Fatigue is a feeling of tiredness or exhaustion that is not relieved even by a good night’s sleep. It can be caused by the cancer itself, or the side effects of treatments. As many as 9 out of 10 people with cancer (90%) get cancer-related fatigue (CRF).
We do not know exactly why cancer treatments cause fatigue, but we do know that many people with cancer experience excessive tiredness which impacts on their daily life. This could be during or following treatment, last for weeks, months or even years, or may be a symptom of the disease itself.
The first step in management is to screen for treatable causes such as anaemia, hypothyroidism, depression, anxiety, weight loss, pain, medication side effects, infection, anorexia, malabsorption, and other comorbidities.
Those scoring 3 or below a 1–10 scale (0 being no fatigue, 10 being worst possible) can be supported to self-manage e.g. provide written information and agree realistic goals.
Fatigue management principles can be introduced to the person early in the pathway (e.g. during prehabilitation) to help them cope with the potential impact fatigue can have. Macmillan and the University of Southampton have developed an online fatigue management resource for people living with cancer called RESTORE. It provides information about things people can do to help them cope with fatigue and aims to improve confidence for people to self-manage fatigue.
Support for fatigue could be from support workers at a supportive/assistive level, clinical nurse specialists and specific AHPs such as occupational therapists and physiotherapists at a registered and enhanced level.
People with severe or recurrent fatigue may be referred for specialist review management (often an occupational therapist or physiotherapist).
Specialist fatigue management might include:
- Clinical assessment and re-assessment
- Provide written information
- Agree realistic goals
- Discuss relaxation and sleep techniques
- Energy conservation, pacing and compensatory techniques
- Anxiety and stress management
- Exercise programme aimed at improving mobility, strength and stamina – will include cardio-vascular work and muscle strengthening programme
- Psychological therapy of cognitive behavioural therapy
- Nutritional support and advice