Dr Michelle King helps us understand why cancer patients experience fatigue and how to manage it.
Around 80% of people diagnosed with cancer will experience fatigue, and that number increases to 99% if they begin receiving chemo- or radiotherapy.1
Patients receiving chemo say that fatigue is what’s stopping them from leading a normal life, even more so than nausea, pain, or depression.1
And, it might not end when treatment does; between 17- 56% of long-term survivors still cope with fatigue.
Cancer fatigue won’t go away after a good night’s rest; it’s a whole-body experience. Even if you muster up the energy to do anything, you could feel exhausted after completing even small tasks.
The problem -fatigue
Fatigue affects your mood, work performance, how you socialise, and your self-confidence. Physical weakness can impact your ability to be active during the day, making things like visiting friends or going for walks seem overwhelming. Mental tiredness can affect your ability to enjoy things, such as reading, working, or driving a car.1
Many cancer patients/survivors don’t discuss their fatigue with their doctors because they feel it’s to be expected and assume nothing can be done about it. Thankfully, that’s not true.
Why is it happening?
Broadly, there are two main reasons why people living with cancer feel fatigue. First, and most obviously, is due to the cancer itself. Tumours produce a substance, called proinflammatory cytokines1, that make you feel weak and tired. When you’re experiencing this type of fatigue, your doctor can help you manage it either with a course of steroids1, or a medication, like modafinil or methylphenidate.2
The second main cause of cancer fatigue is comorbid conditions – additional illnesses that are occurring because of the cancer. How these are treated depends on which ones you are suffering from. They can include anaemia or hypothyroidism, stress, and the after effects of chemotherapy. Travelling long distances to receive treatment is a common cause too.
How to adapt
While there are medical interventions to help you manage fatigue, the best treatment is you. You can change your own thoughts and behaviours around fatigue.
Keep a journal and reflect on the lifestyle changes that you make; tracking it will help you spot when it’s working.
Start some form of exercise or activity, even better if it’s one that you enjoy. It doesn’t have to be a lot, but adding just 30 minutes of exercise three times a week can help. Even if it’s simple exercises that you do in bed. Exercising will not only reduce your fatigue1, but will improve your mood, and self-confidence too.
Work on reducing your stress levels. If you can’t do this alone, chat to a therapist to get some help.
It helps to think of your energy as a piggy bank. You want to fill it up with things that increase your energy levels, like spending time with family and friends, listening to music, going for walks, eating well, and reframing setbacks with humour.
Avoid things that are going to empty your piggy bank (decrease your energy levels e.g. stressful relationships, pain, sleep problems, worrying.)
To manage your fatigue, use the three Ps:
- Planning: Work out a schedule for your day in advance.
- Prioritising: In your schedule, prioritise things that are important: naps, healthy meals, exercise, and spending time with friends.
- Pacing: Expect things to take longer than they used to and pace yourself. Be realistic about what you can achieve.
Discuss your fatigue with your family and doctor. Don’t forget to ask for help when you need it, and accept it when it’s given.
How your doctor can help
- Physical examination to rule out medical conditions e.g. severe loss of weight, anaemia, infection.
- Blood tests to diagnose contributing conditions.
- Screening for sleep problems, depression and memory problems.
- Take a careful history of your medication to see if they may be contributing to the fatigue.
- Radbruch L, Strasser F, Elsner F, Gonçalves JF, Løge J, Kaasa S, et al. Fatigue in palliative care patients—an EAPC approach. Palliative medicine. 2008;22(1):13-32.
- Stewart GD, Skipworth RJ, Fearon KC. Cancer cachexia and fatigue. Clinical medicine. 2006;6(2):140.
MEET THE EXPERT – Dr Michelle King
Dr Michelle King qualified as a psychiatrist in 2007. Since then she has completed a post-graduate diploma in chronic pain management and is currently doing her post-graduate diploma in palliative medicine through UCT. She is part of an interdisciplinary pain clinic and palliative care team. Dr King believes in empowering people so that they can take charge of their physical and mental health, and as a result, live their lives to the fullest.