Treating cancer fatigue
This page tells you about treating fatigue. You can find information about
Treating the causes of cancer fatigue can sometimes help to reduce tiredness. Help is also available for the symptoms of fatigue. There are some suggestions below. It may take some trial and error to learn how to manage fatigue and know what works for you. But the first step is to tell your doctors and nurses about your fatigue. More than half of cancer patients with fatigue never tell their doctor about it. But if you tell your doctor, they can find ways of helping you.
Researchers are looking into a number of different types of drug treatments. These include psychostimulants such as ritalin and modafinil which are drugs doctors use to treat attention and concentration disorders. Other drugs doctors are looking into include anti depressants. The results from the research into these drug treatments is mixed with some studies showing they can be helpful and others not. You can find out more about this and other research on our research into cancer fatigue page.
Most people with cancer will have anaemia at some point during their illness. Although it's not usually life threatening, fatigue caused by anaemia can have a big effect on your daily life. You may need a blood transfusion to bring your red cell count up again and make you feel more energetic. There are different types of anaemia and you may have anaemia for a number of reasons. In some situations it may not be helpful to have a blood transfusion. Your doctor or specialist nurse can assess you to see if it would be helpful for you.
Another treatment for anaemia is a drug called erythropoietin or EPO. EPO is a hormone made by your kidneys that encourages the body to make more red blood cells. A number of studies have shown that EPO can raise haemoglobin levels in the body and improve people's quality of life. But some research has found that EPO may also increase the chance of some types of cancer coming back after treatment. The benefits of EPO may outweigh the risks for some people, but it should be prescribed carefully.
EPO is available on the NHS for people with cancer, in some circumstances. In May 2008, NICE (National Institute for Health and Care Excellence) decided that EPO (with iron injections) should only be given to
Exercise may be the last thing you feel like doing. You may feel so tired that doing any exercise seems ridiculous. But sometimes, the less you do, the less you feel like doing. We know that light to moderate exercise every day helps people with cancer to feel better and can give them more energy. There is now a great deal of research which shows that exercise can help reduce cancer related fatigue.
To start with this may mean just a short walk each day. Then try and increase the distance you go gradually. You can walk with a friend to support you along the way. A pedometer is a great way of keeping track of how active you are. Pedometers are about the size of a matchbox. They clip on to your waistband or belt or around your wrist or in your pocket. The pedometer counts every step you take so you can easily keep track of how your exercise is building up each day.
You can buy a pedometer from a sports shop. As a guide, health experts advise that a healthy adult should walk about 10,000 steps a day. Obviously if you are having treatment or have advanced cancer, that might be too much for you. Talk to your doctor or a physiotherapist about where to start so that you can find a realistic goal.
Try doing your exercise at different times in the day to find out when suits you best. Some people find the early morning a good time. Doing a bit of exercise every day will make you feel less tired and your appetite is likely to improve too. Overall, you may be more able to cope with things and be happier in yourself. But don't overdo it. If you are really aching the next day, you are doing too much. Drink plenty of water whenever you exercise to prevent dehydration. And remember to get advice from your doctor before starting any heavy exercise programme.
Exercise can also help people in the advanced stages of cancer. You may not be able to go for a long walk but even gentle exercises in bed or standing up can help. Your hospital physiotherapist can help you plan an exercise programme that suits your needs and how much you can do.
This can mean
- Finding out more about your cancer
- Talking to other people at the outpatient department
- Going to a support group
- Having some counselling
Just about everyone needs support from someone else when they have cancer. You can get some support from family and friends, or doctors and nurses. But support from other people who've been through the same thing can make all the difference. Talking to other people in a support group can show you that you are not alone. It can confirm that fatigue is something many people with cancer have.
If you have advanced cancer and are very tired, it is important to set yourself a few rest times throughout the day. This can be difficult to stick to and you may try to push yourself to keep going. But that won't help. You'll be more tired and less able to cope. You don't have to sleep during these rest times. If you are having trouble sleeping at night it may be better not to actually sleep.
Just sitting or lying down to rest will help. And remember you don't have to do everything, only the things that are important to you right now. Everything else can wait. There is more information on saving your energy further down this page.
If you have short term fatigue, caused by treatment you may be better off taking a little exercise than resting.
Sleepless nights can make you feel tired, cranky and a bit dazed. If you often have trouble sleeping at night, it may help to change a few things about when and where you sleep. If you have cancer related fatigue, sometimes getting a lot of sleep may not help much because lots of other things are causing your fatigue. But to make sure you sleep as well as possible
- Try to sleep in a quiet, calm room
- Go to bed and get up at the same time each day
- Make sure the room that you sleep in is a comfortable and soothing place - an untidy room may be distracting and make you feel anxious
- Make sure the temperature is right
- Sleep with the window open if you prefer, as long as there isn't too much noise outside
- Spend time relaxing before you go to bed - have a bath, read or listen to music
- Do some light exercise each day to help tire yourself out
- Don't drink too much alcohol before bed - you may fall asleep to start with but you'll have a disturbed night
- Avoid caffeine (coffee, tea, chocolate and cola drinks) after early afternoon
- Limit daytime naps to 45 minutes so it doesn't stop you sleeping at night
- Have a light snack before you go to bed to stop hunger waking you up
- Practice relaxation before sleeping - you could imagine somewhere beautiful you'd like to be
- Listen to a relaxation tape
When you really can't sleep, get up and watch TV, read or listen to music until you feel sleepy. Or try taking a warm bath or a warm milky drink. The amino acids in milk are thought to encourage sleep. Then go back to bed and try again. Do let your doctor know if you often have trouble sleeping.
Eating enough to keep up your energy levels can be hard if side effects from your treatment are making you sick or have diarrhoea. But it is important to try and eat what you can, as your diet plays an important role in controlling fatigue. There are some good tips on how to control diarrhoea and sickness in the main chemotherapy section.
If you would like more information about anything to do with diet, contact one of these cancer information organisations. They will be happy to help and can often send you free factsheets or booklets.
Although some medicines can cause fatigue, some can help to control the side effects of cancer treatment that cause fatigue, including
- Drugs that stimulate your appetite - steroids or progesterone
- Drugs that treat anaemia
- Sleeping tablets
- Anti depressants
Doctors have to find a balance between the positive and negative effects of these drugs.
You can do many things in your everyday life that will help to save your energy. Taking short cuts on some things or getting help from other people may help you feel less tired. You could
- Try not to rush - plan ahead where possible and give yourself plenty of time to get to places, preferably not in the rush hour
- Put chairs around the house so that you can easily stop and rest if you need to
- Sit down to dry off after your bath, or simply put on a towelling dressing gown and let that do the work!
- Have some hand rails fitted in your bathroom to hold on to when you get in and out of the shower or bath (the hospital can help to arrange this for you)
- Prepare your clothes and lay them out in one place before you dress
- Get dressed sitting down, as far as you can. Try not to bend too much - rest your foot on your knee to put socks and shoes on
- Fasten your bra at the front first and then turn it to the back
- Wear loose-fitting clothes, and things with few buttons to do up
- Where possible do household tasks sitting down - peeling vegetables, ironing (or better still, buy clothes that don't need ironing!)
- Use a duster on a long stick and sit to do your dusting
- Write a shopping list and go when the shops are quiet
- If you have children, play games that you can do sitting or lying down - reading, puzzles, board games or drawing
- Ask family and friends for help with shopping, housework or collecting the children from school
- Have plenty of nutritious snacks and drinks in, so you can have something quickly and easily whenever you feel like eating
- Don't forget to do things that you enjoy - it will take your mind off your cancer and make you feel more relaxed
Keep a record of how you are feeling, and how your energy levels change. This will help you know if you are more or less tired than before, and help identify which activities make you feel better or worse.
If you are tired and don't feel like cooking, buy ready made meals. Or buy ready prepared vegetables or pre-grated cheese. Every bit of work done for you will save your energy.
Remember that fatigue for people having treatment for cancer is different from the fatigue some people feel long after finishing their treatment. Things that can cause long term fatigue include
- Bone marrow transplants - in some cases, these can cause fatigue for many years after the transplant
- Cancer treatment in childhood, especially for brain tumours
- Taking tamoxifen for several years
Many people with cancer find it helpful to talk to other people who have the same symptoms as them. If you think this may help, look on the general organisations page for an organisation that can put you in touch with a local support group. Sharing your feelings with someone in the same situation may make you feel less anxious about your fatigue. And you can often get tips on how to cope better from talking about your own situation.
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