Fatigue
Cancer-related fatigue is a common occurrence in patients with cancer, both during and after treatment. It affects over 50% to 90% of all those affected by cancer and is one of the most common side effects experienced throughout treatment.12Thirty percent (30%) of cancer survivors experience fatigue well after completion of treatment.1Cancer-related fatigue is a feeling of tiredness that does not go away with rest. It is different from the fatigue a person without cancer experiences. Cancer-related fatigue can be an obstacle to the patient’s usual daily routine. Fatigue may extend beyond the physical experience to include mental fatigue.
Guidance for professionals
For guidance on assessing fatigue, see A Pan Canadian Practice Guideline for Screening, Assessment, and Management of Cancer-Related Fatigue in Adults Version 2 – 2015
Patient self-assessment tools
One way to assess and better understand cancer survivors’ functional abilities is by asking them to systematically track their energy in performing daily activities, using 2 tools:
The Cancer and Work Fatigue Tracking Tool©
This tool was created by members of the Cancerandwork.ca team along with experts in fatigue assessment. It helps patients assess fatigue easily and quickly. Using a template, patients monitor their fatigue at home and at work over a 4-week period for the purpose of assessing fatigue before return to work, during a gradual return to work and after they have resumed full duties. This fatigue assessment can inform discussions with healthcare providers about the impact of fatigue on work abilities and help with vocational rehabilitation planning.
Energizers and Drainers Interactive Tool
The Energizers and Drainers Tool allows patients to monitor which daily activities improve or restore their energy and which activities drain their energy. The tool is an expanded version of the one found in the British Columbia Cancer Agency’s handbook Cancer and Returning To Work: A Practical Guide for Cancer Patients. One reason it is important to understand the impact of daily activities on energy levels is to inform recommendations for accommodations and energy conservation strategies at work.
Try the Energizer and Drainers Tool
Example of Energizers and Drainers Interactive Tool
| Time of day | Activity | Duration (minutes) | Energy level after 1=low, 5=high |
|---|---|---|---|
| 9 a.m. | Meditated | 30 min. | 4 |
| 10 a.m. | Watched soap opera on TV | 1 hour | 2 |
| 11 a.m. | Went for a walk and stretched | 1 hour | 4 |
| 12 p.m. | Met a friend for lunch | 40 min. | 5 |
| 1 p.m. | Talked on the phone sorting out computer problem | 10 min. | 2 |
Sleep assessment tools and guidelines
Sleep disturbances in cancer patients is a prevalent problem that requires professional attention. More than half of cancer patients will experience some form of sleep disturbance that can impair their daytime and psychological functioning.3
For more information on recommendations for healthcare professionals screening and treating sleep disturbances, see A Pan-Canadian practice guideline for sleep disturbances in adults with cancer (PDF) from Cancer Care Ontario p.34–35.
Sleep tools
If your patient expresses that their sleep disturbances may affect their ability to work, you could recommend that they track their sleeping patterns and practices. This exercise can help obtain an understanding of how their sleeping habits can impact work as well as draw attention to unhelpful practices that might impede sleep.
Self-assessments are a good approach to measure sleep, and document sleep diaries and sleep logs. There are many validated sleep tools and you may be accustomed to one in particular when assessing your patient’s quality of sleep. One validated tool that has been tested with a group of cancer patients is the Pittsburgh Sleep Quality Assessment (PSQI). The PSQI was originally developed by Buysse D.J., Reynolds, C. F., et al. (1995) (6).4
The PSQI assesses patients’ sleep quality in the following 7 areas: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medications, and daytime dysfunction over the last month.
Pain self-assessment tools
If you think pain may be affecting your patient’s ability to work, consider asking them to track their pain levels. Here are 2 tools that can be used:
- Edmonton Symptom Assessment System (ESAS) tool
- Brief Pain Inventory (PDF). This tool measures the intensity of pain and its interference in your patient’s daily life.5
Once your patient has completed these tools, they can bring you their results and ask for guidance on managing their pain and its effect on their work.
