Cancer-related fatigue is quite different to the fatigue a person may feel who is not undergoing cancer treatment. Patients often tire rapidly, with less physical activity than normal and this tiredness is usually not relieved by rest or sleep. The psychological effects of a cancer diagnosis, such as anxiety, stress, tension and disturbed sleep pattern, can result in a patient’s feelings of fatigue. [1]
“Cancer-related fatigue is a distressing persistent subjective sense of physical, emotional, and/or cognitive tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning.”[2]
There is a wide range of information available and many research studies have been carried out into cancer-related fatigue. Such research has shown that it may be a result of the body’s response to the accumulation of various metabolites, including those from protein destruction, increased metabolic rate due to malignancy or to the blood count being low [3]. It has been suggested that drugs which cross the blood brain barrier or those with side-effects of neurotoxicity may be implicated in the development of fatigue. Examples of these drugs are Vinca-Alkaloids, Methotrexate, Cytarabine, Ifosfamide and Asparaginase), although there is limited evidence available to support these thoughts [2].
Cancer drugs factsheets (CCLG)
There are different types of fatigue:
| Type of fatigue | Definition |
| Normal | Where there is an identifiable cause |
| Pathological | Where it is caused by disease process |
| Situational | Where it is related to stress |
| Psychological | Where it is related to anxiety |
Practical advice for patients suffering from cancer-related fatigue
Cancer-related fatigue may resolve when treatment is completed. During treatment and for as long as the child or young person is experiencing fatigue some practical advice can be offered.
It is important to talk to the child or young person about fatigue so they understand why they are feeling like this and that it is a common side-effect of treatment. Encouraging some gentle exercise can be beneficial, alongside an assessment of sleeping patterns (Link Sleeping) and suggesting rest times as part of the daily routine. Talking to the child or young person about their routine to ensure they are not doing too much and advising them to keep a fatigue diary may help to determine the best way to treat it. Encouraging adequate nutrition and hydration can also help with fatigue. Stress and anxiety can be a big contributor, so ensuring that the child or young person has someone to talk to and share worries with can also help[4].
Cancer-related fatigue can have an impact on any activity that a child or young person may wish to participate in; therefore, it is important to address this from a multi professional perspective. The occupational therapist and physiotherapist within the patient’s team can support them by using a person-centred approach to determine what motivates them, then using this to support the child or young person to achieve their goal. Their goal can be achieved by grading an activity that still gives the child or young person a sense of achievement.
Further strategies
- Education about fatigue
- Graded activities
- Energy conservation strategies
- Routine and set rest times
- Healthy eating
- Get support
- Relaxation
- Sleepy hygiene promotion
- Exercise
Exercise
Sport and exercise are important because they:
- Can increase and maintain our level of fitness
- Help us maintain a healthy weight (children and young people may gain or lose weight during treatment)
- Improve our sense of wellbeing and self-confidence
- Improve our sense of belonging, particularly with team sports.
Benefits of sport and exercise during/after cancer treatment
- Release endorphins – ‘feel good’ hormones
- Decreases pain
- Increases strength
- Enhances sleep
- Increases bone density
- Increases appetite
- Relieves constipation.
Physiotherapist/OT may help by:
- Individualised exercise programmes
- Goal-setting
- Exercise referral programmes
When recommending exercise, the type of central venous access device a child or young person has in situ and other factors may mean contact sports are not recommended.
Further reading and information
Sport and exercise for children and young people with cancer This CCLG publication provides advice for children and families about exercising during and after treatment:
These Government fact sheets provide general information about physical activity in specific age groups/abilities:
Children and young people 5 – 18 years
References
[1] Macmillan cancer support information materials available at http://www.macmillan.org.uk/information-and-support/coping/side-effects-and-symptoms/tiredness [Accessed on 23 February 2016]
[2] National comprehensive cancer network (NCCN) (2014) NCCN Guidelines- Cancer Related Fatigue 1, 5-13.
[3] Morrow GR, Andrews PL, Hitcock JT, et al. (2002) Fatigue associated with cancer and its treatment. Support Care Cancer, 10: 389- 398.
[4] Edwards J. (2005) ‘Cancer-Related Fatigue’, in Brighton D and Wood M. The Royal Marsden Hospital Handbook of Cancer Chemotherapy. Edinburgh: Elsevier 241- 243.