Cancer-related fatigue is different from other types of fatigue. Patients with cancer may describe their fatigue as feeling weak, listless, or drained. It can cause the patients to feel too tired to complete daily activities such as eating or walking to the bathroom. This cancer-related fatigue can even make it hard for the patient to think or move. It does not go away with rest. Managing fatigue is an important part of good cancer care so patients should be open and honest with their care providers regarding their fatigue and how it is impacting their daily lives.5
Cancer-related fatigue can last anywhere from months to years and often continues after cancer treatment has ended. Fatigue often gets worse at the beginning of chemotherapy treatment and then gets better until the next treatment. Fatigue typically gets worse throughout radiation treatment. Cancer-related fatigue can vary greatly from day to day and it can be overwhelming for patients. The causes of cancer-related fatigue are not well understood. The symptoms can be the result of the cancer itself and/or the cancer treatment.5
Cancer, as well as cancer treatment, can alter normal protein and hormone levels which are linked to inflammatory processes which could possibly cause or worsen fatigue. Cancer treatment destroys both normal and cancerous cells and this can lead to a build-up of cell waste which requires extra energy from the body to eliminate. Cancer creates toxic substances in the body that alter the way normal cells function. In many cases, fatigue has more than one cause.5
Some common causes of cancer-related fatigue include:5
- anemia, pain
- emotional distress
- sleep problems
- poor nutrition
- lack of exercise
- alcohol or recreational drug use
- other medical problems such as:
- digestive issues
- low thyroid function.
Patients with cancer must plan their day to include times for rest. They should take short naps or rest periods, each lasting 30 minutes or less instead of taking one long nap during the day. Too long of a rest period or nap can lower their overall energy level and make it difficult to sleep well at night. It is common for patients to have sleep problems while being treated for cancer. They may have trouble falling asleep or may sleep too much.6
Certain medications used to treat pain, nausea or depression can lead to feeling tired. Patients should speak with their cancer team if they are feeling tired all the time as medication dosage changes or changing to another medication can help. It is a good goal to sleep 7-8 hours each night – including going to sleep and waking at the same time to establish a healthy sleep routine and avoiding caffeine in beverages, medications, or foods for at least 8 hours before bedtime should help them sleep better.6
While exercise is important, patients with cancer should avoid exercising too late in the evening. Moderate levels of exercise regularly, especially walking, can decrease fatigue and help with sleeping better. If they still have trouble sleeping, they may benefit from working with a mental health professional to address sleep issues. Energy conservation is a way that patients with cancer can ensure they have enough energy to do what they need to do every day. They may need to accept the reality that they may not be able to do everything that they want to do.6
Prioritizing daily tasks in order of importance should be the first step. They should plan ahead and space out activities throughout the day. Completing tasks slowly will allow them to save energy to complete tasks once they begin. It is important to remember to incorporate rest periods between daily activities. Patients with cancer should make sure they do not stand for activities too long or that they do not complete activities, including bathing, in extremely hot or cold temperatures. They should sit whenever possible to complete activities. The use of a shower chair and a chair in the bathroom at the sink can help with activities of daily living. They should store frequently used items within easy reach. For activities that are too taxing such as lawn mowing or vacuuming, patients with cancer should ask others for assistance. This will not only allow the patient to conserve energy, but it will also help family and friends to feel that they are truly helping. It is important when asking for assistance that family and friends are given specific things to do. It may be helpful to have someone who can assist with coordinating assistance in case there are times when the patient is too fatigued to even ask for help.6
Cancer treatment can impact how patients eat or swallow, as well as how things taste. This can make it difficult to eat well. Patients with cancer must eat enough to provide energy and to allow their bodies to heal. Dehydration can worsen fatigue, so patients with cancer must get at least 8 cups of fluids every day. They should also include fiber, protein and fat with every meal and snacks to keep their blood sugar levels more stable and have a sustained feeling of energy.6
Having cancer is stressful. Cancer treatment leads to even more stress. Patients must discuss their stress levels with their cancer care team. They may benefit from joining a support group, counseling, stress management training, or relaxation exercises to help with overcoming their feelings of fatigue. Distraction can be a great way for patients with cancer to cope with fatigue. They can use music, reading a book, or having relaxing visits with family or friends to distract themselves from their feelings of fatigue without utilizing too much energy.6
Many recommendations can help patients with cancer in completing activities of daily living. They must plan ahead to avoid rushing and allow themselves plenty of time to complete daily activities. Sitting to bathe and dry off will conserve energy. Another helpful tip is to don a terry cloth robe instead of using a towel to dry off. It is helpful to use a shower organizer to minimize the need to lean over or reach too far. Long-handled brushes and sponges can help with washing their feet and backs. Grab bars in the bathroom can be helpful, as well as the use of an elevated toilet seat can conserve energy by decreasing the need to sit too low when using the toilet.7
It is helpful to lay out clothing and toiletry items before dressing. To decrease the need to lean over to put on clothing and shoes, patients should bring their feet to their knees if possible, to don socks and shoes, as well as to thread their legs through their pants and underwear. If they cannot cross their legs in that manner, adaptive equipment such as reachers, sock aids, and shoehorns can help with lower body dressing. Comfortable shoes with low heels and slip-on style are preferred. For female patients with cancer, it is helpful to fasten their bra in the front and then move it around to the back. Shirts that button in the front are easier to don than pullover shirts.7
Whenever possible, patients should complete home modifications to assist with energy conservation. For example, patients should place chairs throughout their home to allow for seated rest periods as needed.7
The following are tips for energy conservation during housekeeping:7
- It is important to schedule chores throughout the week rather than trying to complete them all in one day.
- Whenever possible, patients should complete housework while sitting down.
- Dusters, mops, etc. with long handles can save energy.
- A cart with wheels or an apron can be used to carry cleaning supplies.
- When they can, patients should request assistance with heavy housework tasks, shopping, laundry, or childcare.
- It saves energy to slide objects rather than lifting them.
- When it is necessary to lift objects, patients should squat and lift with their leg muscles rather than using their back.
- It is helpful to complete ironing while sitting.
- It is vital to stop working before patients become too fatigued.
The following are helpful tips for shopping:7
- When creating a shopping list, it is helpful to organize the list by aisle or section of the store.
- A grocery cart can be used for support while walking throughout the store.
- It is helpful to shop at less busy times of the day.
- Patients with cancer should request assistance with getting into the car if needed.
- It is helpful to buy clothes which do not need to be ironed.
The following tips are helpful for meal preparation for patients with cancer:7
- Choose convenient and easy-to-prepare foods whenever possible.
- It is helpful to use small appliances that take less effort to use such as a microwave instead of the stovetop.
- Patients should complete environmental modifications within their kitchen to create easy access to items that are used most frequently.
- Whenever possible, patients should prepare meals while sitting down.
- It is helpful to soak dishes instead of scrubbing them to get them clean.
- Allowing dishes to air dry will also save energy rather than towel drying them.
- When cooking, double recipes and freeze half of the meal to be re-heated for a future meal.
- Patients with cancer should also consider the use of a meal delivery service such as Project Open Hand or Meals on Wheels.
The following recommendations will assist patients with cancer with childcare:7
- They should plan activities that can be completed while sitting down, such as drawing/coloring pictures, playing board or card games, reading books, or playing computer games.
- Patients should encourage children to climb on their lap or into a highchair rather than picking them up.
- It is helpful to make a game out of completing household chores to encourage children to participate as they can.
- When needed, ask for assistance with childcare.
For patients with cancer who are still working, they should plan their workload to take advantage of times of the day when they have the most energy. Whenever possible, they should alternate work tasks that are physically demanding with less taxing activities. Patients should arrange their workspace to allow them to access the most commonly used equipment and supplies easily. It is important to continue the completion of leisure activities, especially with a friend. When choosing an activity, patients should plan one based on how much energy they have at that time. They should balance activities with rest breaks.7