Distress, Fatigue, and Sexuality

Cancer patients may suffer from cancer-related or treatment-related quality of life issues that interfere with their usual functioning. Learn about the causes of fatigue, distress, and sexual dysfunction and how to cope with these problems.

Cancer-Related Distress or Depression

Multiple myeloma patients may experience a variety of difficult emotions. Anxiety and distress or depression can be provoked during diagnosis, assessments for response to therapy, treatment, and recurrence. Anxiety may increase pain, affect sleep, and cause nausea and vomiting. Distress is emotional, mental, social, or spiritual suffering leading to feelings of vulnerability, sadness, depression, panic, or isolation. Symptoms of distress and anxiety can include trouble focusing, muscle tension, trembling or shaking, dry mouth, and anger.

Managing Distress

• Talk to the doctor about getting some professional counseling and/or taking anti-anxiety or anti-depressant medication.
• Take time for some relaxation or gentle exercise to help de-stress.
• Share your feelings and fears with others.
• Caregivers should listen carefully, offer support, and validate the patient's feelings.
• Know that it's normal to feel sad and frustrated as a cancer patient.
• Spiritual support through prayer or meditation may be helpful.
• Steroids can increase anxiety, so discuss adjusting your steroid dose with your doctor.

Cancer-Related Fatigue

Cancer-related or treatment-related fatigue is a persistent sense of tiredness or exhaustion that is not proportional to recent activity, is not relieved by sleep, and interferes with usual functioning. Common causes of fatigue in myeloma patients are the following:

• myeloma-induced anemia
• treatments for myeloma
• high levels of cytokines, molecules that send signals within the immune system
• persistent pain
• other medical problems and medications for them
• poor nutrition

Asthenia (General Weakness)

General weakness (asthenia) is often a component of fatigue. Symptoms may affect physical, psychological, and social functioning. If your fatigue is the result of a source other than anemia, there are no laboratory tests that can be used to diagnose it. There are many medical conditions that can cause fatigue, including poor thyroid function, dehydration, liver problems, sleep disorders, infection, and progression of multiple myeloma. Your healthcare team must try to identify the source or sources of your fatigue and find ways to manage it most effectively.

Patients need to openly discuss their feelings of fatigue and weakness with members of their healthcare team. Do not think that feeling tired and weak is not important enough to mention at your appointments. Make note of the following and share with your healthcare provider:

• medications that you are taking (many of the treatments for multiple myeloma increase feelings of fatigue or cause fatigue)
• emotional stress, anxiety, or depression
• presence and location of physical pain
• existence of other conditions or illnesses
• sleep disturbances
• dietary changes
• changes in weight
• changes in activity or daily routine
• changes in health

Managing Fatigue

Your healthcare provider may:

• Adjust your medications.
• Modify your dietary intake.
• Improve your fluid and electrolyte intake.
• Prescribe drugs that can help with daytime wakefulness.
• Suggest a clinical trial for treating fatigue.

What you can do to help your fatigue:

• Get regular exercise (walking, swimming, gentle yoga).
• Do things and see people you enjoy.
• Get a good night's sleep.
• Prioritize your activities and don't try to do too much in one day.

Sexual Dysfunction

Anxiety, distress, fatigue, and some medications cause sexual dysfunction in both men and women.

In Men

Erectile dysfunction has been documented from use of:

• Steroids, Cytoxan® (cyclophosphamide), melphalan, thalidomide, Velcade® (bortezomib), and Revlimid® (lenalidomide).
• Steroid therapy may also reduce desire.
• Other conditions such as diabetes, prostate cancer, thyroid disorders, hypertension, kidney disease, cardiovascular disease, pain, depression, and disturbances in body image may reduce sexual function.

In Women

Women may experience loss of arousal, painful intercourse, loss of desire, and difficulties having an orgasm.

Sexual dysfunction may be caused by medications, hormonal therapy, ovarian failure, pain, body image changes, and changes in interpersonal relationships.

Managing Sexual Dysfunction

• Report your problem to your healthcare provider, who will address underlying concerns to see if they are affecting your functioning
• Seek therapy with your partner to familiarize yourselves with one another's sexual changes
• See a gynecologist, urologist, or endocrinologist to discuss medical treatments for sexual dysfunction that are safe for you to use.