McGill

Fatigue

Dr. Christine Maheu, RN, PhD

Dr. Christine Maheu is an Associate Professor in the Ingram School of Nursing, Faculty of Medicine, McGill University. Dr. Maheu is also an Affiliate Scientist at the University Health Network and the University of Toronto. At McGill University, she teaches research methods, supervises graduate students (masters, doctoral, post-doctoral), mentors practicing nurses and students in research, and conducts research in English and French. She has held research awards with the Canadian Institutes of Health Research, the Canadian Cancer Society, and the Canadian Partnership Against Cancer. These awards funded her research in psychosocial oncology, which focuses on developing and testing psychosocial interventions or measurements tools for various cancer populations. Additionally, in partnership with Ipsos Canada and funded by the Canadian Partnership Against Cancer, she is co-leading a nationwide survey of the needs of cancer patients for transition care from the end of their treatment to three years after their diagnosis. Dr. Maheu received awards for excellence in nursing research (2013, 2015, 2016) from Ovarian Cancer Canada, the Canadian Association of Nurses in Oncology, and the Quebec Association of Nurses in Oncology.

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Ms. Rosemary Cashman

Ms. Rosemary Cashman is a nurse practitioner at the BC Cancer Agency and an Adjunct Professor in the Faculty of Nursing at the University of British Columbia. Her professional experience includes the care of lymphoma, lung cancer and brain cancer patients. She co-chairs the Patient and Family Advisory Council, which guides the brain tumour care program at the BC Cancer Agency. She has authored book chapters and articles related to the care of brain tumour patients and their families. Ms. Cashman was involved in developing and implementing a rapid-access radiotherapy clinic for the palliative treatment of lung cancer and she continues to work in this clinic.

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Kyla Johnson, Occupational Therapist, Segal Cancer Centre, Jewish General Hospital

Ms. Kyla Johnson, M.Sc.A., originally from Edmonton, Alberta, Kyla Johnson works as an Occupational Therapist at the Segal Cancer Center of the Jewish General Hospital. She holds a Master of Science in Occupational Therapy from McGill University. Her goal as a rehabilitation professional in Oncology is to enable people with cancer to be able to do what they want and need to do, in all stages of their cancer experience. Kyla helps develop strategies and accommodations to facilitate a return to meaningful life roles, including work. She is specialized in cancer-related cognitive dysfunction and runs a weekly group teaching strategies to improve daily cognitive functioning. Kyla also leads a volunteer yoga class for young adults with cancer. She lives in Montreal, Quebec.

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Ms. Maureen Parkinson, Vocational Rehabilitation Counsellor, M.Ed. C.C.R.C

Ms. Maureen Parkinson is the province-wide vocational rehabilitation counsellor at the BC Cancer Agency. She has also been vocational rehabilitation counsellor at a public rehabilitation hospital and vocational rehabilitation consultant to insurance companies and the court system. She has instructed and facilitated Service-Canada-funded programs on job searching and career exploration. Ms. Parkinson has a Masters in Counselling Psychology, is a Canadian Certified Rehabilitation Counsellor, and completed the Certified Return to Work Coordinator Program through the National Institute for Disability Management and Research. She has developed return-to-work and job-search seminars for cancer patients and created the guidebook “Cancer and Returning to Work: A Practical Guide for Cancer Patients” as well as on-line articles about returning to work and school. She also co-authored a paper commissioned by the Canadian Association of Psychosocial Oncology, “Cancer and Work: A Canadian Perspective”.

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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:

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.

Back to the list of common cancer treatment side effects