Coping with Fatigue
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Coping with Fatigue

  • Sunday, 14 February 2010 02:16
While everyone knows what it feels like to be occasionally exhausted, people with Cancer who suffer from fatigue - resulting from the disease itself or its treatment - often suffer from a debilitating exhaustion that can last days, weeks or months.

Cancer fatigue, often described by patients as a total lack of energy, is a near universal problem among cancer patients. It is the most common side effect of cancer and its treatment, affecting 76 percent of patients undergoing therapy. Unfortunately, while medical science has been making steady progress in treating cancer itself, cancer-related fatigue is frequently over-looked, under-recognized and under-treated.

"For many patients, fatigue is the constant reminder that they have cancer. Yet despite its prevalence and distressing consequences, it is one of the least understood symptoms of cancer," said Russell Portenoy, M.D., Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, New York City, and chairman of The Fatigue Coalition, a multi-disciplinary group of medical practitioners, researchers and patient advocates that authored a recent survey about fatigue.

Cancer-related fatigue should be screened for or assessed at every healthcare visit. This provides for discussion of management strategies and outlines ongoing or follow-up evaluation.

The causes and effects of fatigue are complex, and there is no established method to assess it. Patients may not report it and clinicians are usually focused on other indicators. Indeed, it is often dismissed by medical professionals with such comments as, "Of course you're tired - you have cancer," rather than viewed as a medical condition that can and should be addressed. While thousands of cancer studies have been conducted, researchers are only now beginning to study cancer fatigue.

Symptoms of Cancer Fatigue

Patients treated by either surgery, radiation or Chemotherapy experience such side effects as pain, Nausea, and fatigue as a consequence of the treatment. Some treatments, the cancer itself or other disorders can also lead to anaemia (an abnormally low level of red blood cells), a frequent source of fatigue for cancer patients. The symptoms of cancer fatigue include not only feeling tired - weak, worn out, drained, "wiped out" - but also leg pain, difficulty climbing stairs or walking short distances, shortness of breath after light activity, and difficulty performing ordinary tasks such as cooking, cleaning, taking a shower or making the bed.

Cancer fatigue can have mental and emotional effects as well. Patients may have difficulty concentrating while reading or watching television, or have trouble thinking clearly and making decisions.

Fatigue also may underlie patients' feelings of low self-esteem and frustration, often resulting in feelings of helplessness or despair. Changes in sleep, daily activity or eating patterns can cause fatigue, as can anxiety, depression or stress.

Consequences of Fatigue

Aside from the discomfort of feeling exhausted, fatigue can pose a number of obstacles to coping with cancer and reaping the full benefits of available treatments. Fatigue can significantly interfere with your Quality of life and may limit the number of chemotherapy cycles that could be administered, which may limit the effectiveness of treatment altogether.

"It's not acceptable to tell patients that fatigue is just something they must live with," said Dr. Portenoy. "We need to create greater awareness about cancer-related fatigue and develop approaches for assessing and treating it. For some patients, treating fatigue may be as important as treating the disease."

Managing Your Cancer Treatment-Related Fatigue

Fatigue is a feeling of tiredness that can keep you from doing the things you normally do or want to do. Fatigue is very common among people receiving cancer treatments. Factors such as cancer itself, low blood counts, nutritional problems, and sleep problems contribute to fatigue, but the exact cause is not known.

Signs of Fatigue:

* You feel weary or exhausted. It may be physical, emotional, and/or mental exhaustion.

* Your body, especially your arms and legs, may feel heavy.

* You have less desire to do normal activities like eating or shopping.

* You may find it hard to concentrate or think clearly.

What You Can Do to Manage Your Fatigue:

Rest and sleep are important, but don't overdo it. Too much rest can decrease your energy level. In other words, the more you rest, the more tired you will feel. If you have trouble sleeping, talk to your doctor or nurse. A "Power Nap" during the day is one hour or less.

Stay as active as you can. Regular exercise like walking several times each week may help. You may find that you are most able to exercise early in the day. Set short term goals for yourself (i.e.: 10 minutes, 2 blocks), and then increase as you are able. Reward yourself.

Drink plenty of liquids. Eat as well as you can, and eat nutritious foods. Carbohydrates and proteins are quick energy foods. Supplements, though nutritious, haven't been proven to directly reduce fatigue.

You can do more by spreading your activities throughout the day. Take rest breaks between activities. Rest breaks save energy for the things you want to do. Let others help you with meals, housework, or errands. Do not force yourself to do more than you can manage. Because cancer-related fatigue is not the result of over-activity, resting or reducing activity alone, will not improve or lessen fatigue. Energy conservation is the deliberate, planned management of personal energy resources, to attempt to decrease energy depletion (Barsevick, et al., 2004).

Do activities that you enjoy and make you feel good. Many people enjoy nature activities such as bird watching or gardening. Try listening to music, or visiting with friends and family, or looking at pleasant pictures. Try to do these activities at least three times per week.

Talk to Your Nurse . . .

* If you have been too tired to get out of bed for the past 24 hours.

* If you feel confused or cannot think clearly.

* If your fatigue becomes worse.

Lynette Radke, RN, MS, OCN® Marshfield Cancer Center, Marshfield, WI.
Melissa Donofrio, RN, BA, OCN®, Miller-Dwan Medical Center, Duluth, MN.
Marilyn Grainger, RN, MS, OCN®, Regional Cancer Center, Waukesha, WI.
Rosanne Schultz, RN, MS, OCN®, Lutheran Hospital, LaCrosse, WI.

Suggested Strategies for Energy Conservation

When considering ways to conserve energy, remember to prioritize, delegate, pace yourself, and plan high-energy activities at times of peak energy.

Activities of Daily Living

* Sit down to bathe and dry off. Wear a terry robe instead of drying off.

* Use a shower/bath organizer to decrease leaning and reaching.

* Install grab rails in the bathroom.

* Use extension handles on sponges and brushes.

* Use an elevated toilet seat.

Organize time to avoid rushing

* Lay out clothes and toiletries before dressing.

* Minimize leaning over to put on clothes and shoes.

* Bring your foot to your knee to apply socks and shoes. Fasten bra in front then turn to back.

* Modify the home environment to maximize efficient use of energy. Example: Place chairs to allow rest stops (e.g. along a long hallway).

* Wear comfortable clothes and low-heeled, slip on shoes. Wear button front shirts rather than pull-overs.


* Schedule household tasks throughout the week.

* Do housework sitting down when possible. Use long-handled dusters, dust mops, etc. Use a wheeled cart or carpenter's apron to carry supplies.

* Delegate heavy housework, shopping, laundry, and child care when possible.

* Drag or slide objects rather than lifting. Use proper body mechanics. Use your leg muscles not your back when working.

* Sit when ironing and take rest periods.

* Stop working before becoming tired.


* Organize list by aisle.

* Use a grocery cart for support.

* Shop at less-busy times.

* Request assistance in getting to the car.

* Purchase clothing that doesn't require ironing.

Meal Preparation

* Use convenience foods/easy-to-prepare foods.

* Use small appliances (they take less effort to use).

* Arrange the preparation environment for easy access to frequently used items.

* Prepare meals sitting down.

* Soak dishes instead of scrubbing and let dishes air dry.

* Prepare double portions and freeze half.

Child Care

* Plan activities to allow for sitting down (e.g., drawing, pictures, playing games, reading, and computer games).

* Teach children to climb up on the lap or into the highchair instead of being lifted.

* Make a game of the household chores so that children will want to help.

* Delegate childcare when possible.


* Plan workload to take advantage of peak energy times. Alternate physically demanding tasks with sedatory tasks.

* Arrange work environment for easy access to commonly used equipment and supplies.


* Do activities with a companion.

* Select activities that match energy level.

* Balance activity and rest (don't get overtired).

Note. Based on information from Donovan, E. (1995, October 25). "Energy conservation." In Fatigue Initiative through Research and Education (FIRE®) course. Educational program sponsored by Oncology Nursing Society and Ortho Biotech Inc., Phoenix, AZ.

The Key to Delegation

Know Your World

What is going on around you that is contributing to your fatigue level (e.g., cancer diagnosis, symptoms related to your cancer or treatment, role changes at home, financial stress, emotional and physical stress)?

Know Yourself

What personal barriers must you overcome to realize the benefits of delegating to others (e.g., sense of anger, feelings of loss of control, achievement concern that it won't be done right, feel abandonment or that you aren't worthy or needed, loss of your "normal" role in the family)? Understand that others can and wish to help, but might not know how to be useful. It is OK to spell it out to them.

Know What Needs to be Done

* Assess what you need done. Learn to let go.

* Plan and prioritize.

* Divide duties among your friends or family members, considering their skill and knowledge level, motivation, and personal traits. Provide a clear understanding of the responsibility and what your expectations are. Delegation can empower family and friends to enhance their talents and skills and possibly develop new ones.

* Evaluate and provide praise. Reinforce good work and good attempts. Resist the temptation to take over if or when things go wrong.

Know the Person to Whom You Are Delegating the Task

Assess the strengths of your family. Who is better at doing the yard work? Who likes to cook? Who does a better job with the housework? Your family members want to help. In letting go, you will show friends and family that you trust and respect them and that you need them. Ultimately, by sharing the work, it allows you to devote more time and energy to activities and areas that are most meaningful to you.


* Openly and honestly let your friends and family members know your feelings.

* Use "I feel" and "I want" statements.

* Communicate who, what, where, when, how, and why.

Resolve Conflict

* Shift your focus: Determine what is possible in this situation, and turn away from negative feelings. Separate the person from the problem.

* Create a positive, open attitude: Listen and empathize with what the other person wants/needs. Respect feelings that are expressed.

* State your feelings: Be direct and honest. State your feelings clearly and factually. Determine what you are willing to do or give to get what you want.

* Evaluate mutual goals: Determine what the other person is willing to do or give up to get what he or she wants and propose a solution that reflects understanding of what you both want/need.

Evaluate Feedback

The final step in this process is providing positive and constructive feedback to your friend or family member. If these words are left unspoken, he or she may wonder, "Did I do ok?", "Does he or she notice what I do?", or even "he or she never thanks me, so what does it matter?" Sharing honest feedback regarding a person's efforts and performance takes courage. Providing praise and constructive criticism will strengthen your relationship and create a greater sense of "team" and support of one another as you face your cancer diagnosis.

Managing Cancer Treatment-Related Fatigue in the Workplace Setting

Cancer treatment-related fatigue may interfere with your ability to perform your workplace duties. Talking with your employer and your co-workers about your fatigue may dispel their uncertainty or uneasiness regarding your lack of energy since starting your cancer treatment. The more they know and understand about cancer treatment-related fatigue, the better they can support you in your workplace setting.

1. Cancer treatment-related fatigue is the most common and longest lasting side effect associated with cancer treatment. Discuss with your employer or supervisor that, to the best of your ability, you would like to remain a productive worker while you are taking your cancer treatment. Be realistic with yourself and your employer about your work goals during this time. Reassess and reprioritize those goals as needed.

2. Cancer treatment-related fatigue can sometimes affect a person's moods, emotions, and the ability to concentrate or make decisions. Discuss with your employer or supervisor possible ways to make adjustments in your workplace responsibilities in order to minimize the impact of cancer treatment-related fatigue on your ability to do your job effectively:

* Consider flexible scheduling to take advantage of peak energy times

* Request a change or modification in your current job responsibility

* Learn a new job skill that might be less physically or mentally demanding

3. Lack of communication between you, your employer, and your co-workers regarding your treatment-related fatigue can often lead to confusion, mistrust, and anxiety. Make an effort to keep an open dialogue with your employer and co-workers about how you are feeling during your cancer treatment. Avoid the trap of not asking for help, if and when you need it.

4. Decide what changes you can make while you are at work to manage your cancer treatment-related fatigue - set realistic work priorities on a daily basis, adjust your work routines as necessary, eat properly throughout the day to maintain your energy, drink plenty of fluids, and take rest periods. Exercise routinely to maintain stamina and maintain medication schedules as ordered by your doctor.

5. Hold an informal "lunch and learn" session at your workplace setting in order to put cancer treatment-related fatigue in proper perspective for your employer and co-workers. Use educational material available from your doctor's office or ask your oncology nurse to consider providing your co-workers with a short talk about the impact of cancer treatment-related fatigue in the workplace setting. Share this website.

© 2006 Oncology Nursing Society. All rights reserved. All use subject to Terms and Conditions of Use set forth at All materials published on or used on the Site are protected by copyright, and used with permission from The Oncology Nursing Society.

You may also find the following documents useful:

An article by Nancy Conn-Levin, M.A - Brain Tumors and Fatigue PDF document. Adobe Acrobat required.

A presentation about "Brain Tumours and Fatigue" by Nancy Conn-Levin, taken from the Brain Tumour Foundation of Canada's "Information Day" in London, Ontario during October 2008 - Fatigue and Symptoms

Cancer Institute, NSW's fact sheet on fatigue -
Do you feel exhausted or tired a lot of the time…? PDF document. Adobe Acrobat required.

Adobe Reader download

This page was last modified on 20 March 2009 at 21:47.


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