Fatigue

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What is cancer related fatigue?

Cancer related fatigue extends beyond typical tiredness, it is an extreme feeling of exhaustion that can impact a person’s physical, emotional, and mental wellbeing. This may arise during or after treatment or it can be a symptom of the cancer.

The duration of fatigue varies among patients, as everyone’s experience will be unique. Fatigue can often improve after you have completed your treatment for melanoma, however, it can continue for some time after your treatment has finished.

Symptoms of fatigue:

Some common effects of fatigue include the following, although it’s important to note that this list is not exhaustive, and these will vary from person to person.

  • Difficultly concentrating
  • Difficulty remembering things
  • Difficulty sleeping
  • Difficulty making decisions
  • Lack of energy
  • Muscle pain
  • Shortness of breath after light activity for example, making your bed
  • Loss of interest in doing things you usually enjoy
  • Urge to rest even when you’ve done little or no activity
  • Feeling anxious, sad or depressed
  • Feeling dizzy or lightheaded

These symptoms can impact your relationship with family, friends, and colleagues. It can also affect your work and your social life. Things you used to do without thinking may now feel like hard work and if you work, you may need to think about cutting down your hours.  This may be challenging and stressful in itself, so do talk to your medical team.

Managing fatigue:

Below are some tips to support your day-to-day life to help manage your fatigue.  Some simple strategies may be useful to support any memory issues associated with fatigue such as using calendar apps with reminder notifications, to do lists, alarms (e.g. oven timers).

Talk:

Talk to your medical team about your symptoms of fatigue. It may be that you have a medical cause of your fatigue such as anemia (when your red blood count is low) or you may need your thyroid levels checking.  It could be that one of your other medicines for a different condition is worsening your fatigue and so this may need adjusting. Your medical team is there to support you.

Let those around you know how you are feeling so that they can understand the physical and emotional symptoms that are impacting your day-to-day life. This way they will be able to support you, with big and small tasks.

If you are working, speak to your manager about reasonable adjustments such as a 5-minute cognitive break (lights off, no sound, no screens to regularly ‘reboot; or asking if it is ok to use a voice to text app in meetings to help with information retention. If feasible, work your hours so you can work at a time when you feel more alert.

Consider counselling support which may be helpful to manage any emotional stress.

Husband consoling wife

Balanced Exercise:

We understand that whilst experiencing symptoms of fatigue, one of the last things many people think about is exercising. There is, however, evidence that maintaining regular physical activity can help reduce fatigue whilst receiving immunotherapy [1].

Also, studies into anxiety and depression have shown that exercise can help reduce anxiety symptoms and improve our mood [2]. Cancer related fatigue does not normally go away with rest.

It is important to find an exercise that suits you and strike a good balance between physical activity and rest.  This exercise could be walking or practicing yoga.  Don’t overdo it and try to slowly build up your exercise.

More about Melanoma & Exercise

Living with melanoma button

Sleep:

Difficulty sleeping is a common symptom of cancer related fatigue and having inadequate sleep can often result in feelings of irritability and low mood. Below are some suggestions and resources that may assist you in establishing a good sleep routine.

  • Try to maintain a consistent sleep schedule, by going to bed and waking up at the same time
  • Create a calm sleeping environment, by keeping your room dark and at a comfortable temperature
  • Minimise your screen time (such as a smart phone) just before bed
  • Do something relaxing before bed, for example, practice mindfulness, read, listen to music or a podcast
  • Incorporate a small amount of physical activity in your day such as yoga
  • Limit your caffeine intake
an image of an alarm clock

Apps that you may find useful:

Headspace
An app providing stress-reduction, meditation and mindfulness tools.
https://www.headspace.com

Calm
An app that aims to improve wellbeing with dedicated features on sleep, stress-reduction, mindfulness, meditation and relaxation.
https://www.calm.com

Eating:

Eating well is also important in managing fatigue. We understand that a healthy balanced diet whilst undergoing treatment can be very challenging due to the potential side effects you may encounter.

Try and eat a healthy balanced diet, maintaining stable blood sugars and keep yourself hydrated. This can help maintain your energy levels and potentially recover faster.

More about Melanoma & Diet

Whilst experiencing fatigue remember to take each day as it comes, do not put pressure on yourself or set unrealistic expectations. You may find that some days are better than others. Remember to be kind to yourself and do not be afraid to seek support from those around you.

 

Additional Resources 

This video helps explains fatigue and what you can do to help manage fatigue:

Further useful links:

Cancer Research: Tiredness with cancer (fatigue)

 Mental Health and Melanoma

Coping with fatigue (tiredness) | Macmillan Cancer Support

This video was produced with support from the Sunnybrook Odette Cancer Centre and the Canadian Cancer Society.

Relevant References:

[1] Hyatt A, Drosdowsky A, Williams N, et al. Exercise Behaviors and Fatigue in Patients Receiving Immunotherapy for Advanced Melanoma: A Cross-Sectional Survey via Social Media. Integr Cancer Ther. 2019;18:1534735419864431. doi:10.1177/153473541986443

[2] Bull FC, Al-Ansari SS, Biddle S, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020;54(24):1451-1462. doi:10.1136/bjsports-2020-102955