Cancer-related fatigue

It’s more than feeling tired!

Cancer-related fatigue is one of the most common side-effects of cancer; many people experience fatigue as a symptom of cancer before receiving their diagnosis. Fatigue is also the most common side-effect of cancer treatments such as chemotherapy, radiotherapy, and immunotherapy. People who undergo surgery often find that they feel more fatigued in the days and weeks following surgery.

Most people with cancer will experience cancer-related fatigue at some point during their cancer journey. The information on this page is intended to help you understand cancer-related fatigue; why you are feeling like this and how to build your energy levels ahead of treatment so that you are able to feel better before, during and after that treatment. 

Cancer related fatigue has lots of causes and contributing factors:

  • The cancer itself
  • Side-effects of medications / treatments
  • Worrying thoughts
  • Pain
  • Stress
  • Uncertainty
  • Surgery
  • Eating difficulties
  • Anaemia – low blood count
  • Reduced activity levels

Cancer-related fatigue is very different to the normal feeling of tiredness that we all experience from time to time after a busy day or lots of activity. Normal tiredness is relieved by sleep and rest. However, cancer-related fatigue is not proportional to activity levels nor to energy exerted, it is not relieved by rest and can persist for a long time.

Charging your battery

Battery at different levels of chargeThink about yourself as a battery: before you were affected by cancer-related fatigue you would expend energy over the course of the day as you went about your activities. Now your battery is smaller so it takes less effort for it to drain. This means that you need to charge your battery more often.

A good way to do this is to alternate demanding activities with easier ones or periods of rest. Resting alone or doing very little activity for long periods of time doesn’t help, because just like a car battery your body needs to keep moving in order to stay charged. Imagine a car parked on the driveway for a long time – the battery doesn’t charge; overtime it goes flat. It is therefore important to remain physically active to help manage and reduce your fatigue.

Understanding about the boom-bust cycle is a useful first step in managing fatigue.

Boom and Bust video to go here.

Mental, Physical and Emotional Energy

Venn diagram showing three overlapping circles titled Mental, Physical and EmotionalWhen thinking about fatigue it is typical to think about the physical impact, for example activities such as walking, climbing the stairs or going out.

For many people fatigue can also cause cognitive changes, such as reduced concentration, memory problems, word finding difficulties and difficulties in thinking clearly. You may also feel emotionally drained.

It’s important to note that any activity whether a physical activity, mental activity such as doing a crossword, or emotional activity such as worrying or thinking all drain energy from the same battery, leaving less in charge for everything else that you do. Sometimes you may feel that you’ve had a restful day yet still feel tired. This may be because you have been using mental or emotional energy which impacts your overall energy levels. It’s a good idea to alternate demanding activities with easier ones; even if those activities seem like they’re not using much physical energy they may be mentally draining – it’s ok to take a break and come back to an activity, this can help your battery to re-charge a little before it goes flat.

Fatigue Management - Strategies for Building and Conserving Energy

There are lots of things that you can do to manage your fatigue and energy levels. When trying to manage fatigue it is useful to 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.

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

Looking weary and having to sit down.

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

Improve your diet

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.  Link to boom and bust video.

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.  These video’s talk about how to do that: (Link to 5ps video and video on how to implement (in development))

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

Looking weary and having to sit down.

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. Link to boom and bust video (in development)

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.  These video’s talk about how to do that: Link to 5ps video and video on how to implement (in development)

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 Well

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.

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 activity

Understanding about the cycle of underactivity will help understand why physical activity is beneficial in managing fatigue.  Link to video (in development, cycle to be taken from boom and bust powerpoint)

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]

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