adapted from "Fatigue and You" by the Oncology Nursing Society 2001
For most people, fatigue is a temporary condition - something you feel after you clean the house or mow the lawn that goes away if you take a quick nap. However, for some people living with cancer, fatigue is a common side effect of treatment that can seriously affect their health and quality of life.
Unfortunately, many people experiencing fatigue do not talk to their doctors about it, because they think that feeling tired from cancer or cancer treatment is "normal". The following questions and answers are designed to assist you in understanding cancer-related fatigue.
What is cancer-related fatigue?
Common and well-recognized signs of fatigue include weakness and exhaustion. Other, less obvious indicators include pain or weakness in your legs, difficulty climbing stairs or walking short distances, or being short of breath after only light activity - like cooking a meal or taking a shower.
Fatigue can also affect the way you think and feel. It can cause you to have difficulty concentrating, lose interest in your pastimes, and make you impatient. Other signs include:
Feeling weary or exhausted.
Feeling very heavy, especially your arms and legs.
Not wanting to do normal activities like eating or shopping.
Finding it more difficult to maintain your personal appearance.
Finding it hard to concentrate or think clearly.
What causes fatigue?
Many things can cause fatigue including: a previous or current medical condition, the effects of cancer and cancer treatment and their related side effects, underlying medical conditions (such as anemia, medication interactions, and dehydration), sleep disturbances, inactivity and immobility, and the physical and emotional demands of dealing with a chronic disease such as cancer.
Why is cancer-related fatigue important to my care?
Fatigue is one of the most frequently experienced symptoms associated with cancer. It can precede, accompany, and follow many cancers and cancer treatments. It often alters your ability to function and can significantly interfere with your quality of life. If unrecognized or unmanaged, fatigue can trigger a sense of hopelessness or depression. Fatigue can also make is more difficult for you to cope effectively with your cancer and to take the steps you need to aid your recovery.
Why should I talk to my doctor or nurse about my fatigue?
It is always important to talk directly with your doctor or nurse about your fatigue, because good communication can help you gain insight into the causes of your fatigue. It may also help your doctor or nurse provide you with helpful suggestions to improve fatigue.
How can I communicate more effectively with my doctor or nurse about my fatigue?
Sometimes it is hard to talk about fatigue with your doctor or nurse because it does not have obvious physical manifestations, it is not easily measured, and it is difficult to find the exact causes. Although there are no quick and easy solutions to fatigue, it is still important to discuss it with your health care providers. Once they are aware of your fatigue, they can share some suggestions that will be useful in helping you cope more effectively with your fatigue.
To improve communication:
Keep the doctor or nurse informed of your energy level throughout the course of your treatment. Let them know when your fatigue has become unusually severe, is unrelieved by rest, disrupts your ability to function or affects your quality of life.
Let your health care team know what is working and what isn't. When you try interventions to diminish fatigue, report back to them whether or not these interventions have been helpful.
How can I minimize the effects of cancer-related fatigue in the workplace?
If you feel that the effects of cancer-related fatigue are affecting your work, consider having an open discussion with your employer regarding changes in your workload. If necessary, consider flexible work schedules and alternative or reduced job duties. Be realistic in setting work goals at this time and seek support from coworkers. Don't be afraid to ask for help when you need it. Other suggestions include:
Plan your workload to take advantage of peak energy times. Arrange work environment for easy access to commonly used equipment and supplies.
Know your legal rights. Check your employee manual to determine company policy regarding sick leave or disability. Know the provisions of the Family Medical Leave Act and the Americans with Disabilities Act. Call the Cancer Resource Center at 415.885.3693 for more information.
Managing Fatigue
Managing your fatigue effectively entails learning to prioritize, plan, delegate and modify daily life activities. Discover which techniques of energy and attention conservation can help you better manage your personal "energy bank".
Strategies for Energy Conservation
Spread your activities throughout the day and take rest breaks between activities.
Sit down to bathe and dry off.
Organize your time to avoid rushing.
Practice good body mechanics. Small changes, such as minimizing bending over to put on clothes and shoes, can make a big difference.
Modify your home environment to maximize efficient use of energy.
Schedule household tasks throughout the week and delegate them when possible. Try doing housework when sitting down.
Plan childcare activities to allow for sitting down. Teach children to climb up on your lap or into the highchair instead of being lifted.
Learn to delegate tasks such as meal preparation, housework or errand running. For more information, read the piece "Delegation to Help with Fatigue".
Don't force yourself to do more than you can manage.
For additional suggestions, you can also check out the information sheet, "Tips for Conserving Your Energy".
Work with your doctor or nurse to help develop a personal wellness plan that includes strategies for getting adequate rest, maintaining or initiating a modified exercise routine, eating a nutritionally balanced diet, and eliminating or minimizing those factors that interfere with quality sleep.
Strategies for Rest and Energy Restoration
Take several short naps or breaks, rather than one long rest period. Rest and sleep are important, but be careful not to overdo it. Too much rest can actually decrease your energy level.
Plan your day so that you have time to rest.
Take short walks or do some light exercise if possible. Some people find that exercise decreases their fatigue.
Plan something active to do each day, even if it is as little as getting dressed and walking outside to sit on the porch. Staying active during the day will also help encourage normal fatigue at night, making sleep easier.
Try easier or shorter versions of the activities you enjoy. Schedule time to rest before an activity. Prioritize the activities that are most enjoyable or most necessary and plan accordingly.
Keep a diary or journal and record how you are feeling as your go through the day's activities. If you experience fatigue, describe it on a scale of 0 (no fatigue) to 10 (the worst fatigue). List your activities for the day. This will help you see a fatigue pattern. Reviewing your fatigue pattern can help you to plan your daily activities or your workload. Sharing this pattern with your doctor or your nurse may also give them the information they need to help you manage your fatigue.
Strategies for Managing Fatigue with Exercise
Research has shown that exercise can dramatically improve a patient's energy level. The optimal type and amount of exercise is unknown, but most physicians would agree that too much rest and too little activity can often increase fatigue. A good balance between periods of rest and exercise is recommended. Moderate aerobic exercise under supervision can improve muscle conditioning and increase energy levels. It is important to remember, though, to start exercising slowly and gradually build up to a more strenuous workout. It is also very important to communicate with your healthcare workers about any untoward side effects that you experience during your exercise programs.
The Cancer Resource Center offers free exercise programs tailored to the individual patient. For more information on these exercise programs, call 415.885.3693.
Strategies for Managing Fatigue with Nutrition
In addition to the tips below, the Cancer Resource Center also has a dietitian on staff to help answer your specific nutrition questions, including how to use nutrition to help with fatigue. To ask about the nutrition program, call 415.885.3693.
Eat small meals or snacks throughout the day.
On days you have more energy, prepare extra meals and store them in the freezer.
Drink plenty of water each day, eight 8-ounce glasses of fluid are recommended every day unless your physician or nurse tells you otherwise.
Eat when your appetite is the strongest.
Ask friends or family members for help with the grocery shopping or cooking.
Try new foods.
Consult with the dietitian to ensure that you are eating a nutritionally balanced diet.
Include good sources of protein, such as meat, poultry fish, cheese, yogurt and milkshakes.
Call the Cancer Resource Center to find out about programs such as Project Open Hand and Meals on Wheels that can deliver meals directly to your home free of charge.
Additional Strategies
Although cancer related fatigue is physically draining, it can be helpful to address the emotional aspects of fatigue by doing activities that are spiritually rejuvenating and healing.
Consider joining a support group or speaking with a skilled therapist. See the list of support groups on this site, or contact the Cancer Resource Center for more information
Take time to experience nature.
Practice stress management strategies, such as meditation and relaxation.
Plan for enjoyable distractions or find ways to incorporate humor into your life.
Do not criticize yourself for not accomplishing as much as you used to. Focus on the present, taking pleasure in whatever it is that you can do.
Fatigue Management Workshops
The Cancer Resource Center hosts monthly workshops discussing fatigue, its causes and strategies to help alleviate it. A health care professional can answer your individual questions at these workshops. For more information, contact the CRC.
Finally, remember that you don't have to do everything yourself. Save your energy for things that bring joy to your life and the things you find most important.
For additional information or resources, visit the Cancer Resource Center at 1600 Divisadero Street, Room B-101, or call us at 415.885.3693. The information in this publication is designed for educational purposes only and is not intended to replace the advice of your physician or health care provider, as each patient's circumstances are individual. We encourage you to discuss with your physician any questions and concerns that you may have.
Ida & Joseph Friend Cancer Resource Center [Reprints Require Permission]
