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Symptom Management:

Symptom Management

Side Effects of Treatment
Side Effects of Chemotherapy
Appetite Loss
Bladder Disturbances
Incontinence - Urinary
Dryness of the Mouth
Fluid and Electrolyte Imbalances
Flu-like Syndrome
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Spinal Cord Compression
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Shortness of Breath
Skin Conditions
Sleep Problems (Insomnia/Oversleeping)
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Sexual Dysfunction


Fatigue is a vague feeling of being tired, weak, or exhausted. It is often a symptom of cancer, when cancer is first diagnosed, or when cancer progresses (Ferrell et al, 1996). It is also the most common side effect of cancer treatment. Some people with cancer have described fatigue as being “tired to the bones” or “hitting a wall.” Others say it is the most distressing side effect of cancer treatment. Fatigue is different for everyone, so it is important that the person who is experiencing it describe how he or she feels. Fatigue may cause decreased ability to work or do physical activity. If the person with cancer is easily distracted and unable to concentrate on mental work or activity, then he or she may have attentional fatigue (Winningham and Barton-Burke, 2000). Depending upon its cause, fatigue can come and go or stay constant for a while. Fatigue from chemotherapy tends to occur a few days after the treatment, peaks, and then gets better before the next treatment. Fatigue from radiation doesn’t happen right away. It develops over the first two to three weeks of treatment and then increases as the treatment continues. It may last three months or more after the treatment is finished. Attentional fatigue can last up until two or three years after treatment is completed.


We currently understand some of the causes of fatigue but not all of them. Fatigue may be related to physical changes caused by cancer or its treatment (chemotherapy, biotherapy, radiotherapy, or surgery). It is reported that the fatigue people get when receiving cancer treatment is more severe than the fatigue healthy people get. In addition, this fatigue lasts longer and is not relieved by sleep. Studies have shown that low hemoglobin is also related to fatigue. Hemoglobin carries oxygen in the blood, so if it is low, the body cells do not get as much oxygen as they need. Also, people who are not well nourished, who don’t drink enough fluid and are dehydrated, or who are not able to move around much tend to have fatigue more easily. Finally, the way a person handles stress, thinks, or behaves can influence fatigue.


If the person on chemotherapy has decreased hemoglobin, or oxygen-carrying capacity of the blood, and it seems like the low hemoglobin level will last for a while, then a medicine called PROCRIT® (Epoetin alfa) may be prescribed. This medicine is given as an injection to keep the hemoglobin at a higher level. This can sometimes manage fatigue. PROCRIT is for anemic chemotherapy patients with most types of cancer.

To manage anemia related fatigue or to lessen it, a person on chemotherapy can also:

  • Eat a well-balanced diet and talk to the nurse or doctor about taking a multivitamin daily.
  • Drink plenty of fluids.
  • Regularly do gentle exercise.
  • Talk about problems with friends and family or the health care team.
  • Ask for help with chores or tasks.

Be sure to talk with your healthcare provider about how you can manage or lessen anemia related fatigue.

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