your usual pace or ability. Fatigue is very common for all of us, when we have had a busy day or not had a good night’s sleep. This type of fatigue is usually short-lived and is a way of our body telling us to slow down and take a break. However, fatigue for people with a brain tumour can occur on a much longer timescale, caused by cancer treatment, other symptoms, or by the tumour itself. This fatigue can disappear after treatment, but may take 6 months to 1 year for energy levels to return to normal, or can take longer. It can also continue even after taking a break or resting, and can affect many areas of daily life. Fatigue is very common in brain tumour patients during (40-70%) and many years after (40%) treatment.

Causes

  • Treatment – during and after treatment, the body requires a great deal of energy for recovery and repair, meaning there is less energy for carrying out daily activities.

  • Anaemia – low levels of red blood cells are a common cause of fatigue in patients with a brain tumour. These cells are responsible for carrying oxygen around the body, which provides our muscles with the energy to do things.

  • Epilepsy – seizures can often create fatigue, as the body can undergo a lot of strain during an episode. Following a seizure, people can often feel they need to go straight to bed, or rest for long periods.

  • Pain – some people living with a brain tumour can experience pain during and after treatment, such as headaches or pain in their arms and legs. This can be physically and emotionally tiring.

  • Diet – cancer treatment can lead to feelings of nausea and loss of appetite. Without staying hydrated and well-nourished, the body does not have enough resources to help with recovery and this can lead to fatigue.

  • Anxiety and Stress – living with a brain tumour can cause a great deal of anxiety and stress, this can take up a lot of energy, and can affect sleep.

  • Depression – negative feelings can also be experienced by people living with a brain tumour, which can lead to a lack of interest or desire to do things, and can be mentally tiring.

Symptoms

  • Lack of energy – desire to stay in bed all the time

  • Muscular aches and pains that make physical activities hard

  • Problems sleeping - sleeping too much or too little, and feeling unrefreshed from sleep

  • Lack of motivation – find it hard to get out of bed in the morning, feeling you cannot be bothered to do much

  • Feeling anxious or irritable

  • Feeling depressed – losing interest in things you once enjoyed, negative feelings about yourself or loved ones

  • Feeling breathless after doing small tasks - such as having a shower or making a meal

  • Lack of concentration - finding it hard follow a TV programme, talking to a friend or completing daily tasks

  • Poor short-term memory, decision-making or finding the right words to say

Links
Research (Prevalence, Causes, Associated Symptoms)

Fatigue in Low-Grade Glioma (2009) [pdf]
Practical strategies for management of fatigue in sleep disorders in people with brain tumours (2012) [pdf]
Risk factors for fatigue severity in primary brain tumour patients (2011) [pdf]
Relationship between fatigue and quality of life in patients with glioblastoma multiformae (1999) [pdf]
Quality of life in brain tumor patients: the relative contributions of depression, fatigue, emotional distress, and existential issues (2002) [pdf]

Interest Groups

Scottish Adult Neuro-Oncology Network: Supportive and Psychological Care Sub-Group
http://www.neurooncology.scot.nhs.uk/index.php/sanon-groups-20/supportive-and-psychological-care/14-spc-definition

Interventions

The Cochrane Collaboration is an organisation that reviews all the available evidence into whether an intervention works or not for a symptom or condition. A review looking into all interventions for fatigue in brain tumour patients is currently in progress, however below are reviews exploring interventions for fatigue in other cancer populations:

Exercise for the Management of cancer-related fatigue in adults (2012) [pdf] – aerobic exercise was found to be beneficial both during and post-treatment.
Psychosocial interventions for reducing fatigue during cancer treatment in adults (2009) [pdf] – fatigue-specific education, self-care, coping strategies and activity management were beneficial. However there was no evidence for psychosocial interventions taking a more general approach aimed at e.g. improving mood.
Drug therapy for the management of cancer-related fatigue (2010) [pdf] – Methylphenidate showed a small improvement in fatigue.
Pharmacological treatments for fatigue associated with palliative care (2010) [pdf] – Methylphenidate showed a superior effect, however evidence was limited and patient groups varied.

Resources
Getting a better sleep [pdf]
Breathing exercises [pdf]
Pleasurable activity suggestions [pdf]
Coping with low mood (building up activity, managing unhelpful thoughts, problem solving, seeking help from others) [pdf]