Key takeaways
- Fatigue is a very common side-effect of cancer treatment; rather than a single cause, it’s likely there are many and that they’re highly personal
- Physical activity at the right level and intensity, can help to build muscle strength and fitness, and promote quality sleep, leading to more energy
- A diet high in plant foods helps to support healthy and diverse gut bacteria, which in turn supports immunity and relieves fatigue
- Speaking to a psychologist can help someone explore the emotional impact of feeling more tired, as well as prioritise tasks and set boundaries
Around two thirds of people who have had cancer treatment will experience fatigue and for nearly half the fatigue lasts for three months. Cancer-related fatigue can have a profound impact on someone’s life. Physically, you might need to do less and rest more, and find it has an effect on your concentration and overall wellbeing. Emotionally, you might start to feel hopeless, disinterested or depressed. Fatigue can also affect a person socially. People with cancer-related fatigue can find they are interacting with people less, experiencing issues at work and in relationships, and are more dependent on others. Support requires a holistic approach, which is why our cancer nurse specialists refer to Perci physiotherapists, dietitians and psychologists. In this article, we speak to a professional in each of these fields, to find out how they can help.
We don’t fully understand why people who have been through cancer treatment experience cancer-related fatigue, but it’s likely to be a combination of factors – relating to the cancer itself and treatment side-effects, as well as more personal factors.
– Lisa Jacques, Lead Cancer Nurse Specialist, Perci Health
What is cancer-related fatigue?
Fatigue is extreme tiredness and exhaustion that doesn’t always go away with rest or sleep, and may affect you physically and emotionally. Everyone knows what it feels like to be tired sometimes, but if you have cancer-related fatigue you may feel like you have very little energy, find it difficult to do simple everyday tasks and it may stop you from doing things you want to do.
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.
Supporting cancer-related fatigue with physical activity
Louise Malone, Consultant Physiotherapist, Perci Health
Cancer-related fatigue is very common and much more intense than normal fatigue, which can be described as extreme tiredness and exhaustion that doesn’t get better with sleep or rest. It’s also complex and can have many different causes. Muscle loss and weakness as a side-effect of cancer treatment are just one of those. While you’re undergoing treatment, you might not be doing as much activity, which also reduces your fitness, so you feel more tired. Another factor is sleep. From stress to discomfort and medications, there is so much that can keep you awake at night. If you find that sleep isn’t restorative, and you’re waking up feeling exhausted, the likelihood is that you’re experiencing cancer-related fatigue.
Cancer-related fatigue can be very challenging, affecting your work, relationships, self-esteem, self-confidence and your sense of who you are, because you can’t do the things you enjoy. It can be really hard to see friends doing things they love when you have no energy.
How can a physiotherapist support cancer-related fatigue?
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. For example, if you’re taking steroids, I’ll know which days you’ll be feeling fatigued and need to rest, and which days you can do a bit more. It’s important not to overdo it, as this can lead to long-term fatigue. If your treatment is happening in a three-week cycle and you do too much in week three, you’ll be exhausted for week one. When you do have energy, just enjoy the feeling.
Pacing is important when addressing cancer related fatigue. Our physical activity plan will involve just one activity each day. If it’s a good day, it can be a little more intense. When you’re going through treatment, this will include strength exercises to prevent muscle loss – just ten minutes, twice a week is enough. After treatment, the exercises will be tailored to your symptoms, and will include cardiovascular exercises like walking or a static bike, as well as stretching.
Routine is also important for people experiencing cancer-related fatigue. A chart can help, with times for waking, rising, eating, napping and exercise. I recommend that people try to stick to the same timings every day of every week. Our consultations will also cover basic sleep hygiene, which is important when working with fatigue.
Louise’s tiredness tip
I’m a huge fan of naps. If you’re exhausted by 8pm, try taking a reset between 2 and 3pm. That extends your evening so you have time for the people and things you love.
Supporting cancer-related fatigue with diet and nutrition
Jo Cunningham, Registered Dietitian, Perci Health
People experiencing cancer-related fatigue need to focus on getting the nutrients they need and taking care of their gut health. Around 70% of our immune cells live in the lining of our gut. If we look after the microorganisms that live there, they can look after our gut lining and, therefore, our immune system. This can help to support every organ in the body, as well as our metabolism, mood/mental health, skin, hair and nails, and help relieve fatigue. I also talk to people about inflammation, which can be a driver of fatigue, and the nutrients which can help improve that.
How can a dietitian support cancer-related fatigue?
Not many people understand that a dietitian can help with cancer-related fatigue. Dietitians are evidence-based and take a holistic approach, so I’ll take into consideration things like 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. There are a few key nutrients and lifestyle factors to think about.
1. Protein
A lack of protein can be a factor in developing cancer-related fatigue, both during and after treatment. It can be difficult to get enough protein if you’re totally plant-based or vegan, so we might make a plan for that. I might also recommend protein powders or supplements for some people but the focus should always be on getting the protein you need through food.
2. Fish and fatty acids
Saturated fats like butter and cheese can cause inflammation, which is a factor in fatigue, so you don’t want to have too much. High levels of Omega 6 and low Omega 3 also lead to inflammation, so I talk with people about how to improve that balance. Studies suggest that if we increase Omega 3-rich food – like sardines, mackerel, salmon, sea bass, chia, flax and walnuts – this can reduce fatigue over three months. It’s important not to take Omega 3 supplements during active treatment. Always discuss any supplements you might want to try with your oncology dietitian and pharmacist, as some cancer drugs interact with supplements. I might also recommend these supplements when treatment is finished.
3. Vitamin D
Low levels of Vitamin D can lead to feeling tired, having a low mood and a feeling of achiness. The whole population needs enough Vitamin D to support the immune system and bone health, however, we often can’t meet the requirements through diet and sun exposure alone. In my experience, the government’s recommendations for Vitamin D supplementation aren’t enough, so I recommend a simple blood test through your GP to check this. Then I’ll know exactly how much you need to supplement with.
4. Gut health
Gut microbes love plants; not just fruits and vegetables, but wholegrains, nuts, seeds, legumes – for example, lentils and chickpeas – and herbs and spices. Inside lots of plants are plant-based chemicals called polyphenols, which can nourish gut microbes. There are around 8,000 different types of polyphenols, and if you’re eating a varied diet, you’d be getting these. Berries – particularly blueberries – tomatoes, tofu, turmeric and onions are all really good sources.
5. Sleep
Getting enough sleep and activity can have a positive impact on your gut microbiome. Ideally you’d be getting seven hours sleep overnight but sleep quality is more important. If you eat well and stay hydrated, that prepares the body for sleep.
Key nutrients to support sleep can be found in nuts and seeds. Magnesium also supports relaxation and you can buy magnesium body rubs for before bed. Reducing caffeine can also help with sleep quality, especially if you’re leaning on it to help you feel less tired throughout the day. Try to limit yourself to 2–3 cups before lunch.
Jo’s tiredness tip
Eating 30 or more different plant foods per week can give you a more diverse gut microbiome, and give you more energy. This sounds like a lot, but actually isn’t that difficult to do. Red, yellow, orange and green peppers count as four; mixed salad leaves have lots and olive oil counts!
Coping with the psychological impact of cancer-related fatigue
Dr Lisa Dvorjetz, Counselling Psychologist, Perci Health
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. Rather than focusing on what you used to do, our work would likely be about adjusting to your current reality and coming back to the present moment when you’re struggling. From there, it’s about prioritising activities based on your energy levels. It’s an ongoing process, and requires a lot of flexibility. Psychology sessions then give you space to reflect on what is and isn’t working, and to explore the emotional and the psychological impact of the changes you’re making.
It’s possible we might take a different approach, using a tool called SMART goals. This would involve looking at the different aspects of managing fatigue, and being clear about what you’re working towards. In our therapy sessions, we would talk through these goals, what’s realistic and the timeframe.
Lisa’s tiredness tip
Many patients experiencing cancer-related fatigue get frustrated with themselves, because they can’t always do the things they want to. Instead of judging yourself and your situation, try to find ways to be compassionate. And remember, it’s okay to ask for help if you need it.
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
Zick et al, ‘Fatigue reduction diet in breast cancer survivors: a pilot randomized clinical trial’, Springer Link, Dec 2016, https://link.springer.com/article/10.1007/s10549-016-4070-y
Al Maqbali, M., Cancer-related fatigue: an overview. British Journal of Nursing, 30(4), pp.S36-S43. doi 101.12968/bjon.2021.30.4.s36, 2021