Survivors Cancer’s impact on work and strategies Fatigue

Cancer-related fatigue is a common occurrence in patients with cancer, both during and after treatment. Cancer-related fatigue affects 70% to 100% of all those affected by cancer during active treatment, and about 30% in post treatment.1 Fatigue is one of the most common side effects experienced throughout cancer therapy treatment. 1 2 Fatigue may also continue well after treatment has ended in about 30% of cancer survivors.1 Cancer-related fatigue is a feeling of tiredness that does not go away with rest. It is different from the fatigue you experienced before cancer. Cancer-related fatigue can be an obstacle to your usual daily routine. 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 work shorter shifts until fatigue is resolved.

What you can do

Fatigue is experienced differently by each person and certain activities will impact some individuals more than others. Knowing your personal limits and understanding the demands of your work will help you determine whether you have the physical capacity to perform your job. You should also consider whether you will have the energy after work to accomplish other non-work related responsibilities as well as self-care.

Consider completing a fatigue self-assessment as a way of better understanding the impact of your activities on your physical and mental stamina.

First, consider how fatigue affects you in your daily life. Are some activities more challenging than others? Do some activities help relieve fatigue or promote energy? The use of the Energizers and Drainers Tool provided on this website may help you identify activities that “energize” and “drain” you.

Energizers & Drainers Interactive Tool

You can also use our Fatigue Tracking Tool to monitor your fatigue level. You can use your results to start a discussion with your healthcare provider.

Fatigue Tracking Tool

You can also try Nutritional Management of Cancer-Related Fatigue Post-Treatment

Find more information on how to manage cancer-related fatigue:

• Attend a fatigue management class or clinic at your local cancer centre. Examples include:
  • The Fatigue Clinic at Princess Margaret 
  • The Energize program at Cross Cancer Institute offered by Alberta Health Services
  • Reclaim Your Energy class at the Princess Margaret Cancer Centre
• The Cancer Related Fatigue video by DocMikeEvans
• Reclaiming your Energy: Coping With Cancer Related Fatigue video by the Princess Margaret Cancer Centre
• Reclaim Your Energy: Coping with Cancer-Related Fatigue pamphlet
• Manage cancer related fatigue: For people affected by cancer pamphlet from the Canadian Partnership Against Cancer
• Fatigue/Tiredness – tips from the BC Cancer Agency
• How to Manage Your Fatigue pamphlet from Cancer Care Ontario

Job accommodations

Modify your work tasks and how you work:

• Develop or enhance your time management and organizing skills – make a routine of planning your day each morning.
• Reduce multi-tasking. Focus on one task at a time making sure to complete the first task before moving to the next one.
• Make to-do lists and prioritize items; check the list throughout the day.
• Reduce distractions, such as notifications, phone calls, noise and clutter in your workspace.
• Consider a graduated return to work.
• Reduce physical exertion. Break demanding tasks into smaller steps to complete. Take a rest break between the steps.
• Consider the energy required to carry heavy items versus making multiple trips with lighter loads.
• Do tasks that are less physically demanding.
• Use electric tools to replace manual efforts.
• Change tasks before you become fatigued.
• Consider a mobility aid on wheels (carts, wheelbarrow, etc.) to move items. Consult with a local physical therapist or occupational therapist for your best option.
• Speech-to-type dictation programs may be helpful.
• Reduce workplace stress—identify which tasks/workspaces are most stressful and work with your employer to develop alternatives. You may want to consider using relaxation and stress management techniques. Talk to your employer to find out what training or employee wellness resources are available.
• Identify non-essential job duties; speak with your manager to explore delegating these tasks to another employee.
• Change positions frequently to minimize physical demands on your body.

Practice energy conservation:

Prioritizing:

• Which duties are essential for your job to be done? Which could be delegated to someone else? Use your limited energy to accomplish the most important duties.

Planning:

• Track your energy levels to recognize patterns of high and low energy points. Schedule more fatiguing tasks or those of higher priority during times of high energy.
• Plan your day so that fatiguing tasks are spread out. Balance high and low energy tasks.
• If possible, spread high energy tasks over several days in your work week.
• Allow time to rest between tasks.
• Do one thing at a time—ensure that you finish every task prior to starting a new one. Things will be accomplished quicker and with less mistakes which saves you energy!
• Gather all necessary materials for a task prior to beginning it.

Pacing:

• Things may take longer; make sure that you take this into account when scheduling your day. Do not expect to be working at the same speed as you were before. Be sure to communicate with your manager and team members the need for more time to complete tasks.
• Implement regular rest breaks. Schedule these rest periods and stick to your schedule. Taking the time to recharge is fundamental.
• Change tasks before you become fatigued.
• Change positions frequently to minimize physical demands on your body.
• Take two minutes every hour to stretch.

Modify your work schedule:

• Ask for flexible work hours to accommodate energy levels.
• Identify and request shift preference (for example, day shifts only).
• Reduce the burden of excessively long commute times by avoiding rush hour.
• Work from home if possible.
• Request time off for medical appointments.
• Explore job sharing if full-time work is too demanding.

Modify your work environment:

• Request parking close to work entrance.
• Relocate your workstation closer to the washroom, break room or other frequently used space.
• Speak with your manager about storing a cot to use during rest periods; take a 20-minute nap or rest during your lunch break.
  • Unable to nap? Practice deep relaxation instead with or without an audio guide.
  • Do something energizing on your breaks, such as meditating, stretching or going for a walk to change your environment.
• Fuel your body:
  • Sip from a water bottle throughout the day to stay hydrated.
  • Keep healthy snacks nearby to help you recharge throughout the day.
• Clean up: a tidy, orderly workspace requires less effort to locate materials.
• Work in a sitting position that takes less energy than a standing position, keeping in mind to change your position from time to time. Use a stand-lean chair if possible; if not, keep a rest chair nearby.
• Wear supportive footwear. Consider clothing options within your dress code that are comfortable and do not restrict your movement or breathing.
• Decrease sensory overload:
  • Use noise-cancelling headphones or earplugs to reduce noisy distractions.
  • Work facing a wall instead of a busy hallway to decrease visual distractions.
  • Optimize the lighting in your environment:
    • Very dim light can cause eye strain and increase fatigue.
    • Bright, flickering lights or glaring surfaces can cause strain and discomfort.
  • Optimize temperature: consider using space heaters, fans, portable air conditioners or humidifiers/de-humidifiers for comfort.

Request a professional ergonomic evaluation of your workstation. If this is not possible, here are a few tips:

• Use an anti-fatigue mat under surfaces where you frequently stand or add anti-fatigue surfaces to your shoes.
• Place frequently used materials within reaching distance.
• Keep frequently used items at waist height to avoid bending or reaching above your head.
• Use a headset if you are frequently on the telephone.
• Ensure a good sitting position.
• Adjust your chair to fit your body.
• Place your computer monitor in the right position.
• Choose a good computer mouse and place it in the best position.

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