Cancer-related fatigue

After being diagnosed or treated for cancer you may experience some of these common feelings or changes:

• fatigue or tiredness
• weakness
• trouble catching your breath
• getting tired more quickly than usual
• taking longer than usual to finish certain tasks

Tips to save your energy by making work easier

The way you do a task is as important as what you do. There are a few changes you can make to everyday tasks to help you save your energy and get the most out of your day.

Prioritize your tasks.

• Prioritize your tasks so that you get the most important things done first.
• Ask yourself the following questions before beginning any tasks:
  • “What things must be done today?”
  • “Should I do this task?”
  • “Why is this task needed?”

Plan when and how to do things.

• Plan your day and week around major tasks.
• Do what is most important when you have the most energy.
• Plan ahead and prepare supplies to reduce extra trips, and avoid rushing and becoming too tired.

Pace yourself.

• Break large tasks into smaller steps that are easier to manage and spread over several days if needed.
• Switch between light and heavy work or easy and hard tasks.
• Do not rush. Allow enough time for each activity.
• Set realistic or reasonable goals to help reduce your stress.

Rest before you feel tired.

• Take short rests to maintain your energy throughout the day. It will take longer to recover if you wait until you are tired.
• To help you remember to take breaks, set alarms to remind you to take breaks during the day.
• If you get tired, stop and rest for 15 minutes whether you have finished the task or not.
• Try a meditation app (for example, Headspace, Calm, or The Mindfulness app).

Breathe deeply and relax.

• Slow deep breathing is relaxing and will help you to pace yourself. For example, as you unload the dishwasher, take slow deep breaths in and slow full breaths out.
• Try relaxation techniques to reduce stress. Read the “Relaxing Exercises to Relieve Stress” pamphlet (see the resources section).

Use proper body mechanics.

• Relieve back strain by keeping one foot up on a low stool while standing.
• Use good posture when driving. For example, adjust your chair so you don’t have to slump forward to reach the steering wheel.
• Sit up tall and avoid slumping to help your lungs to fully inflate when you breathe in. This allows more oxygen to enter your lungs and blood, helping you to feel more energized.

Be careful when lifting items and avoid lifting when possible.

• Slide rather than lift items, if you can.
• Push rather than pull, if you can.
• Hold the item close to your body or use a wheeled cart.
• Split your load into smaller parts if it is too heavy.
• Plan your carrying route and make sure the path is clear.

Avoid tiring postures and body motion.

• Sit when you can. Sitting uses only half the energy needed to stand. For example, consider sitting when folding laundry or preparing meals.
• If you must stand, consider using an anti-fatigue mat, or taking seated breaks regularly.
• Work within your reach to avoid fatigue and injury.
• Use devices with long handles to extend your reach, such as dust pans, reachers, sponges or dusters with long handles.
• Avoid frequent repetitive motions, as these can cause overuse injuries.

Adjust and organize your work and storage area.

• Store or place items that you use often between your shoulder and waist level for easy reach.
• Keep items in places you often use them in. For example, store your shaving razor or make-up near the sink and mirror.
• Make sure you are comfortable in your work area. For example, the ideal table height is 2 inches below your bent elbow. If your table is too high, adjust the height of your chair or use thick seat cushions to make your seat higher.

Use aids.

• Try using aids to save time and energy, like a jar opener or trolley. For example, use cruise control when driving, or a cane if your walking is limited due to fatigue.
• Avoid unnecessary work: use the dishwasher, wear no-iron permanent press clothes.

Learn to say “no”.

• Do not be concerned with pleasing everyone all the time.
• Share your tasks with others when possible.

Examples of how to make daily activities easier

Grooming

• Sit by the sink or mirror when you are grooming (drying or combing your hair, brushing your teeth, washing your face).
• Use toothbrushes or combs with large handles if your grip is weaker.
• Try an electric toothbrush.

Dressing

• Sit down to dress.
• Put your affected or weaker arm in the sleeve first. This will make dressing easier. When undressing, take your unaffected or stronger arm out of the sleeve first.
• Wear loose front-closing tops and bottoms with elastic waists to make dressing and undressing easier.

Showering or bathing

• Use a hand-held shower head.
• Use a sponge or brush with a long handle for
  easier reach.
• Dry off with a terry cloth robe. You will use less energy than if you dried off with a towel.
• Use a bath seat in the tub or shower stall.

Doing laundry

• Sit down to fold and iron your clothing.
• Use tongs with long handles to help you reach into your washer or dryer for your clothes.

Cleaning

• Keep cleaning supplies on each floor of your home. Use dusters, dustpans and bathtub sponges with long handles for cleaning hard-to-reach places.
• Avoid bending your back when vacuuming or mopping. Instead, bend your knees or squat. Take small strokes that are close to your body to maintain good posture. Step forwards to reach the next area instead of bending far forwards. Sit down to change pillowcases and squat to change bed sheets.

Cooking

• Plan ahead when you want to cook. Gather all the ingredients and utensils before you start.
• Use lightweight cookware.
• Use paper plates or plastic cups for snacks and lunches to reduce dishwashing.
• Use electric appliances such as can openers, blenders, food processors and dishwashers.
• Air-dry your dishes on a rack.
• Move heavy items on the counter top by sliding them, if you can.
• Use rubber mat or wet towel under your mixing bowls to help steady them when stirring or mixing.
• Use a trolley with wheels for moving heavy items from one place to another.
• Organize and use rotating table trays (like a Lazy Susan).
• Make large meals and freeze them for later use.

Groceries

• Organize your grocery list by type (fruits, meat, condiments) so you do not have to go back and forth between store aisles.
• Shop with someone who can help with your bags or you can use a buggy.
• Consider using a grocery delivery service, like Grocery Gateway.

Making your work easier

Now that you know how to make work easier, think about some of the work you do everyday and how you can use these strategies or tips. It will help you use your energy wisely and get the most out of your day.

To help you decide what kind of changes you can make, ask yourself these questions:

• How can the task be made easier?
  • Can I use any devices or aids to make the task easier?
  • How can I use fewer and more effective motions?
• When is the best time to do this task? For example, if it is a difficult task, try to plan it for a less busy day, and for a time of the day when your energy is the highest.
• Am I comfortable while doing the task?

Use the Changes to Make Worksheet to write down tasks you would like to change. They can be common daily tasks, difficult or tiring tasks. Under “Changes to make”, write down what you can do to make completing the tasks easier.

Home safety

When you are tired and weak, there is a greater risk of having an accident. Always consider the safety in your home to avoid accidents that can delay your recovery. Here are some safety tips for your home:

Prevent tripping over household items.

• Remove scattered rugs or use double-sided tape to secure them down.
• Clear all small items (bathroom scales, door stops) off the floor.
• Use cordless phones to avoid tripping over the cords or cables.
• Check your stairs (treads or thresholds) for loose boards or carpet.

Keep your home well lit.

• Most people fall on the last step of their stairs. Make the last step more visible by keeping the stairs well lit or painting the last step a different colour.
• Have a lamp beside your bed to avoid stumbling in the dark.
• Consider having a night light between your bedroom and bathroom.

Use safety features or items in your home.

• Use rubber mats in the tub or shower to prevent slipping.
• Try to hold the railing when you are going up or down the stairs.

Balancing your daily activities

Looking at how you are spending your day will help you understand where you are spending your time and energy. This exercise will also help you plan your day, and balance the time you want to spend on self-care, work and free time.

Download the My Daily Activities worksheet and fill it out:

1. Write down all the different activities you do on a regular day. List them under “Activities”.
2. Write down how much time you spend on each activity under “Time spent”. For example, grooming and dressing in the morning may take
   1 hour.
3. Group each activity you listed into one of the following three types. You can record the type under “Type of activity”.
   • Self-care: activities you do for personal care such as dressing, grooming, eating, bathing, toileting, sleeping
   • Work: activities that you feel contribute to society through paid and unpaid work, such as paid jobs, volunteering, household work (such as cooking, shopping, cleaning, laundry, driving).
   • Free time: activities you do for fun when you are not working or engaged in self-care, as a hobby or to relax (socializing, games, swimming, yoga, walking, biking, music, reading, arts and craft,
     watching TV).
4. Review your activities of daily living. Circle each activity type with a different colour. This can help you see whether there is balance in the 3 types of activities or whether one activity is taking up most of your time and energy.
5. Ask yourself if this is the balance you want in your daily activities. If not, think about what changes you would like to make so that there is more balance in your day.
   To help you decide what changes you would like to make, ask yourself these questions:
   • Are all 3 types of activities represented?
   • Are you spending too much time on one activity and not enough on another?
   • What activities are missing that you would like to be part of your daily activities?
6. Think about what you would like the balance of your daily activities to be like. Then divide Circle 2 into 3 parts based on how much of your day’s time you would like to be spending on self-care, work and free time. The goal is to find balance in your daily activities so that you feel you have spent time doing meaningful and satisfying activities.
   
   Here are some tips to help you balance your daily activities:
   • Make small, specific changes that make sense for you.
   • Choose activities that will not take too long to finish.
   • Accept help and support from others (family, friends) to free up time for yourself to do other things.
   • Do activities that will give you a sense of meaning or purpose and make you feel happy and satisfied.
   • Use tips and ideas in this pamphlet to help you use your energy wisely.
7. Write down some small changes that you can make to have more balance in your daily activities. Keep track of what helps and what makes your fatigue worse.

To help you talk about cancer-related fatigue with your doctor or nurse, remember to take the information in this pamphlet with you to your next appointment.

Resources for more information

• Reclaim Your Energy: Coping with Cancer-Related Fatigue Playlist
• Cancer Related Fatigue
  
• Relaxing Your Mind and Body Guided by Stephanie Phan (Audio recordings for deep breathing, Progressive Muscular Relaxation, Body Scan, and Guided Imagery)
• Helpful Hints for Better Sleep
• Relaxing Exercises to Relieve Stress
• Managing Cancer Related Fatigue: For People Affected by Cancer
• Coping with Cancer Related Fatigue
• Nutrition Tips to Manage Cancer-related Fatigue
• Recipes for Cancer Related Fatigue (ELLICSR Kitchen)
  

To find these resources:

• visit the Patient & Family Library (main floor) at the Princess Margaret Cancer Centre
• or visit Cancer Health Information