Managing Cancer-Related Fatigue

Fatigue related to cancer and cancer treatment is common. Cancer-related fatigue can last for months and even years after treatment is finished.  Fatigue is described as physical, emotional, and mental exhaustion that does not improve with rest. 

Causes for Cancer-Related Fatigue

Many things can contribute to cancer-related fatigue.

• The cancer itself can cause fatigue.
• The effects of cancer treatment on your body, like a drop in blood counts.
• Medication side effects
• Infection or other health problems such as diabetes or heart problems.
• Pain, worry, depression, lack of sleep, poor appetite, and other symptoms can also add to fatigue.

Helping your Health Care Providers Help You

• Keep all of your appointments and have your lab work checked when ordered.  This will help your health care team know if there is something causing your fatigue that can be corrected.

• Manage your other health conditions such as high blood pressure or diabetes.

• Ask your pharmacist if any of the medications you are taking might be making you feel tired or sleepy.

• Talk to your nurse and doctor about your fatigue:

• They may ask you to rate your fatigue on a scale from "0" = No fatigue to "10" = Severe fatigue.

• Let our team know how fatigue is affecting our daily activity.

• Notice if your fatigue changes throughout the day.

• Does anything help your fatigue? What makes it worse? Has it changed since your last visit?

• Let your nurse and doctor know if you are having problems with the following: Pain control, nausea or vomiting, loss of appetite, ability to eat a healthy diet, weight loss or gain, depression or anxiety and difficulty sleeping

Strategies to Manage and Cope with Cancer-Related Fatigue

Cancer-related fatigue is real.  It can affect your mind, your body, and your spirit.  Fatigue that goes on and on can make you feel helpless. Here are ideas to help you deal with fatigue.  Sometimes, just knowing you are doing something to address the problem can help you feel more in control.

Take Charge

• Keep track of the times in your day when you are most tired and plan around those times. 

• Keep a "fatigue diary" for a week.  Every two hours, write down what you were doing and then rate your level of fatigue.

• The diary may help you see if there are certain times when you have more energy.

• It may help you see what activities give you energy and which ones make your fatigue worse.

• YOU decide which tasks are most important.

• Try to schedule important tasks for when you have the most energy.

• Pace yourself. spread household tasks throughout the week. try not to 'over-do-it" any one day.

• Pass tasks along to others when you need to.

• Ask for help. Accept help when it’s offered.

• Be specific when you tell people what  they can do.

• Make it something helpful, like cutting the grass, changing the bed sheets, etc.

• Don't forget to thank those who have helped you.
• Keep it simple.
  • Buy clothes that don’t require ironing.
  • Buy easy to prepare foods such as pre-chopped vegetables.
  • When you do cook, make enough for two meals and freeze one for later. 
  • Use labor-saving devices like a cart to carry things or taking the escalator or elevator.

Restore Energy

• Do activities that you enjoy and that make you feel good. This may be quiet reading time, spending time with family, or visiting with friends.
• Do not ignore your spiritual side.
  • It may be difficult to find meaning in your current situation but it is helpful.
  • Do not let your fatigue isolate you. It may be helpful to discuss your feelings of anxiety, tension, frustration, depression, and fatigue with someone you trust and who will listen.
• Eat a healthy diet
  • You want to avoid unplanned weight loss or gain during treatment.
  • Discuss weight changes with your health care team. This includes a dietitian who specializes in nutrition during cancer treatment.
• Massage Therapy
  • Massage therapy can help reduce stress levels and improve sleep. Talk to your doctor first before starting massage therapy.
• Take advantage of “the specialists”.
  • Ask for help when you need it and accept help when it is offered.
  • We have a number of specialist who may help you. This includes psychologists, professional counselors, social workers, and others.

Exercise/Physical Activity

• Exercise is the one thing research has found that actually helps improve fatigue. You may feel more tired than you ever have before, but you need to keep moving!
• Ask your health care team before you start an exercise program.
  • Talk to your team about physical or occupational therapy.
  • See what is available in your community for walking trails, swimming, or yoga.
  • Check out the YMCA! They have free programs for cancer patients.
• Set goals
  • Set goals that you can achieve.
  • Start slowly if you have to. Gradually build up your exercise routine.

Sleep/Rest

Many patients will complain that sleep does not seem to improve their fatigue. Many will also complain of difficulty getting a good night’s sleep.

• Form a sleep pattern. Go to bed at night and get up in the morning at the same time 7 days a week.
• Try to sleep 7 to 8 hours each night.
• Set a bedtime routine. At least 2 hours before bedtime:
  • Start to relax. Take a bath or read for a while.
  • Avoid nicotine and caffeine.
  • Enjoy a light snack but limit fluids.
  • Get regular exercise, but NOT just before bedtime.
  • Stop using electronic equipment such as a computer, notepad or cell phone.
• Create a comfortable sleep environment:
  • Minimize noise, dim lights, and keep the bedroom cool.
  • Replace your mattress every 10-12 years and your pillow every year.
  • Use light covers and bedclothes.
• Limit daytime naps to less than 1 hour. Do not nap during the 4 hours prior to bedtime.
• Consider getting help from a sleep specialist.

Fatigue at Work

Dealing with fatigue at work can be stressful. It would be best if you could have an open discussion with your employer and co-workers and felt they would understand. However, that is not always the way it works.

• Know your resources
  • What are your employee rights and benefits?
  • You may wish to speak to a social worker to know what resources to check.
• You may want to discuss work options with your employer.
  • Can you work from home?
  • Is flexible scheduling an option?
  • Can the job be temporarily modified to reduce physical or mental demands?
• Try to keep communications open with co-workers.
  • Co-workers can be a great source of support.
  • Help co-workers to understand that your cancer treatment is causing fatigue.
• As much as you are able, adjust your work environment so frequently used items are right at hand.

When to call your health care provider

Talk to your health care provider if:

• You are having distressing physical or emotional symptoms that are increasing your fatigue.
• You have symptoms of anemia. This would include unusual shortness of breath, dizziness, dull headache or chest pain, or pale skin color.
• Your fatigue is increasing significantly during the past 7 days or you feel it is lasting longer than it should.