Cancer-Related Fatigue

Fatigue is the most common symptom for cancer patients, and the most common side effect of cancer treatment. It is a general lack of energy, tiredness or exhaustion, which is different from tiredness a person usually feels at the end of the day. It is a feeling of physical, emotional, and mental exhaustion even though patients are getting enough rest and sleep.

Cancer-related fatigue can affect daily lives. This may last for months after cancer treatment.

Causes of cancer-related fatigue include:

• Side effects of cancer treatment
• Nutritional imbalance
• Anaemia (low blood hemoglobulin level)
• Lack of exercise
• Psychological factors, such as emotional distress, depression or anxiety
• Pain
• Sleep problems
• Hormone imbalance
• Nausea and vomiting
• Stress, anxiety or depression
• Medicines for nausea, pain, anxiety and depression.
• Alcohol or recreational drug abuse
• Other health conditions, such as reduced lung function, reduced renal function and heart problems

It is important to understand what causes or worsens fatigue, so that doctors solve the problem.

These questions will help describe fatigue to one’s health care team:

• How severe is the fatigue?
• When did the fatigue begin?
• How long does it last?
• What were you doing when you felt most tired?
• Has it changed over time?
• What makes it better or worse? 

Several things can be done to help minimise cancer-related fatigue.

• Understanding one’s own fatigue: Know what is contributing to cancer-related fatigue. One can use a diary to record the pattern of their fatigue and how it varies over several days. This will help identify any “triggers” that worsen the fatigue.
• Maintaining a healthy lifestyle: A healthy lifestyle makes a big difference. Fatigue is usually correlated with one’s quality of sleep.
  • Stay active. Though one may not feel energised, one should try to be active as long as it is manageable, while gradually pushing one’s limits.  This will also help one sleep.
  • Exercise. One may feel tired, but exercising will help counter cancer-related fatigue and build strength over time. Try gradually increasing the intensity each day.  One will sleep better and feel more refreshed the next day.
  • Rest when needed. Limit daytime naps to 30 minutes at a time and no more than twice a day. Do not nap after 4pm. The more one sleeps during the day, the less they will sleep at night.
  • Do not smoke. Try using nicotine gums or patches after consulting healthcare professionals if needed.
  • Avoid caffeine intake, such as coffee, tea, chocolate or Coke after 3pm to prevent interference on sleep quality.
  • Avoid alcohol. Alcohol disrupts sleep and can interfere with the action of some medicines.
  • Maintain a healthy diet. Maintain a balanced, vegetable-based diet with more vegetables (including tofu, beans and legumes) and less animal protein. Avoid fast food.  
• Slowing down: Plan one’s day and schedule activities to coincide with times one feels more energetic.
  • Give oneself more time, take regular breaks, and be patient to minimise self-imposed stress.
  • Postpone less important activities.
  • Keep frequently used objects close by to prevent using excess energy.
• Managing stress and distress:
  • Do not pressurise oneself. Try to accept that the body needs time to recover and be compassionate.
  • Find ways to unwind and relax. 
  • Talk to your family or friends. Let them help
• Paying attention to mind-body wellness: Evidence suggests that mindfulness practices, yoga, and acupuncture can reduce fatigue in cancer survivors. Other mind-body strategies that might be helpful include:
  • Music therapy
  • Massage
  • Relaxation
  • Qigong: a type of relaxation and meditation
• Counselling: Talking with a counsellor may help reduce fatigue and manage your stress.

Smart patient (by Hospital Authority): Cancer related fatigue (Chinese version only)

HKU Med, Jockey Club Institute of Cancer Care (JCICC): Managing Cancer Treatment-Related Fatigue

Videos

▶️ Hospice Home: Fatigue Management (Chinese version only)