Key takeaways
- Fatigue is a very common side-effect of cancer and its treatment, and can be long-lasting
- Getting quality sleep, eating well, exercise and psychological support can all have a positive impact on fatigue
- Reasonable adjustments at work that can support someone experiencing fatigue include short breaks, reduced or flexible hours, and working from home
- Although cancer-related fatigue will often resolve on its own, professional support can make a big difference to someone’s quality of life
One of the most common side-effects of cancer treatment is cancer-related fatigue. It’s much more intense than normal tiredness and affects around two thirds of people who have had cancer treatment. For nearly half of those people, the fatigue lasts for three months or longer. Fatigue can impact a person physically, psychologically and socially, and make things challenging both at home and work. While cancer-related fatigue usually resolves eventually, the right support can make a significant difference to someone’s quality of life, their decision to return to work and ability to do their job. In this guide, our professionals share advice about how to manage cancer-related fatigue in the workplace.
What causes cancer-related fatigue?
Scientists haven’t yet agreed on a single cause of cancer-related fatigue; rather, it’s thought to be related to several different factors and the relationship between them. Some of these factors are particular to each person, such as their type of cancer and treatment programme, previous psychological challenges like depression, anxiety or loneliness, as well as how much physical activity a person does and the quality of their sleep. Fatigue may also have a treatable cause, for example, anaemia, which can be treated with iron supplements. You may need a blood test to check for this and your GP or nurse can arrange this. Other factors contributing to cancer-related fatigue might include changes to hormones and immunity after treatment.
How to manage cancer-related fatigue
Speaking to a healthcare professional can be a good place to start, to check that your fatigue isn’t related to a treatable cause. There is good evidence that lifestyle changes can help to manage fatigue and these include:
Getting quality sleep
If you aren’t sleeping well at night, this can disrupt your circadian rhythm (sleep wake pattern), resulting in an increased desire for naps during the day and feeling more tired overall. It can be beneficial to create a sleep routine that caters for at least seven hours of quality sleep a night. Set a regular bedtime and stick to it, and establish a wind-down routine that involves limiting your use of electronics. Also ensure your sleep environment is dark, quiet and comfortable.
Sleep is often one of the first things I explore with a patient, as it can have such a huge impact on someone’s day-to-day life, and their ability to cope with cancer and its side effects. Sleep hygiene is all about creating an environment and routine that supports good sleep. Can you cut down screen time in the evening? Can you have a warm bath before bed or a warm decaffeinated drink? Can you read a book or listen to an audiobook as a way to relax? Is your bedroom cool and dark? Setting a regular sleep pattern and sleep hours can also really help.
– Dr Lucy Davidson, Psychologist, Perci Health
Eating well
A well-balanced diet of fresh, nutrient-rich foods can help reduce fatigue. Your body can function more effectively when you meet its nutritional needs and provide all the necessary vitamins and minerals. Dehydration can further contribute to fatigue, so also make sure you are drinking plenty of water each day.
Not many people understand that a dietitian can help with cancer-related fatigue. Dietitians work with the whole person, taking into consideration whether you’ve gained or lost weight during treatment, your digestion and what a typical day looks like, including sleep, stress and physical activity. Then, of course, we’ll look at your diet and what changes we can make to support the fatigue.
Jo Cunningham, Registered Dietitian, Perci Health
Physical activity
Exercise after cancer treatment can actually reduce fatigue. This is because physical activity releases ‘feel good’ endorphins, making you feel more energetic. The exercise doesn’t have to be intense. There are many benefits to walking after chemotherapy, for example, as not only can it help tackle fatigue but it can also lift your mood and improve sleep quality. If walking isn’t your thing, light gardening or a gentle swim are other good options.
Fatigue management is quite a new field, and not everyone understands it. The benefit of seeing a specialist cancer physiotherapist is our knowledge and experience in this area. Routine is also important for people experiencing cancer-related fatigue. A chart can help, with times for waking, getting up, eating, napping and exercise. I recommend that people try to stick to the same timings every day of every week.
Louise Malone, Consultant Physiotherapist, Perci Health
Psychological support
Talking therapies can help you come to terms with your emotions and give you the tools you need to manage them. Being able to process your feelings more effectively can reduce internal ‘noise’ and physical symptoms that interrupt your sleep. Psychological support can also help you to reframe your perspective about your fatigue and improve your coping skills.
Fatigue is an invisible side effect of cancer treatment, so can be difficult to understand and cope with. It’s common to experience feelings of shame or guilt when you’re struggling with fatigue, because you can’t do the things you used to be able to or are expected to. Friends, family and colleagues might not understand what you’re going through or how to help, which can also be difficult. Working with a specialist oncology psychologist can be beneficial because we know about the physical side-effects of cancer treatment, especially those you can’t see, like fatigue.
Dr Lisa Dvorjetz, Counselling psychologist, Perci Health
Making adjustments at work
When returning to work after cancer, your employer should make reasonable adjustments for you, to make things easier and allow you to carry out your tasks effectively. There are also specific changes you can make to help you cope with fatigue. These adjustments will differ from person to person and will likely change from day to day, depending on how tired you feel.
For example, there may be times at work when you feel tired, are uncomfortable or need to take medication. Ask your employer about the options that are available for extended or additional breaks during your working day. If you live close to your workplace, you may be able to have a longer lunch so you can go home for a lie down, or if you have a job where you are on your feet most of the time, you can explain that you may need to sit down for a moment.
Other reasonable adjustments might include:
- A phased return
- Changing your hours
- Reducing your hours
- Working from home
- Longer breaks
- Lighter duties
- Sharing responsibilities with a colleague
- Parking close to the office
Cancer is categorised as a disability, and therefore you have a legal right to reasonable adjustments when you return to work after treatment. Making a plan with an employer is an important part of the return to work process. An occupational therapist can speak to your employer on your behalf or help you prepare for these conversations, so it’s clear for both parties what the guidance is around making reasonable adjustments to support you back to the workplace.
Anna Howells, Occupational Therapist, Perci Health
Coping with cancer-related fatigue can be really challenging, especially after the challenges of cancer and the treatment itself. The right support can make all the difference. Our Cancer Nurse Specialists are here to listen and provide guidance, as well as refer you to the Perci professionals who can support you physically, psychologically and practically.
While we have ensured that every article is medically reviewed and approved, information presented here is not intended to be a substitute for professional medical advice, diagnosis, or treatment. If you have any questions or concerns, please talk to one of our healthcare professionals or your primary healthcare team.
References:
Al Maqbali, M. (2021), Cancer-related fatigue: an overview. British Journal of Nursing, 30(4), pp.S36-S43. doi 101.12968/bjon.2021.30.4.s36