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How Do I Cope With Cancer Fatigue?

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Published on January 20, 2020

Key Takeaways

Dr. Bram Kuiper, a clinical psychologist who has worked with cancer patients for over 32 years, joined Patient Power to discuss some causes of the extreme physical and mental exhaustion patients can experience, and a multifaceted approach to combat cancer-related fatigue.

Watch as Dr. Kuiper shares ways to monitor fatigue and manage energy levels.

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Transcript | How Do I Cope With Cancer Fatigue?

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Rebecca Seago-Coyle:           

Hi everyone. I'm Rebecca Seago-Coyle with Patient Power, and I am the Content Strategist and Community Director. Today, I'm here with Bram, and we're going to be talking about cancer and fatigue. Welcome. 

Dr. Kuiper:                 

Thank you, Rebecca. And my name is Bram Kuiper. I am a clinical psychologist, psycho-oncologist, and I've been working with cancer patients for the last 32 years. So, I have a lot of experience with all kinds of problems you are dealing with, like depression and fear of recurrence, but also, importantly, with fatigue. And at this moment, we are talking with each other, because we developed a non-medical solution in addition to medicine for fatigue. And I'm very pleased to tell you about it. 

Rebecca Seago-Coyle:           

Wonderful. So, Bram, can you tell us what—I think folks who are going through cancer today, one of the things that they do experience is being tired all the time.  How do they prepare for that, and how do they help solve that problem when they're going through treatments?

Dr. Kuiper:                 

Yeah, very important questions, Rebecca. So, in the first place, we know that fatigue has many causes, can have many reasons. We know that, for example, limited physical activity can be the reason for fatigue. Sleeping disorder—70 percent of all the fatigued cancer patients suffer from a sleeping disorder, and mood problems, having problems with your nutrition. So, most of the time, there are many factors influencing the fatigue. It's not one factor. It's many different factors.

So, you have to be aware about your own vicious cycle you enter in after a while. That's the first thing. So, you have to monitor the causes playing in your individual life. Secondly, it's very important to manage your energy and also, of course, to manage your expectations about your energy. And it's also important to talk about energy instead of fatigue.

And I'd like to emphasize something else. The cancer-related fatigue is different from normal fatigue, and I think we have to say that loud and clear. It's because it comes suddenly without any warning. It's not only being fatigued. It's being exhausted.

Rebecca Seago-Coyle:           

Right. And not just physically exhausted, but sometimes mentally exhausted. I think that's something people don't realize as well. 

Dr. Kuiper:                 

Sure. I fully agree with that. And so, it's a combination of physical and mental fatigue. And the third factor is that it takes a long period to recover, because other people who are normally fatigued, they can have a good night. And then they wake up, and they're full of energy, and they start the day. But that's not with cancer-related fatigue.

So, returning to what you can do. So, you have to first monitor, then manage your energy. And also, thank the fact that it's not constantly at the same levels. So, it would go up and go down.

Rebecca Seago-Coyle:           

I think that's really good advice. I love the three things that you talked about, about fatigue, like monitoring what your fatigue is, managing your energy levels, and then also understanding the recovery time can be longer. I know when I was going through my own treatment, someone told me about a theory called the spoon theory. Are you familiar with that? 

Dr. Kuiper:                 

Yeah, yeah. I know. I know, yes. 

Rebecca Seago-Coyle:           

Yeah. So, the concept of that is you have, say five spoons. You're given five spoons every day, and you have to decide who you give your spoons to. Where do you give your energy towards? And when you're going through cancer, you have to learn how to say no. And it's hard, because I think a lot of us are yes people, and we want to do things, and we don't want cancer to slow us down. But it's part of the recovery process. 

Dr. Kuiper:                 

Yeah, I fully agree. And I think that it's a good and simple way to understand that. But with the spoon theory, it's only spending energy, but you can also win spoons. You can get spoons. So that's, I think, also important to think about.

Rebecca Seago-Coyle:           

So, talk to me a little bit about what advice do you give people when you're recovering from cancer? You mentioned that it may take longer than you expect. So, how do you coach people and talk to people about getting back to normal? I think we all agree that the phrase that's floated around there a lot is the “new normal” after cancer. 

Dr. Kuiper:                 

Yes.

Rebecca Seago-Coyle:           

So, how do you talk to people about recovering from cancer fatigue

Dr. Kuiper:                 

Yeah. It has to do with the fact—I, first of all, start with letting people talk about their own lives and how it changed, and what their expectations are about life. And that's the first thing. And then, I like to work on planning. Every patient, every person is unique. So, we plan the future with little steps, not big steps, only little steps. And don't be disappointed if after two steps forward, there's one step backwards, and that enough is enough, also. So, it's a mirror, of course. Cancer is a mirror. You're faced with yourself and all your good things and your bad things.

Rebecca Seago-Coyle:           

Well, I feel like you were kind of asking some deep questions there—to be or not to be, or it is what it is sort of things, and internal reflection. Well, I think it's good to sometimes take a step back and look how far you’ve come. And I think sometimes, we don't do that very often. And notice six months ago, I was really tired. Now, I'm still tired, but maybe I'm not as tired as I was six months ago.

Dr. Kuiper:                 

Yeah, yeah.

Rebecca Seago-Coyle:           

So, recognizing progress.

Dr. Kuiper:                 

Yeah, right. So, from my background, I'm a cognitive behavioral therapist, and we work with milestones. And so, you have to monitor your progress because if you ask somebody, "Can you tell me about the last two weeks?" They say, "Oh, oh. Where are the last two weeks?" But if you write down every day about your moods, and about your sleep, and about the pain, etcetera, so you have a kind of diary, then you can be more precise about your progress. And then, you can figure out whether there are, for example—weekends are better or worse than the other days, for example. So, you can see specific symptoms.

And that's another thing. Like I told you, Rebecca, from my perspective, you know that our behavior is influenced by our emotions, and our emotions are more or less determined by our thoughts. And often, if you have a chronic problem like fatigue, then there are a lot of non-helpful thoughts influencing your feelings, your emotions, and it has influence on the way you're living. The main goal is to keep persons mentally and physically active. So, if you are afraid of exercising, don't be afraid, because it's also, for fatigued people, very good to be active even if you feel tired.

Rebecca Seago-Coyle:           

Yes. I will say I feel like that sometimes feels counterintuitive. It's like I'm tired, but I do know from experience if I go walk around the block and get some fresh air, I do feel reenergized. And I think it's hard for people to think that way sometimes. 

Dr. Kuiper:                 

Yeah, I think so. And so, that's a good example. And you probably forget the fact that you’ve done that. So, sometimes it's good to make a notation about it. So, the next time you will do it because, “Oh, yeah, I know there is a hurdle, and there is a threshold. When I go for it, then I will get some benefits.”

Rebecca Seago-Coyle:           

Exactly. And I think reminding people even just a little bit of exercise, a little bit of fresh air can help that. When we say exercise, we don't necessarily mean go out and run a marathon.

Dr. Kuiper:                 

No, no, no. 

Rebecca Seago-Coyle:           

It's just a little bit of movement of your body that really can help. 

Dr. Kuiper:                 

Yeah, I agree with that. That's also connected with my explanation about the non-helpful thoughts. If you think exercise means you have to swim three kilometers or run the marathon, it's not that.

Rebecca Seago-Coyle:           

Right. 

Dr. Kuiper:                 

You start with a three-minute walk around your house, for example. And after a week, you can walk for five minutes or six minutes, or something like that. And I mentioned that it can lead to social isolation, so a lot of people suffer on their own. Always ask other people to help you. Try to find somebody. It can be somebody, it can be a neighbor. It can be one of your kids. It can be one of your colleagues, just somebody to ask to be a buddy for two or three months to support you and help you get more energy. 

Rebecca Seago-Coyle:           

And I think on the flip side of that, I actually have several friends who've been through a cancer diagnosis, too. And recognizing if you've been there before, and you see someone else going through it, saying something of, "Hey, I know how you're feeling." It's more than just say, “Call me if you need something.” It's maybe saying—actually, I saw this recently, "Hey, I'm headed to the grocery store. What can I pick up for you?" Offering, on the flip side, if you’ve been on the receiving end of someone's help, paying that forward and recognizing they're probably feeling a little fatigue as well.

Dr. Kuiper:                 

I fully agree with you. Yeah.

Rebecca Seago-Coyle:           

Well, Bram, this has been really exciting and really great advice. Just to kind of summarize what we've talked about today, from your experience of dealing with cancer and fatigue in patients, and from a psychological point of view, there are three things that I really heard you mention. And that was monitoring, taking a step back and monitoring what could be the causes of fatigue. What are you doing, or what's causing the fatigue? Kinda helping managing, finding new ways to manage your energy.

And then, also recognizing that the recovery process may take longer than you're really expecting, and that's okay, because you're a new person. You’ve gone through something, and that can really help your recovery process. 

Dr. Kuiper:                 

Yeah. I fully agree with your recap.

Rebecca Seago-Coyle:           

Yes. Well, Bram, thank you again for your time today. Here at Patient Power, what we always say is knowledge can be the best medicine of all.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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