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Managing Cancer-Related Fatigue

This information will help you manage cancer-related fatigue during and after your cancer treatment.
 
Fatigue is the most common side effect of cancer and cancer treatment. Fatigue related to cancer is different from fatigue that people without cancer experience. People describe cancer-related fatigue as feeling tired or weak, not wanting to do things, not being able to concentrate, or feeling slowed down. The fatigue can range from mild to severe. It can develop gradually over time, or it can begin suddenly.
 

Causes of Cancer-Related Fatigue

No one is sure what exactly causes cancer-related fatigue, but it may
be caused by:
 
  • Cancer treatments, including chemotherapy, radiation therapy, surgery, and some biologic therapies
  • Medications to treat nausea and manage pain
  • The build-up of toxic substances that are left in the body after cells are killed by cancer
  • Injury to normal cells
  • Infection
  • Fever
  • Pain
  • Loss of appetite or not getting enough calories and nutrients
  • Trouble sleeping
  • Anemia (low level of red blood cells)
  • Shortness of breath
  • Dehydration
  • Extra energy your body needs to repair normal cells
Other factors that may cause cancer-related fatigue include:
 
  • Anxiety
  • Depression
  • Grief
  • Not having enough restful sleep at night
  • Being less active
  • Family stress
  • Dealing with tests and treatments
  • Traveling to and from the hospital for treatment
  • Other medical conditions

How to Manage Cancer-Related Fatigue

The first step in managing cancer-related fatigue is to tell your nurse and doctor what you are experiencing. 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 1 week, keep a list of your activities and note how you feel when you do them. This is called an activity log. You may notice a pattern to your fatigue. For example, are you more tired right after chemotherapy or just before another treatment? Are you more tired in the afternoon or the evening? Based on the answers to these and other questions, your doctor will be able to suggest the best ways for you to manage your fatigue.
 
Here are some suggestions to help manage your fatigue.
 
  • Improve your sleep routine. Avoid caffeine, alcohol, and tobacco after 6:00 pm. They may keep you awake. You can also try to relax by listening to music or reading before bedtime.
  • Develop a routine for your daily activities. Know when you need to rest and when you have energy for activity. This can help you plan your days.
  • 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 at those times when you have more energy.
  • 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 energy. Rest often before you feel fatigued.
  • 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. Do not be afraid to rely on support from family, friends, or community organizations. 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 you feel this way, ask friends to drop you a note or an email instead of calling. Many patients use an answering machine or voicemail 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 is helpful. In this case, tell people how much their calls mean to you and ask them to call often.
  • Ask your doctor or nurse for help with things that add to your fatigue. Your doctor may be able to give you medication for pain, nausea, vomiting, and sleep problems.
  • Follow a healthy diet. Eat small, well-balanced, high-protein meals and snacks throughout the day. You need less energy to digest smaller meals than you do for larger meals. 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. Do not cut yourself off from your friends. Spending time with them is important, but make sure to pace yourself.
  • Walk daily, with your doctor’s approval. Light exercise may help increase your energy level.
  • Get emotional support. Your family and friends can help you deal with stress and fatigue. You may also want to join a support group for people with cancer. Many people also find that spirituality can help with concerns and worries. You can talk to a chaplain at Memorial Sloan Kettering Cancer Center (MSK) or ask to see a clergy person
  • 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. For more information about complementary therapies, call the MSK Integrative Medicine Service at (646) 888-0800 or go to: www.mskcc.org/cancer-care/integrative-medicine
  • Ask your doctor or nurse about meeting with an occupational therapist (OT). An OT is a healthcare professional who can help you make a plan to participate in as many activities as possible without overtiring.

Tips for Saving Your Energy

  • Use a wheelchair while travelling longer distances, if one is available.
  • Take your time with your activities and sit while you work. Remember to maintain normal breathing and stop and rest often if you feel tired.
  • 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. This allows for better circulation and normal breathing.
  • 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 an arm’s length, squat or bend at your knees and not at your back.
  • Sit in front of a mirror or sink for activities that take more time, such as putting on makeup or shaving.Keep your hair in a style that is easy to care for.
  • Shower with warm, not hot, water.
  • Put a caddy over your shower so you do not have to reach and bend to grab your soap and shampoo.
  • Install grab bars in your shower. Use a shower 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 get dressed. 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.
  • Select shirts or blouses that button at the front and bottoms that fit loosely. These are easier to get on and off.
  • If you need to bend over to reach for something, exhale when you bend over and inhale when you reach.
  • Wear slip-on shoes with low heels and shock-absorbent soles or insoles.