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Fatigue/Tiredness

Fatigue is a feeling of tiredness or lack of energy. While everyone knows what it feels like to be occasionally exhausted, cancer-related fatigue can be debilitating. It feels terrible!

Fatigue_Tiredness- Patient Handout

Fatigue is a feeling of tiredness or lack of energy. It is the most common symptom that people with cancer experience. The amount of fatigue, how often is happens, and how long it lasts can be different for each person.

Chronic cancer-related fatigue may not improve with rest and can affect your ability to function. You may be affected physically, emotionally, socially, and spiritually. 

Many patients do not tell their health care team about how tired they are because they believe that there is nothing that can be done for fatigue related to cancer or cancer treatment.


Signs of Fatigue:

  • You feel weary or exhausted. It may be physical, emotional, spiritual and/or mental exhaustion
  • Your body, especially your arms and legs, may feel heavy
  • You have less desire to do normal activities like eating or shopping
  • You may find it hard to concentrate or think clearly

Cancer-related fatigue can be caused by (or made worse by):

  • The disease
  • Medical problems related to the disease or treatment, for example dehydration, electrolyte (blood salts) imbalance, fever, infection, nausea, pain, or anemia
  • Treatments for the disease such as radiation or chemotherapy 
  • Some medications
  • Lack of sleep
  • Depression
  • Lack of exercise
  • Being an older adult

Fatigue is a real symptom and should not be ignored. While it might be a 'normal' part of cancer symptoms, it does not always mean that the cancer is getting worse or that the treatments you are receiving are not working.

There are some helpful ways to deal with cancer-related fatigue, so make sure to talk to your health care team if fatigue is a problem for you.

 

Tell your health care team how you are feeling.


Your doctor or nurse may ask you questions to help them better understand your fatigue. They might ask you to rate you fatigue on a scale from 1-10. They may also ask you to keep a fatigue diary/journal. A fatigue journal can help you track patterns in your fatigue.


Your health care team can:

  • Treat medical problems that cause fatigue
  • Help you find resources in your community
  • Give you support
  • Refer you to specialists as needed

Talk to Your Nurse, Doctor or Pharmacist:

  • If you think any of your current medications might be causing more fatigue (especially before stopping any medication)
  • If you have been too tired to get out of bed for the past 24 hours
  • If you feel confused or cannot think clearly
  • If your fatigue becomes worse

Remember to get medical help right away if you:

  • Feel dizzy, lose your balance or fall
  • Feel like your cancer related fatigue is suddenly much worse
  • Suddenly get short of breath or have a fast heart beat
  • Have a fever higher than 38°C (100.4° F)
  • Have any unexplained bleeding or bleeding that does not stop
 

Fatigue can affect you in many ways. Here are some common strategies for managing fatigue.


Memory and Concentration

A decreased attention span and difficulty understanding and thinking are often associated with fatigue. Attention problems are very common during and after cancer treatments.

  • Plan activities that require a clear head or concentration when most rested
  • Learn new information in small amounts
  • Make reminder lists and/or keep a diary or daytimer to keep track of appointments and to plan activity schedules

Nutrition

Rather than having three large meals a day, try to have many small meals instead. Dried fruits and nuts are great snacks.

  • Eat whenever you start to feel hungry
  • Try to eat your protein first before other meal items
  • Continue to drink lots of fluids as dehydration can make fatigue seem worse. Make sure you check with your nurse or doctor about the total amount of liquids you drink in a day if you have another medical issue (for example, congestive heart failure)
  • Make mealtimes pleasant and as stress free as possible

Exercise

It is hard for patients to exercise when they feel tired. With chronic fatigue, however, increasing the amount of time one rests can actually make the feelings of fatigue worse. Regular, mild to moderate exercise can boost energy levels, elevate one's mood, and lessen the feeling of fatigue.

  • Do regular, mild to moderate exercise—not infrequent, intense workouts
  • Start slowly and increase activity level over time as you are able to. For instance, start out walking for 5-10 minutes, 2-3 times a week and increase it slowly to 20-30 minutes, 3-4 times per week
  • Most important: if you are feeling unwell or experience a change in heart rate, breathing or pain skip exercise and resume when feeling better. Don't forget to talk to your nurse or doctor if this happens

Sleep and Rest

It is a common mistake to think that resting more will make the feeling of tiredness disappear. This is true for acute fatigue but is not the same of on-going chronic or cancer-related fatigue. There are many things you can do to try and make your feeling of fatigue less. Think about the following:

  • Night time should be reserved for the longest sleep of the day
  • Try to do some soothing or relaxing activities at bedtime
  • Avoid lying in bed except when you are sleeping
  • Nap for only 20 minutes at a time during the day if possible
  • Try to keep the bedroom free from activities such as reading or watching T.V.
  • Avoid any 'screen time' (like computers, video games, electronic books) before bedtime as the light from the screens may interfere with your ability to fall asleep
  • Do not eat before bed. This may cause indigestion ('heartburn'). Try to eat light snacks in the evening
  • Avoid smoking, alcohol and/or caffeinated drinks before bedtime.
  • Do not do strenuous activities before bedtime. Relax before bedtime. Sometimes drinking warm decaffeinated beverages, and/or relaxation techniques such as meditation, warm baths, or music can help

Emotional Stress

Cancer is stressful and your mood, beliefs, attitudes, and reactions to stress can also affect the amount of fatigue you feel. 

  • Remember that feeling emotional is "normal" and it is OK to be upset or angry about what is going on for you
  • If your cancer treatment is finished, do not expect yourself to get "back to normal" right away. Give yourself some time to get back on your feet
  • Talk to someone you trust about your feelings
  •  Ask for an appointment with the Patient and Family Counselling Team
  • Join a support group

  • Learn about meditation, deep breathing, or relaxation techniques
  • Keep a diary or journal about your feelings and experiences

Social Supports

Social supports are more valuable than ever for someone with cancer related fatigue. Family members, friends and community groups can help you manage fatigue. Here are some ways they can help:

  • Accept offers of help and don't be afraid to ask for help
  • Learn to delegate (or temporarily 'give away') tasks and chores you need to do
  • Ask someone to accompany you to appointments and have them write down any information you might need later

Suggested Strategies for Energy Conservation


Activities of Daily Living

  • Pace yourself and balance activity with rest
  • Sit down to bathe and dry off. Wear a terry robe instead of drying off
  • Have a chair in the bathroom so you can sit down when you wash up and brush your teeth

Organize time to avoid rushing

  • Develop a routine and think about when your energy is highest and lowest. Then organize your day around those times
  • Minimize leaning over to put on clothes and shoes
  • Bring your foot to your knee to apply socks and shoes
  • Modify the home environment to maximize efficient use of energy. For example, place chairs to allow rest stops along a long hallway

Housekeeping

  • Schedule household tasks throughout the week
  • Drag or slide objects rather than lifting. Use proper body mechanics. Use your leg muscles not your back when working
  • Stop working before becoming tired

Meal Preparation

  • Use convenience foods/ easy-to-prepare foods
  • Use small appliances (they take less effort to use)
  • Prepare meals sitting down
  • Prepare double portions and freeze half

Child Care

  • Sometimes people dealing with cancer related fatigue feel like they are somehow letting their family down. This can be extra difficult for parents.
  • Explain to your child(ren) that you are feeling tired and are not able to do as much as in the past. Their response and suggestions may also help you
  • Plan activities with your children that can be done while sitting down
  • Plan activities where you can sit while the children play/interact with you
  • Avoid lifting smaller children (teach children to climb up on the lap or chair)
  • Try to include children in age-appropriate chores
  • Accept offers of babysitting, play-dates or driving from people you trust
  • Talk to your healthcare team if you need a break and don't have anyone to help with your children

Fatigue Fighting Tips for Caregivers of People with Cancer

Below are some Fatigue Fighting Tips for cancer caregivers. It is important to take care of your own health and well being so that you can give the best possible care to your loved one.

  • Take some quality time for yourself - schedule a day off or some quiet time at home
  • Watch for signs of stress, such as impatience, loss of appetite, or difficulty sleeping
  • Don't be afraid to ask for or accept help from friends or family - suggest specific tasks or projects that they can do to help you
  • Make sure you are educated about your loved one's illness -knowledge is empowering
  • Use resources in your community that can help you and your loved ones. Take advantage of transportation agencies, home care services, support groups and educational programs
  • Don't be afraid to openly acknowledge your caregiving situation or discuss your feelings with family and friends. With proper support and education, caregiving can actually bring families closer together
  • Give yourself credit – know that the care you give does make a big difference
  • Talk to a counsellor

 

Recommended websites: Fatigue Websites


BCCA Library pathfinder: Fatigue and Sleep Pathfinder


Symptom management guidelines: Fatigue and Anemia


Online Learning Session:

Tired of Being Tired? How People With Cancer Can Manage Their Fatigue 24:02min 2012 

(Microsoft Silverlight required to view - no cost. If viewing on Chrome browser does not work, use Explorer.)


This online session aims to to teach cancer patients how to communicate effectively about their fatigue. Another goal is to give a greater understanding and awareness of cancer-related fatigue. The speakers provide useful strategies to help manage fatigue in all realms: physically, socially and emotionally, in order to optimally manage their cancer-related fatigue. Presented by Helen Wong, MSW Patient & Family Counsellor and Jennifer Finck, RN (BCCA Vancouver Island Centre Pain & Symptom Management program).

 

Revised Jul 2014

SOURCE: Fatigue/Tiredness ( )
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