Cancer Related Fatigue
Suzy Coughlan
Specialist Dietitian in Oncology
Fatigue
What is fatigue/tiredness?
How common is it?
What is Cancer Related
Fatigue? (CRF)
Described as a ‘persistent subjective sense
of tiredness related to cancer or cancer
treatment that interferes with usual
functioning’ (Mock et al 2003)
What is CRF?
World Health Organisation
International classification of
diseases
(see sheet)
Incidence
• 82% have fatigue for a few days in a
month
• 56% have fatigue most days
• 7% have never experienced fatigue
Stone P, Richardson A, Ream E, Smith AG, Kerr DJ, Kearney N
(2000) Cancer related fatigue. Results of a multi-centre patient
survey: Annals of Oncology II pp 971-975
Impact of CRF
• Describe how CRF makes you feel.
Causes
•
•
•
•
•
Surgery
Radiotherapy
Chemotherapy
Adjuvant therapy i.e. hormone treatment
Disease load
• Depression and anxiety
• Anaemia
• Hypothyroidism
Perpetuating factors
•
•
•
•
Inactivity and de-conditioning
Poor diet
Belief that activity will make fatigue worse
Sleep disturbance or disturbed circadian
rhythm
• Pain and ongoing symptoms
• Drug side effects
• Psychological effects
Energy/Fuel Analogy
Adds fuel to the tank
Food/drink
Sleep/rest
Exercise
Psychological/feel
goods
Energy/fuel Analogy
Uses fuel from the
tank
Activities of daily living
Work/activity
Exercise
Physiological function
120
100
80
60
40
20
0
.0
0
AM
2.
00
PM
4.
00
PM
6.
00
PM
8.
00
10 P M
.0
0
PM
AM
12
.0
0
AM
Typical
Fatigue
Pattern
Normal
10
00
8.
Energy %
Use of energy
Time of day
8.
00
10 A
.0 M
12 0 A
.0 M
0
2. A M
00
4. PM
00
6. PM
00
8. PM
00
10 P
.0 M
0
P
M
Energy %
Use of Energy
100
90
80
70
60
50
40
30
20
10
0
Typical
fatigue
Pattern
How to manage your energy
•
•
•
•
•
•
•
Always Plan ahead
Pace your self
Prioritise
Get the balance right (work, rest and play)
Delegate
What can you use to make it easier
Talk to others – be honest about how you feel
Importance of Exercise
•
•
•
•
•
•
Improves output from the heart
Improves oxygenation
Increases muscle strength
Improves mobility
Mobilises fat for energy
Beneficial effect on mood
How to Exercise
• Try to include a cardiovascular exercise such
as walking as able
• Consider strengthening exercises
• Plan exercise into your routine
• Remember 30 minute recovery rule
• Liaise with physio about adapting exercise
suitable to your symptoms
• If exercise causes pain STOP and get advice
Importance of good
nutrition
• Eat 3 meals a day and include snacks if very
fatigued
• Do not skip meals or make do with nonnutritious snacks
• Include a carbohydrate at each meal
• Enrich meals and snacks if experiencing
weight loss
• Plan meals
• Consider using convenience meals; Wiltshire
Farm Foods; Meals on Wheels +/or batch
baking
Personal Goals
• Plan ahead to maintain control and to
achieve what is important to you.
• Be realistic!
• Consider how you are feeling
• Breakdown plans into manageable
chunks
• Communicate to family/friends/work
Summary
• Cancer related fatigue is a very common and
distressing symptom of cancer treatment
•You cannot just push through CRF, try and
actively manage your energy levels effectively
•Ask for help from health professionals