Lung cancer, fatigue and loss of appetite
My dad has had lung cancer for over a year. He has had chemotherapy but is not having treatment now. He feels very tired all the time and has no appetite. I am worried that his cancer has got worse and no one seems to be helping him.
Tiredness and lack of appetite are difficult symptoms to cope with. This page has information that we hope will answer some of your questions and help you understand your Dad’s symptoms. You can find information about
People with cancer often feel very tired and lack energy. Doctors call this fatigue. Loss of appetite is also very common. These symptoms can be very distressing and frustrating for your Dad and the people around him. There may be several reasons for the symptoms and there are things that can be done to help. It doesn’t necessarily mean that the cancer is getting worse. His doctor will be the best person to talk to about this.
Fatigue means tiredness and lack of energy. You feel as if you can't do things at your normal pace. We all have these feelings at times but they usually go away if we are able to rest. Fatigue for people with cancer can be very different. It may not go away even with rest. It can go on for weeks, months or even years after treatment. This is called chronic fatigue. In general most people having treatment for cancer get their normal energy levels between 6 months and a year after treatment ends. But for some people it can take longer.
Now that pain and sickness are usually well controlled, fatigue is the most common and troubling symptom for people with cancer. As many as 9 out of 10 people may have it at some time during their illness or treatment. But only 2 in 10 think that something can be done about it. So most of them don't ever mention it to their doctors. Doctors and nurses haven't always appreciated the long term effects of fatigue on people with cancer. But there is an increasing amount of research in this area. Things are improving and there are ways of relieving fatigue.
Fatigue can be very frustrating. You and your Dad may underestimate how much it can affect daily life. It can affect people mentally, physically, emotionally and spiritually. Everyday life can be hard work and he may not have the energy to cook, clean, wash or go shopping. Your Dad may not even feel up to a chat at times. Doctors may overlook fatigue, leaving your Dad feeling as though he has been left to cope alone.
All this can affect the way your Dad feels about himself and his relationships with people close to him. He may feel very down and not want to go out or be with people. This may be hard for others to understand, as they are not feeling the same way.
The symptoms of fatigue are very general and other things can cause them too. Your Dad should always let his doctor know of any new or unusual symptoms he has. Your Dad may
- Lack energy – he may just want to stay in bed all day
- Feel he cannot be bothered to do much
- Have problems sleeping
- Find it hard to get up in the morning
- Feel anxious or depressed
- Have aching muscles – he may find it hard to climb stairs or even walk short distances
- Be breathless after small tasks, such as showering or making his bed
- Find it hard to concentrate, even if only watching TV or chatting
- Find it hard to think clearly or make decisions easily
- Lose interest in doing things he usually enjoys
- Have negative feelings about himself and other people
We don't fully understand the causes of cancer fatigue, but we know that a number of things can contribute to it including
- The cancer itself
- Other health problems, such as diabetes or heart disease
- Side effects from cancer treatment such as chemotherapy, radiotherapy or biological therapy
- Anaemia – a shortage of red blood cells in the body causing low levels of oxygen
- Side effects from other drugs such as steroids or painkillers or sleeping tablets
- Problems with eating such as loss of appetite and feeling and being sick
- How you feel – anxiety or depression can increase fatigue
- Sleeping problems
It is not unusual for people with cancer to have times when they feel very sad. But if these feelings continue for long periods it may mean that the person is depressed. Depression is quite common in people with lung cancer and is more than feeling low for a short time. It is important that your Dad sees his doctor if he has been feeling like this for a long time.
It may help your Dad to talk to a counsellor about his feelings. There is information about what counselling is in the coping with cancer section. Your Dad's doctor can prescribe him drugs for depression, if appropriate. Anti depressants can really help with clinical depression.
You may not be able to do much about some of the causes of cancer fatigue. But there is help available for the symptoms. There are suggestions below. Your Dad may find that our suggestions don't always help. Trial and error, learning how to manage fatigue and time may help more in the long run. But the first step is for your Dad to tell his doctors and nurses about his fatigue. More than half the cancer patients who have fatigue have never told their doctor about it.
It may help your Dad’s fatigue to
- Treat anaemia
- Get support from other people
- Improve his diet
- Learn to manage his fatigue
Most people with cancer will develop anaemia at some point during their illness. Your Dad's doctor can check whether he is anaemic by doing a blood test. Although it's not usually harmful, fatigue caused by anaemia can have a big effect on daily life. If he is anaemic a blood transfusion will bring the red cell count up again and provide an energy boost. Up to a third of chemotherapy patients may need a blood transfusion for anaemia.
This may be the last thing your Dad feels like doing. He may feel so tired that the idea of doing any exercise seems ridiculous. But sometimes the less people do the less they feel like doing. Light to moderate exercise every day helps people with cancer to feel better and can give them more energy. Just a short walk each day helps. But it is important not to overdo it. Your Dad should get advice from his doctor before starting an exercise programme.
Exercise can also help people with advanced cancer. They may not be able to go for a long walk but even gentle exercises in bed or standing up can help. Your Dad may be able to get some advice from his hospital physiotherapist. They can help to plan an exercise programme that is suited to his needs.
It may help your Dad to talk to other patients with cancer. Just about everyone needs support from someone when they have cancer. Support from other people who've been through the same thing can make all the difference. Talking to others at a support group can show that you are not alone. It can confirm that fatigue is something many people with cancer have to get to grips with. Like you, your Dad may worry that his fatigue means his cancer is getting worse, but it may not mean that at all.
If your Dad has advanced cancer and is very tired, it is important that he sets himself a few rest times throughout the day. This can be difficult to stick to and he may try to push himself to keep going. But that could make him more tired and less able to cope. He doesn’t have to sleep during these rest times. If he is having trouble sleeping at night it may be better if he doesn’t actually sleep during the day. Even if he just sits or lies down somewhere quiet, it may help to give him more energy. Just sitting or lying down to rest will help. There is information about conserving your energy further down this page.
Eating enough to keep up your energy is hard if you have no appetite. But diet plays an important role in controlling fatigue. So anything your Dad can manage to eat will help. You can get advice from a dietician at the hospital. Your Dad's doctor can prescribe nourishing drinks that he can sip between meals to boost his calorie intake.
If your Dad is feeling sick as well this will make it harder for him to eat much. There is information about feeling and being sick and ways to help control sickness in the section about coping physically with cancer.
If you or your Dad would like more information about anything to do with diet, contact one of the organisations on the lung cancer organisations page. They will be happy to help and can send you free factsheets or booklets.
Your Dad can do many things in his everyday life that will help him save energy. Taking short cuts on some things or getting help from others may both help him feel less tired. Here are some suggestions
- Try not to rush – plan ahead where possible
- Allow plenty of time for travel, and avoid the rush hour if possible
- Put chairs around the house so he can easily stop and rest if necessary
- Sit down to dry off after a bath, or simply put on a terry towelling dressing gown and let that do the work
- Get hand rails fitted in your bathroom to hold when getting in and out of the shower or bath (the hospital can help to arrange this)
- Prepare clothes and lay them out in one place before dressing
- Get dressed sitting down, as far as possible
- Try not to bend too much – rest a foot on the other knee to put socks and shoes on
- Wear loose fitting clothes and things with few buttons
- Where possible do household tasks sitting down – for example, peeling vegetables or washing up
- Use a duster on a long stick and sit to do dusting
- Write a shopping list and go when the shops are quiet, or shop on the internet
- Ask family and friends for help with shopping and housework
- Have plenty of nutritious snacks and drinks in, so he can have something quickly and easily whenever he feels like eating
- Don't forget to do things that he enjoys – it will take his mind off his cancer and make him feel more relaxed
Doctors call any loss of appetite anorexia. Anorexia is common in people with cancer. It can happen in the early stages of the disease or much later if the cancer grows and spreads to other parts of your body. As many as 1 in 4 people diagnosed with cancer (25%) have loss of appetite. Up to 9 out of 10 people with advanced cancer lose their appetite. There may be a particular cause for your Dad’s loss of appetite. Or it may just be that he is feeling too tired or fed up to bother eating much.
Cancer and treatments such as chemotherapy or biological therapy can cause loss of appetite. Chemotherapy can change the taste of some foods or cause sickness. The memory of this can stay with you and affect appetite even after treatment is over.
These are some suggestions that might be helpful to improve your Dad's appetite. Encourage him to
- Try to eat small amounts of high protein and high calorie foods every 2 or 3 hours instead of 3 large meals a day
- Ask friends and relatives to prepare meals for him – cooking can put you off eating
- Add extra calories and protein to foods (using butter, cream, milk, honey or cheese)
- Avoid fried foods or foods with a strong smell if they make him feel sick
- Keep snacks handy to nibble – such as nuts, crisps, grated cheese or dried fruit
- Eat cold or slightly warm food if the smell of cooking puts him off eating
- Prepare and store small servings of favourite foods ahead of time – so there is always something to eat when he does feel hungry
- Try out new foods and tastes
- Give himself a break if he really doesn’t feel like eating much every day – always drink, but make up for lost calories another day
- Avoid getting over tired – everything is more difficult to cope with if you are exhausted
- Avoid drinking large amounts before eating – it will fill him up
- Ask his doctor to prescribe a high calorie meal in a drink if he is worried about losing weight
- Relax and not do anything else while eating
- Have a small glass of an alcoholic drink, such as sherry or beer, before meals – it can stimulate appetite for some people
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