Managing fatigue related to cancer and its treatments

What is fatigue?

Fatigue is the feeling of extreme tiredness or exhaustion all or most of the time. It can feel overwhelming and unrelenting and it is often not improved by rest.

Some people describe fatigue as feeling ‘weary’, ‘exhausted’ or ‘washed out’.

Fatigue is a common symptom of cancer and its treatments. Fatigue can affect anybody at any time regardless of their age or type of cancer. For some people fatigue is very mild and does not interfere much with their daily life but for other people it can be very disruptive.

Please visit www.gloshospitals.nhs.uk/fatigue-and-cancer for more information about fatigue, sleep, nutrition and keeping active.

Common features

If you experience fatigue, you may have one or more of the following symptoms:

• Lacking in motivation, feeling you cannot be bothered. Avoiding socialising because it is too much effort.
• General tiredness and a feeling of having no energy.
• You may feel as if you could spend whole days in bed, unable to complete the smallest chore.
• You may find it difficult to remember things and have trouble thinking, speaking or making decisions.
• Your judgement may be impaired and decision making may be more difficult or slow.
• You might experience difficulty getting to sleep.
• You may find you have less interest in sex and intimacy.
• You may feel sad and upset.
• Feeling impatient with those around you, affecting relationships with family and friends.

Causes of fatigue

Cancer

Cancer itself can cause fatigue. It is unclear whether different types of cancer bring about different levels of fatigue. There are many factors which make a difference and they are individual to you.

Pain

Pain can make fatigue seem worse and fatigue can make pain seem worse. Let the health professional looking after you know if you have any pain. It is important to be honest about the level of pain you are experiencing so that the right treatment can be given.

Treatment

Chemotherapy, radiotherapy, hormone therapy, immunotherapy and surgery can all increase the amount of fatigue you can feel.

Anaemia

Red blood cells contain haemoglobin which carries oxygen to all the cells of the body to provide energy. If the haemoglobin level is low this is called anaemia.

Eating problems

Cancer and/or the treatment for cancer can lower your appetite, meaning that you have less energy. Problems such as sickness, having a sore mouth, difficulties in swallowing or changes in your bowel movements can reduce the amount you feel able to eat. Help and advice can be provided by your health professional. You may benefit from a referral to a dietitian.

Medication

Some medication can cause fatigue and/or drowsiness. You may be warned about this and it is important to report this to the health professionals looking after you if it persists.

Psychological effects of cancer

Anxiety, depression, stress and tension can combine to increase fatigue. Treatments are available which could help. If you would like more information, please speak to your health professional.

How long will the fatigue last?

Everyone is affected differently and the length of time fatigue lasts depends on its cause.

Some people find that levels of fatigue can affect them in peaks and troughs. You may feel fatigued for some time after your treatment for cancer has finished. This may be weeks, months or years. Fatigue can disappear then come back again. Some people find fatigue settles quickly once they have completed their treatment.

Please talk to a health professional if you are worried.

What can I do?

Talking

Fatigue is a real symptom which your health professionals need to know you are experiencing in order to help. Talk to family and friends so they know how you feel. Be honest about how much fatigue is affecting your life. Try keeping a diary which can be useful when discussing how you have been feeling.

Planning and prioritising

Plan periods of activity and rest - doing things ‘little and often’. If you are feeling particularly well one day, take advantage of this but take care not to do too much as you may feel more tired the next day. It is difficult to get a balance between doing things and taking enough rest. Sometimes this is learnt by trial and error.

Decide what is most important and if you need help with chores, make sure you ask. Do not feel guilty about asking for help. Remember, you may have good and bad days.

It is difficult but you may have to accept that you cannot do everything you used to. It is important that you do not use all of your energy to do jobs. Try to find time each day to do something you enjoy.

It may be helpful to plan activities around treatment. Let friends and family know that visits, although welcome, can be tiring and need to be planned.

Energy levels

It is important to find a balance between exercise and rest.

Try keeping a diary to show when during the day you feel less fatigued and do your tasks or activities during these times. You may soon find you have less occasions of feeling fatigued.

Exercise

We know that exercise and keeping active can improve fatigue symptoms and recovery from cancer treatments. Not being physically active at all can make fatigue worse. But there are things you can do to help you feel better:

• It is important to tell your doctor or other health professional what effect fatigue is having on your everyday life.
• Start your exercise at a level that is right for you. Light, gentle exercise can gradually be built up over time. If your usual fitness levels are higher, it is fine to exercise at that level if you are well enough.
• Usual everyday activities may be enough exercise but it can be difficult to get the balance right – find your own level. This may vary from day to day.
• Regular exercise such as walking is one of the best and safest ways to exercise. Swimming can be beneficial and Nordic walking is also an activity many people find helpful.
• Try to exercise or take on an activity every day, even if it is indoors.
• Start at a steady pace and gradually increase the distance or amount you do.
• Even walking, standing and going up and down stairs at home can be enough to help.
• Make sure you allow time for recovery after exercise.
• Physical activity can improve your emotional health and lift your mood as well. It has also been shown to be beneficial in helping with psychological health.

There are many fatigue and exercise management courses available for you to access – your health care professional can refer you.

Rest and sleep

• Aim to keep to a normal sleep pattern. Take time to relax properly before going to bed. A regular wake-up time in the morning can strengthen your sleep routine.
• Try to establish a regular routine to help you to wind down before bedtime.
• A daytime nap can be beneficial (earlier in the day). If it interferes with how well you sleep at night, try setting an alarm clock so that you only sleep for 30 to 40 minutes each nap. This has been found to be helpful, as you do not sleep as deeply during this time.
• Make sure that your bed and bedroom are comfortable – not too hot, not too cold, quiet and dark.
• If there is something troubling you and there is nothing you can do about it right away, try writing it down before going to bed and then tell yourself to deal with it tomorrow. Keeping a notepad by the side of the bed to write down the things that wake you may help.
• Many people believe that alcohol can aid falling asleep. However, it can disrupt normal sleep patterns, resulting in increased fatigue so alcohol before bedtime is not advised.
• Caffeine can act as a stimulant and it may be helpful to avoid this in the evenings.
• If you cannot sleep, get up after 15 minutes and do something you find relaxing such as reading, watching television or listening to quiet music. After a while you should feel tired enough to go to bed again to sleep.

Working

Some people with cancer or undergoing cancer treatment are able to continue to work. Others find they need to cut down their hours or stop altogether. Ask your health professional for advice about what they think is realistic for you.

Talk to your employer, human resources or occupational health department. Things you may need to consider are:

• Changing your hours of work.
• Asking your colleagues to be supportive and help with some of your work.
• Arrange to do some work from home if possible.
• Ask your employer about lighter work if you find it too tiring.
• Take regular breaks during your working day.

Diet tips

You may feel that you have a reduced appetite and that it requires a lot of effort to eat when you have fatigue.

• Try to eat a well-balanced diet without cutting out food groups.
• Try to prepare meals in advance if possible or ask others to help.
• Ask friends and family to help with shopping and stock up on foods that will last for some time.
• Cold meals can be as good for you as hot meals and quicker to prepare.
• Softer foods may take less effort to eat (such as shepherd’s pie, scrambled egg, lasagne).
• Microwaving food or ready meals, whether fresh, frozen or canned, can save time and effort.
• Eating small meals/snacks more often may be easier to face than 3 large meals. It can be useful to have meals served on small tea plates so that you do not feel overwhelmed by a large amount of food.
• Try to drink plenty of liquids. Milk, glucose drinks or liquid nutritional supplements can also provide you with extra nutrients.

Please speak to a health professional if you are concerned about weight gain or loss, eating and drinking or alcohol related issues.

Further information

Gloucestershire Hospital Fatigue Resources

Online video resources supporting the management of fatigue including contact details for extra support. www.gloshospitals.nhs.uk/fatigue-and-cancer

Macmillan Next Steps Cancer Rehabilitation

This is a cancer rehabilitation service offering support to enhance and maintain health and wellbeing through workshops, phone calls and email support. For more information contact:

Tel: 03004216586

Email: nextsteps@ghc.nhs.uk

Website: www.ghc.nhs.uk/our-teams-and-services/macmillan/

Macmillan Cancer support

Tel: 0808 808 0000

Website: www.macmillan.org.uk

Cancer research UK

Tel: 0808 800 4040 - Helpline

Website: www.cancerresearchuk.org