‎Fatigue is a feeling of tiredness or lack of energy. It is the most common symptom for people with cancer. Fatigue is different for each person.

Chronic cancer-related fatigue may not get better with rest. It can affect your ability to function. It may affect you physically, emotionally, socially, and spiritually.

Signs of fatigue:

• You feel weary or exhausted
• Your body, especially your arms and legs, feel heavy
• You do not feel like doing normal activities, like eating or shopping
• You find it hard to concentrate or think clearly

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

• Cancer and cancer treatments
• Medical problems related to cancer or treatment such as dehydration (lack of water), infection, nausea (feeling queasy), or pain
• Some medications
• Not enough sleep or exercise
• Depression or sadness
• Being an older adult

Fatigue is a common part of cancer and cancer treatment. It does not always mean the cancer is getting worse or that treatments are not working.

‎Tell your health care team how you are feeling. Many patients believe there is nothing that can help their fatigue. This is not true.

If you think any of your medications might be causing more fatigue, tell your health care team. Do not stop taking any medications before speaking with them.

Tell your health care team if your fatigue is making it hard for you to work.

Call your health care team right away if:

• You have been too tired to get out of bed for 24 hours or more
• You feel confused or cannot think clearly
• Your fatigue is suddenly much worse

Fatigue can affect you in many ways. Here are some ways to help manage fatigue.

Attention and concentration

You may have trouble concentrating, paying attention, understanding and thinking. Attention problems are very common during and after cancer treatments.

Try these tips to help your attention and concentration:

• Plan activities that need a clear head or concentration when you are most rested
• Make reminder lists
• Keep a diary to keep track of appointments and to plan activities

Sleep and rest

It is a common mistake to think that resting more will make the feeling of tiredness go away. This is true for acute (short-term) fatigue but is not the same for ongoing (chronic) or cancer-related fatigue.

Getting a good night sleep can make you feel better. However, it can be hard to sleep at night if you are resting too much during the day. Your longest sleep of the day should be at night.

Try these tips to get a good sleep at night:

• Only lie in bed when you are sleeping
• Do soothing or relaxing activities at bedtime. Try having a warm drink, a warm bath, meditating, or listening to music
• Do not nap for more than 20 minutes at a time during the day
• Do not have any 'screen time' before bedtime. This includes computers, smart phones, video games and some electronic books. The light from the screens can keep you awake
• Only eat light snacks in the evening. Do not eat big meals right before bed. You may get indigestion ('heartburn')
• Watch TV or read in another room of your home
• Do not smoke, drink alcohol or have caffeinated drinks before bedtime
• Do not do strenuous activities, like exercising, before bedtime

Food and drink

• See if three or four larger meals each day or small snacks every 1-2 hours feel better for you. Eat whenever you start to feel hungry.
• Soft or liquid foods need less energy to eat. Try soups, stews, scrambled eggs and smoothies.
• Stock up on ready-to-eat, nutrient dense foods such as nuts, seeds, fresh or dried fruit, and yogurt.
• Dehydration can make fatigue seem worse. Check with your health care team about the amount of fluids you should drink in a day.

Exercise

It can be hard to exercise when you feel tired. However, resting too much can actually make chronic fatigue worse. Exercise can boost your energy levels, elevate your mood, and lessen the feeling of fatigue.

• Do regular, mild to moderate exercise. Do not do infrequent, intense workouts.
• Start slowly and increase your activity level over time. For example, start out walking for 5-10 minutes, 2-3 times a week. Then, slowly increase to 20-30 minutes, 3-4 times per week.
• Do as much as you are able to.

If you are feeling unwell, have pain, a change in heart rate or change in breathing, stop exercising and start again when you are feeling better. If this happens, talk to your health care team.

Emotional stress

Cancer is stressful. Your mood, beliefs, attitudes, and reactions to stress can also affect your fatigue.

• Feeling emotional is 'normal'. It is OK to be upset or angry about what is going on for you.
• If your cancer treatment is finished, do not expect to get 'back to normal' right away.
• Talk to someone you trust about your feelings.
• Ask for an appointment with BC Cancer Patient & Family Counselling, or join a BC Cancer support group.
• Learn about meditation, deep breathing, or relaxation techniques.
  
• Keep a journal about your feelings and experiences.
  

Social supports

Family members, friends and community groups can help you manage fatigue:

• Explain to your loved ones how you are feeling. It can be hard for others to understand how tired you really are. If it helps, give them this handout.
• Let people help you. Ask for help.
• Delegate (temporarily 'give away') tasks and chores you need to do.
• Ask someone to come with you to appointments. Have them write down important information.
  

Ways to save your energy

Pace yourself and balance activity with rest. Keep a routine and think about when your energy is highest and lowest. Organize your day around those times.

Bathing and dressing

• Sit down to bathe and dry off.
• Put on a terry robe instead of drying off.
• Put a chair in the bathroom so you can sit down when you wash up and brush your teeth.
• Try not to lean over when you put on clothes and shoes. Put your foot on your opposite knee to put on socks and shoes.

Around the House

• Put chairs in the hallway for rest stops
• Do not do all of your chores in one day
• Drag or slide things instead of lifting
• When picking up something, bend at the knees and use your leg muscles, not your back, to lift
• Stop working before you get tired

Child care

When you have cancer-related fatigue, you may feel like you are letting your family down. This can be extra-hard for parents to adjust to.

• Explain to your child(ren) that you are tired and are not able to do as much as you normally can. Their suggestions may help you.
• Plan activities with your children that you can do while sitting down.
• Try not to lift smaller children. Teach them to climb up on your lap or a chair. This can be hard but try your best.
• Include children in age-appropriate chores.
• Let your friends and family babysit or drive your children to activities, school or daycare.
• Talk to your healthcare team if you do not have anyone to help with your children.

Making Meals

• Ask family and friends to help you get groceries and make meals
• Buy easy-to-prepare foods or use a grocery- or meal-delivery service
• Make meals sitting down
• Make double portions and freeze half
• Choose one-pot or one-bowl recipes

Tips for caregivers of people with cancer

It is important to take care of your own health so you can give the best possible care to your loved one. It is hard to take care of someone if you are feeling fatigued.

• Take some 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 trouble sleeping.
• Do not be afraid to ask for or accept help from others. Give them things they can do to help you.
• Make sure you know about your loved one's illness. This can help you take care of them.
• Take advantage of transportation services, home care services, and support groups.
• Talk about your feelings with family and friends. With support and education, caregiving can bring families closer together.
• Know that the care you give makes a difference.
• Talk to BC Cancer Patient & Family Counselling.
  

• BC Cancer Library Fatigue and Sleep Pathfinder
  
• Recommended websites, books, handouts and support programs about fatigue and sleep
  
• Video – Cancer Related Fatigue: Dr Mike Evans
• BC Cancer Supportive Care Services