Cancer Related Fatigue

Fatigue can be a significant problem for individuals undergoing cancer treatment. This page contains information that will help you understand cancer-related fatigue and give you suggestions for managing fatigue in your daily life. If you need further information after reading this booklet or at any time, talk to your doctor, nurse or occupational therapist – they want to help!

Goals Of Fatigue Management

Health professionals at roswell Park Cancer institute (RPCI) have developed strategies to help you manage your cancer-related fatigue. These strategies stress the importance of using energy effectively and keeping regular schedules of sleep and rest. The goals of these strategies are to reduce your level of fatigue, to maximize your productivity, to help you maintain important activities in your daily life, and to help you adjust to limitations imposed by fatigue.

Ask you doctor about fatigue. There may be medical or treatment methods that could be helpful in managing your fatigue.

What Is Fatigue?

Fatigue is the feeling of being tired physically, mentally and emotionally. When you are fatigued, you have less energy to do the things you normally do, or want to do. Cancer- related fatigue is a severe type of fatigue that may be caused by cancer treatments, such as chemotherapy, radiation therapy or surgery. Unlike normal fatigue, cancer- related fatigue can be chronic, may not be relieved easily by rest or sleep, and could interfere with your ability to perform your usual activities independently.

  • Fatigue can be one of the most distressing side effects of cancer treatments, and it can severely affect your quality of life.
  • You may experience mild, moderate, or severe fatigue while receiving treatment; however, feeling fatigued does not mean that your treatment is not working or that your cancer is getting worse.

What Can Cause Fatigue?

Fatigue is a common result of chemotherapy, radiation therapy and blood and/or marrow transplant treatments, due to the destruction of healthy cells in the body. Anemia – too few red blood cells to meet the body’s energy needs – also can cause fatigue. Anemia can be prevented or decreased by taking iron pills, vitamin B-12, folate or drugs that stimulate the production of red blood cells. These drugs may increase energy and activity levels. Your doctor will tell you if anemia is the cause of your fatigue, and whether taking any of these medications could benefit you.

  • Sleep disruption, stress and not eating or drinking enough also can cause fatigue.
  • Pain can also contribute to your fatigue. Talk to your health care professional about ways to manage or reduce your pain.

Describing Cancer-Related Fatigue

People describe cancer-related fatigue in the following ways:

  • Feeling tired, weak, weary, worn-out, slow, exhausted, short of breath after light activity, lack of energy; heaviness in arms and legs
  • Impatient, difficulty concentrating
  • Lack of interest in pastimes and hobbies, leading to feeling sadness, irritable and frustrated
  • Difficulty sleeping; sleeping too much

Ways To Manage Fatigue/Get The Most Out Of Your Day!

Maintain Good Nutrition

Eating a proper diet that provides proper nutrition is important in dealing with cancer-related fatigue. Because side effects of cancer treatments can make getting good nutrition more difficult, try some of these suggestions:

  • Eat well-balanced meals and drink plenty of liquids
  • If large meals are too difficult to eat, try eating many small meals or snacks
  • Use liquid diet supplements (Boost, ensure) to get extra calories and needed nutrition
  • Eat foods which are high in complex carbohydrates (pasta, fresh fruits, whole grain breads) for long- lasting energy
  • Let friends and family prepare meals for you, especially if you are too tired to do so. Try snacking on graham or animal crackers, which are low in fat, and high in carbohydrates

If you need further assistance with planning meals or getting needed nutrition, please speak with your doctor who may refer you for a nutritional consultation.

Decide What Is Necessary

Choosing the really important activities is essential to conserving energy. Decide which activities you must do today, and those that can wait or be delegated to family and friends. It is important to set realistic, highly-achievable goals for each day or for part of the day. By doing so, you can feel good about yourself and conserve your energy.

Try to follow some of these tips when deciding which activities are necessary:

  • Put off jobs that need not be done everyday (making the bed)
  • Be flexible; your goals might change during the day (you may wake up and want to do the laundry, but find you are a little tired; so you do the dishes instead)
  • Accept help from others! Let your friend or neighbor go to the store for you
  • Keep a "wish i could" list near your phone so that when a friend or neighbor calls and asks what they can do, you can tell them! Remember favors can be repaid at a later time.
  • Do not force yourself to do more than you can manage
  • Take it slow and pace yourself during activity

Plan Your Day

Plan activities for the time of the day when you tend to have more energy. This allows you to more fully enjoy these important activities. Plan ahead for rest periods between activities to minimize the amount of fatigue you acquire throughout the day.

Here are some tips:

  • Rest between activities such as bathing, dressing, walking and doing chores at home
  • Pace yourself. Everything does not have to be done now. Get up, take a shower, rest for 5-10 minutes, then get dressed. Rest again before making breakfast. You will be surprised at all of the energy you will save by resting in between activities!

Conserve Your Energy

You can control how and when you will use your limited energy. By following the suggestions mentioned in this booklet, you will be on your way.

Here are some more helpful suggestions:

  • Store frequently-used items within easy reach and close by to reduce trips to the kitchen and bathroom. for example, in the morning, carry all needed materials into the bathroom. use a wheeled cart and push it to the bathroom if possible. a cart can also be helpful in the kitchen to move needed materials.
  • Try easier and shorter versions of activities you enjoy. instead of standing to do an activity, sit. Prepare a meal sitting at the table instead of standing at the counter.
  • Use proper body mechanics. When sitting, use well supporting chairs; adjust work heights to avoid bending over; bend at hips and knees, not at the waist; when seated, use a cross leg method to wash or dry feet. try putting legs and feet on a footstool to avoid bending during dressing and bathing.

Plan Regular Exercise

Plan an exercise to do everyday despite the fatigue. Studies have shown exercise to be a helpful way to fight fatigue and increase the amount of energy we have. You should exercise even when you don’t feel like it; even if it is only for a few minutes at a time.

Consult with your doctor before beginning any exercise program. When given the oK by your doctor, try some of these suggestions:

  • Aerobic exercise – walking, running, rowing, bicycling or dancing – is an excellent way to exercise and get energy.

If your fatigue is more severe and these activities are impossible, try getting dressed and walking around the house. The important thing is to move about as much as you can, even if it is just a little.

  • Ask your doctor if a physical or occupational therapy consultation is needed to establish an exercise program to increase energy and endurance.

Use Restorative Activities

Restorative activities help rest your mind, boost your spirits and improve your sense of well- being. Activities such as those listed below can decrease stress and assist in distracting you from thinking about your fatigue.

Stress relieving activities

  • Yoga
  • Meditation
  • Exercise
  • Massage
  • Visual imagery
  • Laughing
  • Enjoying nature by bird watching or fishing

Distracting activities

  • Listening to music, playing music or singing
  • Reading a book
  • Playing cards
  • Playing a board game
  • Video games
  • Visiting with a friend
  • Doing a hobby or making a craft
  • Enjoy the company of a pet

Ways To Manage Fatigue Through Rest And Sleep

In addition to getting the most out of your day through good nutrition, doing only what is necessary, exercising, planning and using restorative activities, you have to rest.

The following tips promote rest and sleep:

  • Maintain a regular schedule of nap and sleep times. Going to bed and waking up at the same time each day will help your body get into a routine. This will make falling asleep easier at night.
  • Stay as active as you can during the day, without becoming overly fatigued. Remember your strategies are to plan, do what is necessary and conserve your energy. Remember that doing nothing will not reduce fatigue. By being active during the day, you will be assisting more normal fatigue or the tiredness you feel at the end of the day to set in. You may fall asleep quicker and sleep better, because you had a more active day.
  • Proper positioning during sleep may improve the quality and quantity of your sleep. Occupational therapists and physical therapists can give you techniques for better positioning while you are sleeping.
  • Taking rest breaks are important, so rest when you need to! taking a nap is OK as long as you do not have trouble falling asleep at night. Naps should only be for short periods during the day, no longer than one hour.
  • Listening to relaxing music or reading a book before bed may help you to fall asleep. Whatever seems to make you sleepy and is relaxing is good to do at night before bed, to help yourself to get a good night's sleep.
  • Taking a warm bath or drinking warm milk also can help you to fall asleep. Do what works for you!
  • Limit your intake of caffeine and other stimulants, especially later in the day. Limiting fluids after 7 pm may also decrease the sleep disruption associated with bathroom needs at night.

Fatigue Facts

1.    Fatigue is the most distressing symptom associated with cancer and its treatment. (Network National Comprehensive Cancer of the American Cancer Society)
2.    Fatigue occurs in 78%-96% of people with cancer, particularly in individuals actively undergoing treatment.
(Cancer Nursing 14 (4): 188- 199, 1991) (Seminars in Hematology 34 (3 supplement 2): 4-12, 1997) (National Cancer Institute Cancer Web http: //www.graylab.ac.uk/cancernet)
3.    Cancer related-fatigue is the most common side effect of cancer treatment. (NCCN of the American Cancer Society)
4.    30%-75% of cancer survivors have reported fatigue continuing for months or years after completing active treatment (NCCN of the American Cancer Society)
5.    Cancer-related fatigue can appear suddenly and can be overwhelming. Rest does not always relieve fatigue. (Oncology Nursing Society, 1997; Wake up to Cancer Fatigue)
6.   Fatigue can affect many aspects of daily life. It can affect mood and emotions. (Oncology Nursing Society, 1997: Wake up to Cancer Fatigue)