Managing fatigue

What are the causes

Fatigue can sometimes begin from the day of diagnosis.  It can be part of the overwhelming experience of hearing you have cancer.  Physical activity levels can drop as you are thrown out of your routine, and this may trigger the early stages of fatigue.

The cancer itself can cause fatigue.  It can use up your energy and make you feel less like eating and being active, which then makes fatigue worse. 

Cancer and its treatment can cause your bone marrow to make fewer red blood cells, these carry oxygen around the body.  This may result in anaemia which can cause fatigue.  Iron pills can help, or you may need a blood transfusion.  This can be done as an outpatient or with an overnight stay.  A transfusion takes six to nine hours. 

Cancer may also stop your body making chemicals such as potassium and calcium.  These keep your muscles working properly, including your heart.  If you don’t have enough of these chemicals, then you will feel tired.

Chemotherapy

Many people experience fatigue when they have chemotherapy.  Your red blood cell level is most likely to drop between treatments, so it is common to have some fatigue at that time.

Platinum based chemotherapy, which is used to treat ovarian cancer, can cause anaemia.  This can be helped using a drug called erythropoietin (EPO) which helps the bone marrow produce more red cells.  

Travelling to hospital for your treatment and spending time there, is itself tiring and stressful.

Feeling or being sick, having diarrhoea and not drinking enough fluids can also add to fatigue.

You are more likely to experience fatigue if you are having a combination of treatments, are elderly, have advanced cancer, are in pain or have depression. You can read more about chemotherapy here.

Current research

Research into the causes of fatigue and how it develops suggests that inflammation and the body’s immune system could be involved.  It is looking at how genes that control inflammation could be risk factors for long-term fatigue.

It has also been found that cancer can cause cells to release higher levels of cytokines which are chemicals that affect hormones and nerves and could be linked to fatigue.

Studies have found that exercise seems to be the most successful way of managing and reducing fatigue.  Exercise needs to be planned carefully to avoid peaks of energy followed by troughs of tiredness – which can increase fatigue.

Exercise that is tailored to your individual needs and circumstances is the most effective way of managing cancer related fatigue. 

The difference between fatigue and regular tiredness

Fatigue has symptoms that are more serious than the tiredness we are all used to experiencing from time to time.  It can stop you from taking part in your usual activities and enjoying your life.

• You might want to stay in bed and not bother to do much.
• It may be hard to get up in the morning and be hard to go to sleep at night.
• You may feel sad and anxious and negative about yourself.
• It can be hard to concentrate, even on talking with a friend or watching TV.
• Your muscles may hurt so you can’t go upstairs or walk far.
• Everyday tasks are making you breathless.
• Your heart rate has increased.
• It is difficult to think properly and make decisions.
• You are losing interest in activities you used to enjoy.
• Having more sleep and rest doesn’t seem to make it better.

Pain and fatigue

Pain can make fatigue worse so getting effective pain control could help.  It is important to find a balance as strong painkillers such as morphine can themselves cause fatigue and make the pain worse.

Pain can be frightening and make you think your cancer is getting worse. Worrying about pain can cause anxiety and depression which will make you more tired. 

Remember that pain can be a side effect of chemotherapy or nerves recovering from surgery and other treatment. This can arise a long time after your treatment has finished.  Your pain may not be related to your cancer.

Strategies to try

Pacing is a key strategy to managing cancer related fatigue. 

Get to know your energy levels and patterns so you can plan your activities and exercise when these are at their best, such as mornings or afternoons.

Try to set realistic expectations for each day or week. 

Spread your activities out over the week, so you can use your energy evenly.

Most importantly, don’t suffer alone.  Seek help from your medical team to get the support you need, especially if your mood is low and you are struggling emotionally.  Sometimes it can be hard to describe how you are feeling.

Be kind and compassionate to yourself, without the need to always push through and get everything done.  It may help to check how you are feeling each day and rate your fatigue levels from one to 10, to help you plan the day ahead.  

Getting enough rest

Make sure you get enough rest.  It is important to balance rest with activity which is also part of your recovery.  Have a rest after a period of activity.  You may also need to rest after meals.

Include times to rest when you plan your day. 

You don’t have to sleep but if you do, try to keep to short naps (no longer than 30 minutes and avoid these late in the day), so your night-time sleep is not reduced.

Try not to stand for too long, so sit down to do tasks if you can and sit down to take a shower.  Plan activities that allow you to sit down and go to places where you know you can be seated.

Ask for help and accept offers of help.  Someone may be able to go shopping for you or take children to school.

Tell your family including your children that you are very tired and need to rest.

Plan your sleep

Keep to a regular sleep routine.  Don’t sleep late in the day if you have had a bad night as this can disrupt your sleep pattern.  Early in the evening, try turning off screens and devices that emit blue light.

Eat well

It is important to eat enough to give you the energy you need.  If you are too tired to cook meals or have no one to help you, try eating little and often.  Remember to include protein in your diet, your body needs this to repair itself after surgery and other treatments.  

A dietitian can help you to plan your meals to ensure you are getting the nutrients you need.  You can ask your clinical team or GP to be referred for this service.

Exercise!

Keeping a balance between resting and taking exercise will help you to manage your fatigue.  Inactivity weakens muscles and makes the fatigue worse while exercise will give you energy, help your appetite and improve your sleep.

You can ask to be referred to see a physiotherapist, or a cancer exercise specialist/personal trainer who will advise you about the best exercise for you and help you to plan activities that meet your needs and promote your recovery.

Start by moving around a little more often and slowly build it up.  Do something you enjoy; this might be a gentle exercise routine or a short walk.  On days when fatigue levels are high, try seated exercises or gentle stretching. 

Developing a routine can help you to stick to your exercise programme. You could keep a diary of your exercise so you can see how you are progressing.  Try to avoid long periods of inactivity as this can make fatigue worse. Exercise can also give you a sense of achievement and help your confidence.

Drink fluids when you exercise to make sure you don’t get dehydrated.  Speak to your doctor, nurse or physiotherapist if you are planning to go on a more demanding exercise programme.

Mindfulness, meditation and breathing exercises

These techniques can help you to manage fatigue.

They can help to restore you when you feel anxious and lacking energy.  Just 10 minutes a day can bring about a sense of calm, leaving you feeling more in control.

Aids to help you

There is a range of aids designed to help people with limited strength and energy.  These include perching stools, which support you while you are cooking and doing other household tasks, wheeled trolleys with trays so you don’t have carry items yourself and shower seats.

These are available after an assessment by an occupational therapist.  They can advise you on managing your fatigue and recommend aids to help with your daily activities.  You can be referred to this service by your GP.  Aids are also available from the British Red Cross.

Commodes are also available.  You can keep one downstairs to save you climbing your stairs just to use the toilet.  Use a fabric throw to disguise it as a chair.  

Useful links

NHS website - Household gadgets and equipment to make life easier

The Mobility Aids Centre - Household Aids

British Red Cross store - Assisted Daily Living

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We welcome your feedback. If you have any comments or suggestions, please email r.grigg@ovacome.org.uk or call 0207 299 6653.