This information will help you manage fatigue during and after your cancer treatment.
Patients describe fatigue as feeling tired or weak, of not wanting to do things, not being able to concentrate, or being slowed down. It can be a side effect of cancer treatment or from the cancer itself. Cancer fatigue is the most common symptom people experienced with cancer and cancer treatment, but there are things you can do to help.
What causes fatigue?
While no one is sure of the exact cause of fatigue, we do know that it can be severe. It varies from person to person and it can begin gradually or start suddenly. Many factors can contribute to it. It may be caused by:
- Medications used to kill cancer cells
- The destruction of cancer cells
- Medication given to treat nausea
- The waste products of destroyed cancer cells
- Injury to normal cells
- Inadequate nutrition intake
- Anemia (a reduced amount of red blood cells in your blood)
- Shortness of breath
- Extra energy your body needs to repair normal cells
Other factors that can cause fatigue are:
- Changes in sleep patterns
- Not being able to move around
- Family stress
- Dealing with tests and treatment(s)
- Traveling back and forth for treatment or to the doctor/hospital
What can I do about my fatigue?
The first step in handling fatigue is to let your nurse and doctor know you are experiencing it. Be sure to report the level of your fatigue when you talk to them. It is helpful if you can be specific, e.g., “I was so tired that I couldn't work for 3 days,” rather than “I was really tired.”
For 1week, keep a list of your activities and note how you feel when you do them. This is called an activity log. Are you more tired in the afternoon or the evening? Is there a pattern to your fatigue? For example, are you more tired right after chemotherapy or just before another treatment? Based on the answers to these and other questions, your doctor will be able to suggest the best ways for you to handle your fatigue.
How can I manage my fatigue?
- Establish a sleep pattern. Avoid caffeine, alcohol, and tobacco after 6 pm. They may keep you awake. You may also want to try to relax by listening to music or reading before bedtime.
- Develop a routine. Learn the cycle of when you need to rest and when you have energy for activity. This can help you plan your days.
- Take short naps and rest during the day. Once you identify the times when you are most fatigued, you can schedule rest periods. Mix rest with activity to build or maintain your stamina. Rest often before you feel fatigued.
- Plan your activities. It may help to prioritize what you need to do each day. This will help you save your energy for things that are necessary and most important to you. Schedule important activities for those times when you have more energy.
- Try to avoid activities that make you most fatigued. Look at your list of activities and think about how you felt when you did them. Ask for help. Don't be afraid to rely on support from family, friends, or social agencies. Many organizations provide transportation to treatments and help with cooking and cleaning. Ask to speak with a social worker for more information.
- Make your preferences known to friends and family. For example, some people undergoing treatment prefer not to talk on the telephone because they find conversation exhausting. If this sounds like you, ask friends to drop you a note or an email instead of calling. Many patients use their answering machines to screen their calls when they are fatigued. This way you can talk to people when you feel up to it. Other people find that talking with loved ones helpful. In this case, tell people how much their calls mean and ask them to call often.
- Ask your doctor or nurse for help with things that add to fatigue. The doctor may be able to give you something for pain, nausea, vomiting, and not being able to sleep.
- Follow a healthy diet. Eat small, well-balanced, high-protein meals and snacks. Smaller meals require less energy to digest than larger meals. They provide energy evenly all day. You may want to ask your doctor or nurse about taking vitamins. Speaking with a dietitian may also be helpful. Your doctor or nurse can arrange this for you.
- Keep socially active. Don't cut yourself off from your friends. Time with them is important, but be sure to pace yourself.
- Walk daily, with your doctor's approval. Light physical exercise may help increase your energy level.
- Seek support. Your family and friends may help you deal with stress and fatigue. You may want to join a patient support group.
- Ask your doctor or nurse for help with anxiety and depression. They may have you talk with a social worker. Learning relaxation techniques may help you manage anxiety.
If you would like help figuring out how to manage your fatigue, ask your doctor or nurse for a consultation with an occupational therapist (OT). An OT is a health care professional who can guide you in modifying your activities. When your activities are broken down into smaller segments they can become more manageable. An OT can help you prioritize your activities and make a plan to participate in as many activities as possible without overtiring.
Many patients find that spirituality can bring peace. It helps some people with concerns and worries. You may talk to a chaplain at Memorial Sloan Kettering Cancer Center (MSKCC) or ask to see a clergy person.
How can I save my energy?
- Use a wheelchair for travelling longer distances if one is available.
- Stop and sit to rest often if you feel tired during activity.
- Take your time with your activities and sit while you work.
- Do not hold your breath.
- Sit on higher seats, which are easier to stand up from than low seats.
- Work at a table or counter top that is waist-high.
- Organize and store your work items where you use them and can get them easily.
- Maintain good posture.
- If you must reach for something lower than arm's length, squat or bend at the knees not your back.
- Sit in front of a mirror or sink for activities that take more time, such as putting on make-up or shaving.
- Keep your hair in a style that is easy to care for.
- Shower with warm, not hot water.
- Use a caddy over your shower so you do not have to reach and bend.
- Hold onto grab bars when you enter and exit the tub.
- Wash your hair in the shower, not over a sink.
- Use a bench to sit in the tub while you shower.
- Use a sponge or brush (e.g., back brush) with a long handle to scrub your feet and other areas that may be hard to reach.
- Dry off with a towel while sitting or put on a terry cloth robe.
- Choose your clothing and lay it out before you begin to get dressed.
- Select shirts or blouses that button at the front and bottoms that fit loosely.
- It is best if you exhale when you bend and inhale when you reach for something.
- Sit on a chair or at the edge of your bed to get dressed.
- Clothe the lower part of your body first.
- Place your underwear inside your pants and match the waistbands together. This way you can insert your legs into the underwear and put on your pants at the same time.
- To put on your socks and shoes, sit and bring your foot to the opposite knee instead of bending over.
- Wear slip-on shoes with low heels and shock-absorbent soles or insoles.