Fatigue is a state characterized by exhaustion, weakness, lassitude, weariness and decreased capability of physical function. While acute fatigue can be a normal result of periods with lack of sleep or of lassitude, a long period of fatigue, known as chronic fatigue, is not normal and can interfere with people’s quality of life. In patients with cancer, the term that refers to these ongoing condition is cancer-related fatigue (CRF). Being a rare but aggressive type of cancer, patients with mesothelioma are prone to experiencing CFR.
Mesothelioma develops in the mesothelial cells, which line the organs to keep them moist and form a layer known as the mesothelium. This type of cancer is caused by exposure to asbestos, since the material can release fibers into the air that are inhaled or swallowed. The asbestos fibers then become trapped in the body and irritate the cells, causing the formation of tumors. Fatigue is one of the symptoms experienced by patients not only due to the disease itself, but also due to treatment.
How Fatigue Affects Patients with Mesothelioma
Fatigue can be experienced by patients with mesothelioma for one of two reasons. It can take decades between asbestos exposure and the first symptoms, but as the disease progresses, patients start to experience symptoms like weight loss, breathing difficulty, insomnia, anemia, hormonal changes and loss of appetite, which lead to chronic fatigue. In addition, not only can anxiety and depression related to coping with mesothelioma cause fatigue, but fatigue can also be the origin for anxiety and depression. Regarding treatments, it is common for patients to experience fatigue during and after chemotherapy or radiation therapy. Fatigue after chemotherapy or radiation therapy usually gets worse with subsequent cycles and can last even a year or two after the end of the treatment.
Patients with mesothelioma that experience fatigue may feel the need to spend more time resting and sleeping, too tired to work or conduction daily activities, tiredness even after sleep, lethargic after minimal exertion, as well as sudden and overpowering fatigue. Factors that contribute for fatigue or its exacerbation include pain medication, nausea medications, treatment-related weight loss, stress, poor sleep, depression, anemia or other blood component imbalances.
Management of Fatigue in Mesothelioma Patients
Fatigue in mesothelioma patients is unpredictable and the patient may feel energetic one day and exhausted in the other without any alterations in activity or rest. There is currently no cure for mesothelioma, but there are treatments that can help ease the symptoms, including surgery, chemotherapy and radiation therapy. In addition, the physicians can identify the cause for the fatigue and recommend specific strategies that help fight it. In the case of a physical cause, like anemia or lack of sleep due to pain, a solution like iron supplements or pain medication respectively can reduce the symptoms. Physicians can also teach patients how to conserve and ration their energy, prioritizing activities and keeping track of energetic expenditure according to the chemo cycles.
Recommendations include spending energy on fun activities instead of housework or chores, scheduling periods to rest rather than waiting to be tired, as well as avoiding long and hot showers. It may seem paradoxical, but mild to moderate exercise can reduce fatigue by minimizing the loss of muscle mass, which is common among mesothelioma patients. Nutrition can also help fight fatigue since patients often feel nausea or lack of appetite and not eating enough contributes to fatigue. However, having a diet high in protein and calories can help reduce the symptom. In addition, it is important that patients readjust their expectations. By understanding that fatigue is part of the disease and treatment, patients can schedule their activities more realistically and allow themselves to rest as needed.
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