Cancer-related fatigue
The information on this page is intended to help you understand cancer-related fatigue and support you to build your energy levels.
Understanding Fatigue – It’s more than feeling tired!
Everyone feels tired from time to time, but cancer related fatigue is different to normal tiredness. While tiredness is usually linked to activity levels and improves with rest, fatigue is different; it can be an overwhelming sense of tiredness that doesn’t go away with rest or sleep. It can affect your whole body, your mind, and even your emotions.
Different types of energy and fatigue
When we think about energy levels and fatigue it’s common to focus on physical things like walking or needing a sleep. But cancer-related fatigue—is different. It can affect how you think, feel and respond to the world around you.
Fatigue Affects More Than Just Your Body. Fatigue can show up in different ways.
Thinking and Memory
You might notice cognitive changes such as reduced concentration, word-finding difficulties, memory problems or slower thinking – often referred to as “brain fog”.
Emotions
You might feel more emotional than usual – more tearful, anxious or easily frustrated.
Senses
Everyday things like background noise, lights and strong smells can feel overwhelming. This is called sensory fatigue— when your brain gets tired from processing too much around you. You might notice things more intensely, like a smell that normally wouldn’t bother you suddenly feeling overpowering.
Even if you haven’t done much physically you might still feel tired or exhausted, because your energy has been used in other ways.
All Kinds of Activities Use Energy
Think of your energy like a battery. Everything you do —whether it’s walking, thinking, worrying, or being in a noisy place—uses up some of that battery. That’s why you might feel wiped out even if you haven’t done much physically.
Also in this section
Signs and Symptoms of different types of fatigue:
Physical
- Lethargy, feeling heavy or sluggish
- Achey or weak muscles
- Clumsiness
- Headaches
- Blurry vision or slurred speech
Emotional
- Feeling more irritable or snappy
- Tearfulness or crying more easily
- Getting frustrated quickly
- Feeling anxious or over-whelmed
Cognitive
- Difficultly concentrating
- Forgetfulness
- Slower thinking
- Struggling to find the right words
- “Brain fog”
Sensory
- Feeling drained in busy or noisy places
- Wanting to leave or avoid certain environments / places
- Headaches or tension after being around lots of noise, lights, or smells
- Noticing smells, lights or sounds more intensely
- Needing extra rest after being in places with lots going on
If you have been feeling tired with no obvious link to physical activity levels, you are not alone!
Most people with cancer will experience fatigue at some point. It is the most common symptom of cancer, and many treatments such as chemotherapy or radiotherapy, and surgery can worsen fatigue.
Charging your battery:
Before cancer-related fatigue, you would have used energy gradually throughout the day. Now your energy drains more quickly, and you need re-charge more often.
A good way to do this is to by alternating demanding activities with easier ones or short rest periods. But remember – rest alone isn’t enough. In fact, sitting still for long periods can make fatigue worse. Just like a car battery, your body needs to keep moving to stay charged. Imagine a car parked on the driveway for a long time – the battery goes flat. Staying gently active can help reduce fatigue over time.
Fatigue Management - Strategies for Building and Conserving Energy
There are lots of ways to manage your energy levels. It is best to start using strategies before treatment begins, but it’s never too late – even if you have started or even finished your treatment.
Think about how fatigue impacts your daily life and the things that you want or need to do.
Click on the image and summary that best describes how tired you have felt over the last week, and how it prevents you from doing what you want to do.
Not at all tired. I can do everything I normally do.
Normal energy level.
A little bit tired. I can do almost everything I normally do.
You feel a bit more tired than usual. You can still do everything you need to do
Somewhat or moderately tired. I can do some of the things I normally do.
Fatigue is noticeable and upsetting. You do less daily physical activities. Work may be affected.
Extremely tired. I can do very little.
You are very tired everyday. You often feel a need to sit or rest. You feel puffed. Doing daily tasks is very difficult. Exercise does not seem possible.
Use these ratings to view the advice best suited to your current fatigue levels. Remember your ratings may change over time and it’s ok to come back to this page to re-rate your fatigue levels.
These rating scales have been adapted from Fitch, M.I., et al., The fatigue pictogram: psychometric evaluation of a new clinical tool. Canadian Onclology Nursing Journal, 2011. 21(4): p. 206 with thanks.
No fatigue with no impact to daily life
It’s great that you are not experiencing any cancer-related fatigue!
Continue to engage in normal daily activities, including physical activities such as household chores and gardening; eat well, sleep well and exercise.
Here are some resources you may find useful:
Getting Active
An introduction to physical activity with different levels of exercise.
Physical Activity and cancer
A booklet by Macmillan Cancer Support
Eating to prepare for cancer treatment
Why good nutrition is important in preparing for treatment
Be mindful that many people with cancer will experience fatigue at some point. As your treatment commences it’s a good idea to re-rate your fatigue levels in order to address any changes as quickly as possible.
Mild fatigue with minor impact to daily life
Learning and practicing fatigue management strategies can help prevent fatigue from getting worse and reduce the impact of it on daily life, meaning that you’ll be able to more of the things that matter to you.
Avoid boom and bust
It is important to avoid a boom bust pattern of activity as over time this can make fatigue worse resulting in more disruption to daily life.
Pace yourself
The best way to manage your fatigue and reduce impact on day to day life is to pace activities across the day, alternating demanding activities with easier ones or periods of rest. Click for more information about how to do that.
Here are some resources you may find useful:
Getting Active
It is important to remain physically active as this helps to manage and to prevent cancer related fatigue.
Managing fatigue
A booklet from Macmillan Cancer Support
Moderate fatigue with a decrease in daily activities
There are many ways to manage fatigue including treating any potential contributing factors such as anaemia and reduced nutritional intake. Talk to your health care provider about treating any underlying factors.
Avoid boom and bust
It is important to avoid a boom bust pattern of activity as over time this can make fatigue worse resulting in more disruption to daily life.
Pace yourself
The best way to manage your fatigue and reduce its impact on day-to-day life is to pace activities across the day, alternating demanding activities with easier ones or periods of rest. Click for more information about how to do that.
Cancer Research UK
Cancer Research UK have lots of good advice about treating cancer related fatigue here.
You might be experiencing cognitive changes such as memory problems, word finding difficulties or reduced concentration. Cancer Research UK have some good advice on ways of managing this here.
A Fatigue Diary
Working out what works well for you in managing fatigue may involve some trial and error. Keeping a diary for a few weeks can help you to see what times of day your energy levels are highest, what makes your fatigue feel better or worse and how fatigue affects different areas of your life.
A diary can also help you to plan you time. It is recommended that when planning your day you alternate activities that demand higher levels of energy with restful, relaxing activities to provide a chance to re-charge over the course of the day. Macmillan Cancer Support have produced a guide and diary template that you can access here.
Here are some more resources you may find useful:
Getting Active
It is important to remain physically active as this helps to manage and to prevent cancer related fatigue.
Eating to prepare for cancer treatment
How to make the most of your dietary intake.
Macmilllan Restore website
Monitor and manage your fatigue
Severe fatigue with a big impact on daily activities
When you are feeling extremely tired every day, doing daily tasks may feel impossible. This is frustrating and distressing and can cause upsetting thoughts and feelings, which themselves contribute to fatigue.
One technique to help manage difficult thoughts and feelings is Mindfulness.
Mindfulness is about having an awareness of your thoughts and feelings as they happen moment to moment. This awareness helps to show when you are caught up in thoughts in a way that isn’t helpful and it allows you to stand back from your thoughts and choose to pay attention to the world around you instead. This technique can help you to notice and deal with signs of stress and anxiety earlier and more effectively helping to manage the emotional and mental aspects of fatigue.
- The free Velindre Mindfulness app has been created by Velindre Cancer Centre and provides Mindfulness and Relaxation exercises that you may find beneficial.
- There is further information on Mindfulness on this website which you can access here.
Introducing gentle activity
Whilst you are feeling extremely tired, physical activity feels impossible. However, introducing some very gentle activity will help to start recharging your battery and increase your energy levels. Here are links to videos with guided gentle Tai Chi movements that you can do seated in your chair:
Cycle of inactivity
Understanding about the cycle of underactivity will help understand why physical activity is beneficial in managing fatigue.
It may also be useful to speak with your healthcare provider about addressing any underlying factors such as anaemia and reduced nutritional intake.
Macmillan have produced information about cancer-related fatigue that you might find useful. This is available in audiobook or written text:
References
1. Prue G, Rankin J, Allen J, et al.: Cancer-related fatigue: A critical appraisal. Eur J Cancer 42 (7): 846-63, 2006. [PUBMED Abstract]
2. Berger AM, Abernethy AP, Atkinson A, et al.: Cancer-related fatigue. J Natl Compr Canc Netw 8 (8): 904-31, 2010. [PUBMED Abstract]
