Cancer-related fatigue is common in patients with cancer, both during and after treatment. It affects over 50% to 90% of cancer survivors and is one of the most common side effects experienced throughout treatment.1 2 Fatigue may also continue well after treatment has ended in about 30% of cancer survivors.2 Cancer-related fatigue is a feeling of tiredness that does not go away with rest. It is different from the fatigue experienced before cancer, and can be an obstacle to completing usual daily routines. The exact cause is not well understood, but many factors are known to contribute to cancer-related fatigue. Cancer, cancer treatments and its side effects, anemia, deconditioning, malnutrition, metabolic abnormalities, hypothyroidism, anxiety and depression are some of the factors involved in cancer-related fatigue. Fatigue may extend beyond the physical experience to include mental fatigue.
Vocational implications
Research shows that cancer survivors may experience challenges in returning to work, especially if their jobs entail physically demanding tasks.3 With safety-sensitive jobs (such as machine operation), fatigue needs to be monitored and addressed to prevent accidents or injury. Survivors may need more rest breaks on the job or shorter shifts until fatigue is resolved.
Physical therapists and occupational therapists can evaluate workplaces and workstations and recommend strategies for addressing cancer-related fatigue.
What patients can do
Fatigue is experienced differently by each person and certain activities will impact some individuals more than others. Knowing personal limits and understanding the demands of the work will help determine whether one has the physical capacity to perform the job. A cancer patient should also consider whether they have the energy after work to accomplish other non-work–related responsibilities as well as self-care.
Consider recommending that your patients complete a fatigue self-assessment as a way of better understanding the impact of their activities on physical and mental stamina. First, help your patients to consider how fatigue affects their daily life. Our Energizers and Drainers interactive tool can help them identify activities that either sap or generate energy.
Find more information on how to manage cancer-related fatigue:
- Attend a fatigue management class or clinic at the local cancer centre. Examples include:
- The Energize program at Cross Cancer Institute by Alberta Health Services
- Reclaim Your Energy class at the Princess Margaret Cancer Centre, Toronto
- The Cancer Related Fatigue video, DocMikeEvans
- Reclaim Your Energy: Coping with Cancer-Related Fatigue (PDF), Princess Margaret Cancer Centre
- Reclaim your energy with cancer related fatigue video, Princess Margaret Cancer Centre
- Manage cancer related fatigue: For people affected by cancer (PDF) pamphlet created by the Canadian Partnership Against Cancer
- Fatigue/Tiredness: Tips from the BC Cancer Agency
- How to Manager Your Fatigue (PDF) booklet from Cancer Care Ontario
Practice energy conservation:
Prioritizing:
- Which duties are essential for the job to be done? Which could be delegated to someone else? How to use limited energy to accomplish the most important duties.
Planning:
- Tracking energy levels to recognize patterns of high and low energy points. Scheduling more fatiguing tasks or those of higher priority during times of high energy.
- Plan the day so that fatiguing tasks are spread out. Balance high and low energy tasks.
- If possible, spread high energy tasks over several days in the work week.
- Allow time to rest between tasks.
- Do one thing at a time – finish each task prior to starting a new one. Things will be accomplished quicker and with fewer mistakes which saves energy.
- Gather all necessary materials for a task prior to beginning it.
Pacing:
- Things may take longer. Make sure to take this into account when scheduling the day.
- Do not expect to work at the same speed as before. Be sure to communicate with managers and team members the need for more time to complete tasks.
- Take regular rest breaks and stick to the schedule. Taking the time to recharge is fundamental.
- Change tasks before becoming fatigued.
- Change positions frequently to minimize physical demands on the body.
- Take 2 minutes every hour to stretch.
Job accommodations
There are many ways that jobs can be modified to accommodate cancer-related fatigue:
- Plan a graduated return to work.
- Identify non-essential job tasks and explore delegating them to other employees.
- Reduce workplace stress.
- Modify work schedules.
- Modify the work environment.
Reduce physical exertion:
- Do tasks that are less physically demanding.
- Break demanding tasks into smaller steps.
- Rest between the steps.
- Make multiple trips with lighter loads.
- Use electric tools to replace manual efforts.
- Change positions frequently to minimize physical demands.
- Switch tasks before becoming fatigued.
- Use wheeled devices to move items (e.g., cart, wheelbarrow).
- Work in a seated position. If not possible, keep a rest chair nearby.
- Consider a stand-lean chair.
- Reduce typing by using speech-recognition software.
Reduce workplace stress:
- Identify which tasks or work environments are most stressful.
- Work with the employer to develop alternatives.
- Consider providing instruction on relaxation and stress management techniques.
- Refer the patient to employer wellness resources, if available.
Modify work schedules:
- Use flexible work hours to accommodate low-energy times of day.
- Change shifts to fit the employee’s highest daily energy level and prevent fatigue.
- Reduce long commute times by avoiding rush hour.
- Work from home if possible.
- Request time off for medical appointments.
- Explore job sharing or part-time hours, if full-time hours are too demanding.
Modify the work environment:
- Request a parking spot close to the building entrance.
- Relocate the workstation closer to the washroom, break room, or other frequently used space.
- Request a resting room, a couch or a cot to nap or rest during breaks or lunch.
- Use a headset for the telephone.
- Use noise-cancelling headphones or earplugs to reduce distracting sounds.
- Move the workstation to face a wall instead of a busy hallway to decrease visual distractions.
- Optimize the workstation lighting. Eliminate very dim lights or bright, flickering lights and glaring surfaces.
- Ensure comfortable temperatures by installing a space heater, fan, portable air conditioner or humidifier/dehumidifier.
- Install an anti-fatigue mat where the employee frequently stands.
