Fatigue (feeling weak, slow, and tired) is the most common and burdensome symptom. Fatigue can get better after radiation or chemotherapy ends, but it may take some time.

Why fatigue happens during cancer

• Anemia (low red blood cell count)
• Poor appetite or treatment side effects like nausea
• Stress and lack of sleep
• Little physical activity
• Nerve and muscle weakness
• Breathing problems
• Pain
• Infection
• Medication side effects

Fatigue from cancer can affect daily life and quality of life. It may cause problems with relationships and social activities, mood and well-being, and the ability to focus or think clearly.

Managing Fatigue

Some things that can help:

• Blood transfusions, iron supplements, and medicines to help make new blood cells if you have anemia
• Exercise programs
• A healthy eating plan (a dietitian or nutritionist can help)
• Relaxation techniques, such as meditation programs and yoga
• Medication reviews with a healthcare provider
• Antidepressant medications

Depression and anxiety are common in older adults with cancer

They are linked to lower quality of life and more problems with treatment. People with cancer and their families may not recognize the signs of depression.

Older adults with cancer may report more:

• Problems with their health, relationships, and outlook on life
• Feelings of being a burden to family, friends, and caregivers

Tell your healthcare provider if you feel low, irritable, or hopeless. Depression can and should be treated. Do not feel ashamed about your feelings.

Cancer patients with a higher risk of depression include those with:

• An advanced stage of cancer
• Pain that is not well controlled
• Physical limitations
• Chemotherapy

Managing Depression

Older adults with cancer have treatment options, such as:

• Medications: Antidepressant medicines work well in older adults. A lower dose may be needed to avoid side effects. The healthcare provider must choose drugs that work safely with chemotherapy or other medicines.
• Counseling: Talking to a counselor or therapist about depression is one of the best ways to understand and cope with emotions. Counseling often works even better when taken along with antidepressants.
• Support groups: Many older adults with cancer find help in support groups with people of similar ages and cancer types. Healthcare providers, the American Cancer Society, hospital social workers, or community centers and places of worship can help you find support groups.

People with cancer have a higher rate of suicide than other groups. Talk to your healthcare team, family, or caregivers if you have thoughts of suicide.

If you need immediate help, call the National Suicide Prevention Lifeline at 988 or 911. You can also go to the nearest Emergency Room.

Some people may have fuzzy thinking or confusion, especially during chemotherapy. This is known as chemotherapy-associated cognitive impairment, or “chemo brain.” Older cancer patients may be more likely to have trouble thinking during treatment.

Most of these effects do not last long, are not serious, and often get better on their own. However, some older adults may have a harder time doing daily activities.

Managing Changes in Thinking or Memory

To help manage these problems, consider:

• Using a daily planner and keeping to-do lists
• Keeping an easy-to-read list of addresses and phone numbers
• Doing brain exercises, such as taking a class
• Getting enough sleep and exercising regularly
• Eating a balanced diet, including brightly colored vegetables each day
• Trying to focus on one task at a time
• Asking others for help when needed
• Keeping a diary of memory or attention problems to share with a healthcare provider

If symptoms do not improve, you may need to see a specialist for an evaluation and a treatment plan.

Many older people with cancer have a poor appetite, nausea, or vomiting. These symptoms can lead to weight loss and loss of muscle strength.

Before starting cancer treatment, work with your healthcare team to improve your appetite and keep your weight stable. Nutritional supplements can help. Medicines can improve appetite or reduce nausea, but they may have limited benefits and side effects. Your provider may prescribe them for a short time.

Helpful hints for a better diet

• Eat small but frequent meals
• Focus on highly nutritious foods that are not heavily processed
• Consider making smoothies to take in high amounts of nutrition in an easy-to-digest form
• Limit fatty foods to avoid nausea
• Add lemon or lime juice, herbs, and spices to improve the taste of food
• Eat in a comfortable setting with food that looks appealing
• Take supplements when your healthcare provider recommends them. These may include B vitamins, vitamin C, or vitamin D.

Pain can range from mild to severe and can change from day to day. Pain may be acute (starting suddenly) or chronic (lasting a long time). There are many treatment options for pain, and managing it is an important part of cancer care.

Tell your healthcare provider if you have pain. They need to understand what you are feeling and help you manage it. Treating pain early can keep it under control and prevent it from getting worse.

See the Pain Management chapter for more information on this topic.