Cancer-related fatigue is the most common and burdensome side effect experienced by people living with and after cancer and is an often overlooked condition in the medical field. Upwards of 95% of individuals experience cancer-related fatigue at some point following a cancer diagnosis, with approximately 30% experiencing significant and unresolved fatigue up to and beyond five years post-treatment. The causes of cancer-related fatigue are multifactorial and unique to each individual, requiring a personalized combination of medical, behavioural, psychosocial, and supportive therapies to address effectively. Due to the prevalence and relative lack of familiarity with cancer-related fatigue within the medical community, it is entirely likely that you have treated, or are currently treating, individuals with unrecognized and unresolved cancer fatigue who need and deserve personalized fatigue care.
Cancer-Related Fatigue Prevalence and Impact
Approximately 1,700,000 people are living with and after cancer in Canada (Canadian Cancer Statistics, 2021 & 2022). Epidemiological studies have reported that ≥29% of survivors living ≤5 years post-diagnosis and ≥10% of survivors living >5 to 25 years post-diagnosis experience clinically significant levels of cancer-related fatigue. These prevalence rates translate to >114,000 Ontarians and >460,000 Canadians living with this debilitating yet treatable condition. Despite this obvious need, there are currently limited resources available for individuals living with or attempting to minimize the effect of cancer-related fatigue.
The impact of cancer-related fatigue can be profound and is associated with higher rates of disability and lower quality of life. A 2010 paper by Larkin et al., reported that cancer-related fatigue is the longest-lasting and most intrusive side effect of chemotherapy treatment, persisting longer than pain, nausea, and depression, with the greatest effect on daily life. This same study found that people experiencing cancer-related fatigue report small tasks, such as walking, house cleaning and eating to be more difficult, with significant emotional consequences, such as a feeling of loss of control of their life.
Cancer fatigue also imposes a significant financial burden on people living with and after cancer, as well as their caregivers. Many individuals who report particularly burdensome levels of cancer-related fatigue are still actively engaged in school, work, raising and supporting their immediate and extended families, volunteering, or social activities. For example, a study by Curt et al. (2000) assessed the occupational impact of fatigue in 177 cancer patients, and reported that more than 75% of individuals had to change their employment status as a result of fatigue, with the mean number of sick days typically used as a result of fatigue being 4.2 per month.. Related research identified that approximately 20% of caregivers also need to take days off to help support their loved one’s and miss, on average, 4.5 days of work per month (Curt et al., 2000).
What to Look for In Your Patients
Many healthcare practitioners are unfamiliar with the symptoms, risk factors, and clinical presentation of cancer-related fatigue and may be unsure of how to best support patients living with it.
Common symptoms of cancer-related fatigue include:
Strong and constant feelings of tiredness NOT relieved by sleep
Decreased concentration or memory
Decreased ability to carry out normal daily activities
Irritability and mood changes
Decreased interest in activities that usually bring joy
Decreased motivation
Decreased energy levels
Decreased mental alertness
Changes in sleep patterns or appetite
Are you treating patients who report or who you suspect may be experiencing cancer-related fatigue? Our clinical care team of physicians and rehabilitation specialists are available to help answer your questions or get started working with them right away!
Cancer Fatigue Services: Who We Are
Cancer Fatigue Services is the first medical service specializing in assessing and treating cancer-related fatigue in Canada. We were established in 2023 by Dr. Scott Adams, a physiologist and scientist with >15 years of experience studying the adverse effects of anti-cancer therapies and caring for people living with cancer treatment-related sequelae, like fatigue. Our mission is to transform the lives of cancer patients and survivors by alleviating their fatigue, reigniting their vitality, and restoring their hope for a life well-lived. Our clinical care model is based on the national (e.g. Canadian Partnership Against Cancer) and international guidelines (e.g. American Society of Clinical Oncology; European Society of Medical Oncology) for cancer fatigue management, directly informed by the guidance of global experts and the clinical experience of the leading international fatigue care centre (e.g. MD Anderson Cancer Center), and innovative, evidence-based fatigue testing and therapeutic approaches.
Our Process
A physician referral to our clinic is required for patients to be eligible for OHIP coverage. Once referrals are received, our Customer Care Team contacts patients to book a brief 30-minute intake call. During the call, we review the high-level details of patients’ fatigue concerns and health history, answer their questions, and provide more information about the specific services and healthcare coverage options that are available to them. Patients then meet our clinic care team to complete a Comprehensive Fatigue Consultation (i.e., a ~90-minute assessment). During the comprehensive consultation we assess all the known causes and contributing factors to cancer-related fatigue, including medical, physical, emotional, cognitive, behavioural, and demographic outcomes. Patients are also strongly encouraged to complete an optional, but highly informative, cardiopulmonary exercise test (CPET) which provides greater insight into the underlying pathophysiology of each individual’s fatigue.
Following the assessment, our team uses all available information to develop a personalized Fatigue Care Plan and delivers it back to patients in approximately 1-2 weeks, wherein treatment recommendations and next steps are discussed. With the Fatigue Care Plan in place, our patients then complete a free personalized Fatigue Counselling Session to address the greatest obstacles they face with respect to effectively managing and treating their fatigue, provide targeted educational resources, and teach self-monitoring / management strategies.
How to Refer
If you suspect your patient is experiencing cancer-related fatigue and are a physician, please use this referral form to refer your patient. We will provide you with regular updates on your patient’s progress within our care.
If you are not a physician, please inform your patient about our services and send them back to their family physician or oncologist seeking a referral to our clinic.
Cancer-related fatigue is complex, challenging to manage, and often influenced by a combination of unique medical, behavioural, and psychosocial factors. However, no previous dedicated multidisciplinary medical fatigue management service has been established to help Canadians with this significant burden. We are Canada’s first medical care service for cancer-related fatigue.
We are dedicated to bridging this gap and ensuring you get the answers you deserve and the care you need to treat your fatigue and the factors causing it.
Cancer-related fatigue: an overlooked and underserved condition
Cancer-related fatigue is arguably the most prevalent and generally debilitating health concern experienced by people living with and after cancer; however, awareness of the etiology, treatments, and supportive care needs for people experiencing cancer-related fatigue is rather limited throughout the medical community. Approximately ⅓rd of the 1.7 million Canadian cancer survivors (>460,000 people) are living with clinically significant levels of cancer-related fatigue that negatively impact their daily lives. However, cancer-related fatigue is often not addressed by primary care physicians or oncologists, and the most effective treatments for cancer-related fatigue are not currently covered by any provincial health ministries in Canada.
“Before founding Cancer Fatigue Services, there were no medical treatment clinics for cancer-related fatigue in Canada. Our clinic and team stand out as the first and only medical care service specializing in assessing and treating cancer-related fatigue through an innovative precision medicine-based care model.
Our precision medicine-based care model comprehensively assesses and delivers personalized treatments for the major causes of cancer-related fatigue. This hybrid model of in-person and virtual care options ensures our services are always within reach of our patients, allowing us to increase our reach while simultaneously decreasing patient barriers to engagement. We are working to ensure equitable access to care by prioritizing public- and insurance-funded assessment and treatment services and establishing a Compassionate Coverage for Care Program to ensure that financial constraints do not prevent people who need help from getting it.”
Scott Adams, RKin, CSEP-CEP, PhD Founder & Chief Executive Officer Director of Research & Training
Our Goals Towards that Commitment
We are working hard to create a future where the lives of those affected by cancer are no longer impacted by fatigue. To accomplish this, we are committed to:
Establishing and delivering a high standard of personalized medical care to our patients.
Achieving clinically significant and lasting improvements in fatigue and related risks for our patients.
Setting new care standards and ensuring appropriate healthcare coverage is available to support the assessment and treatment of cancer-related fatigue.
How We Alleviate & Treat Fatigue
With our comprehensive approach to fatigue care, we are committed to empowering individuals and providing them with the tools and support needed to overcome their fatigue and live life to the fullest.
We conduct comprehensive fatigue assessments, carefully evaluating each person’s unique needs and challenges. Our team then develops a Personalized Fatigue Care Plan based on the assessment results and works with every individual to ensure their care plan is effective and fits into their lifestyle. We also offer tailored fatigue counselling sessions, providing individuals with fatigue-related education, prevention tips, and management strategies for fatigue.
Exercise therapy is recognized as the most effective treatment for cancer-related fatigue. At Cancer Fatigue Services, we offer supervised fatigue and exercise therapy that are unique and customized to every person and will most effectively treat fatigue and associated risks. We offer in-person and virtual exercise therapy sessions to make it as accessible as possible for everyone.
Contact us todayto start the process of living a healthier and fatigue-free life!
Regulated Health Professionals play a crucial role in helping people prevent, manage, and treat common cancer treatment-related health issues, like fatigue, throughout the trajectory of cancer survivorship (i.e., from diagnosis to end of life). A critical antecedent to providing the best possible care for patients is a solid understanding of what each practitioner does (i.e., their scope of work) and when it is most helpful to refer patients to them. This article is the first in a series that will feature the important work being done across regulated health professions and how each profession can meaningfully impact the fatigue, health, and well-being of people living with and after cancer. Here, we summarize the major Regulated Health Professions that provide essential, complementary aspects of care for people living with or trying to prevent cancer-related fatigue.
Chiropodists and Podiatrists
Chiropodists and podiatrists assess, diagnose, and treat disorders of the bones, skin and soft tissue of the feet, aiming to keep people functional, mobile, and independent.
Fatigue Treatment and Management: Chiropodists and podiatrists can help manage foot-related issues that may exacerbate fatigue, such as providing custom orthotics to improve mobility and reduce pain. This is extremely important for individuals with cancer-related fatigue, as the most effective treatment is exercise therapy.
Fatigue Prevention: By ensuring optimal foot health, chiropodists and podiatrists can help prevent complications that lead to decreased physical activity, thus helping to maintain energy levels and prevent fatigue.
They also play a role in screening for some cancers, including monitoring changes in nails and skin to ensure no malignancies are developing. During cancer treatment, maintaining semi-regular appointments with Chiropodists and Podiatrists can help ensure any changes that may be occurring in the feet or lower limbs that may be early signs of treatment-related complications like peripheral neuropathy or lymphedema are caught quickly. They are also integral in fall prevention and optimizing function if a lower limb surgery is needed (such as an amputation) and by fitting people for orthotics.
Dietitians
Dietitians are experts in food and nutritional sciences and are the only regulated health professionals that assess, diagnose, support, and treat health conditions with food and nutrition.
Fatigue Treatment and Management: Dietitians offer personalized nutritional plans to address deficiencies and optimize energy levels, helping to manage fatigue in cancer patients and ensuring that patients are consuming the correct balance of nutrients required to support exercise therapy.
Fatigue Prevention: Through balanced diet plans and proper nutrition education, dietitians can help patients maintain adequate energy levels and prevent fatigue.
Dietitians offer support to people affected by cancer throughout their care to and provide nutritional support using their understanding of the complex changes that may occur in certain types of cancer. For example, those with head and neck cancer may have problems eating, drinking, or swallowing as the structures required for those activities have been removed or they may be experiencing pain, while those experiencing gastrointestinal cancers may have difficulty with absorbing sufficient nutrients. It is important not to confuse dietitians with nutritionists who are not registered and do not receive the formal training of a dietitian.
Kinesiologists
Kinesiology is the study of human movement, performance, and function. Kinesiologists are experts in biomechanics, anatomy, and physiology and use evidence-based research to treat and prevent injury and disease and improve movement.
Fatigue Treatment and Management: Kinesiologists design and implement exercise programs tailored to the needs of cancer patients, helping to induce the physiological remodelling required to treat cancer treatment-related injuries, reverse dysfunction, and reduce fatigue.
Fatigue Prevention: Regular physical activity guided by kinesiologists can enhance overall fitness and energy levels, helping to prevent the onset of fatigue.
Kinesiologists are integral in managing cancer-related fatigue due to their expertise in exercise therapy. They work closely with the medical team to develop and implement individualized exercise therapy plans that address each patient’s needs to optimize their function and improve fatigue. They can also assist in improving ergonomics to decrease pain or discomfort that may be contributing to fatigue, and aid with return-to-work planning and disability management.
Naturopaths
Naturopaths are healthcare practitioners who emphasize a holistic approach to wellness. They utilize natural therapies and lifestyle interventions to support the body’s ability to heal and maintain optimal health. They are trained in various modalities, including nutrition, herbal medicine, acupuncture, and lifestyle counselling, to provide comprehensive care tailored to individual needs.
Fatigue Treatment and Management: Naturopaths use personalized treatment plans that may include dietary recommendations, herbal supplements, and stress management techniques to address underlying causes of fatigue. Their holistic approach helps to balance the body’s systems, thereby reducing fatigue and enhancing overall vitality in cancer patients.
Fatigue Prevention: Naturopaths help prevent fatigue by promoting a healthy lifestyle through balanced nutrition, adequate rest, and regular physical activity. Their focus on preventative care ensures that patients maintain optimal energy levels and resilience against the physical and emotional stressors associated with cancer.
Naturopaths contribute significantly to the care of cancer patients by offering natural and integrative therapies that complement conventional treatments. Their emphasis on whole-person care helps manage fatigue symptoms and improve patients’ overall well-being. Through continuous support and education, naturopaths empower patients to take proactive steps in their health journey, fostering long-term wellness and fatigue prevention.
Nurses
Nurses are critical members of the healthcare team, providing comprehensive care that encompasses medical, emotional, and educational support. Their role is pivotal in managing the complex needs of cancer patients, particularly in addressing symptoms like fatigue.
Fatigue Treatment and Management: Nurses provide essential care in managing fatigue by administering treatments, monitoring patient progress, and educating patients on energy conservation techniques. They offer practical advice on managing daily activities and ensure patients receive appropriate medications and interventions to alleviate fatigue.
Fatigue Prevention: Through continuous assessment and proactive care planning, nurses help prevent fatigue by addressing early signs and symptoms. They educate patients on healthy lifestyle practices, including proper nutrition, hydration, and rest, to maintain energy levels and prevent the onset of fatigue.
Nurses play a multifaceted role in supporting cancer patients, combining clinical expertise with compassionate care. They are often the first point of contact for patients, offering critical insights and interventions that help manage and prevent fatigue. By fostering a supportive environment and coordinating with other healthcare professionals, nurses ensure patients receive holistic and individualized care throughout their cancer journey.
Occupational Therapists
Occupational therapy is a very broad profession and involves linking physical health with social care and the surroundings in which people live, including their work, home, and leisure activities. Occupational therapists assess what individuals can do for themselves and support people with mental health issues, encouraging people to find practical solutions to manage their health and well-being.
Fatigue Treatment and Management: Occupational therapists assist patients in developing energy conservation strategies and adaptive techniques to manage daily activities without excessive fatigue.
Fatigue Prevention: They educate patients on efficient ways to perform tasks and incorporate rest breaks, helping to prevent fatigue by optimizing energy use.
More generally, occupational therapists play an important role in supporting people receiving and recovering from cancer treatments. They teach people new ways of doing things and how to adapt when function has been lost and advise on how the home environment can be changed to help people cope with physical problems caused by their cancer or treatment. Occupational therapists are also experts at prescribing and educating on assistive devices, such as wheelchairs or walkers, to keep people active and allow them to participate in their exercise therapy sessions for cancer-related fatigue.
Orthotists and Prosthetists
Orthotists assess, design and provide custom-made external devices such as splints, braces, and specialist footwear to modify the structural or functional characteristics of an individual’s limbs. Prosthetists provide the best replacements possible for individuals who have lost limbs through cancer or its treatment and help restore function and independence with artificial limbs.
Fatigue Treatment and Management: Orthotists and prosthetists create custom devices that improve mobility and reduce physical strain, helping to manage fatigue.
Fatigue Prevention: By providing supportive orthotic and prosthetic solutions, these professionals help patients maintain an active lifestyle and prevent fatigue.
Both allied health professionals are important for keeping people active, reducing pain, and facilitating recovery from cancer and cancer-related fatigue. Both are often hospital-based and work closely with occupational and physical therapists to optimize function after cancer and treatment.
Physical Therapists
Physical therapists are experts in the physical function of individuals and can assist people affected by cancer throughout all stages of their care. Physical therapists are critical for prehabilitation, which prepares people for their cancer treatment, and rehabilitation, which uses restoration and adaptation techniques during recovery and survivorship.
Fatigue Treatment and Management: Physical therapists design individualized exercise programs to correct functional imbalances and improve strength, flexibility, and endurance, which helps to manage fatigue.
Fatigue Prevention: Engaging in regular physical therapy can enhance physical fitness and energy levels, preventing the onset of fatigue.
Cancer and cancer-fatigue are associated with a wide range of physical and psychological symptoms. Using a combination of physical and psychological approaches, including movement, exercise, and manual therapy, to optimize mobility, function, cardiovascular and skeletal muscle health, pain management, and overall quality of life. Physical therapists strive to help people remain independent for as long as possible.
Psychologists/Psychotherapists
Psychologists and/or psychotherapists deliver psychosocial interventions and counselling focusing on improving quality of life, reducing distress and improving function during or after cancer and its treatments. They can also work with families and friends to support them during this difficult time.
Fatigue Treatment and Management: Cancer and fatigue can cause immense emotional distress. Psychologists and psychotherapists offer counselling and cognitive-behavioural strategies to address emotional and psychological factors contributing to fatigue.
Fatigue Prevention: They help patients develop coping mechanisms and stress management techniques, preventing fatigue by promoting mental well-being.
Psychosocial support can help patients feel less overwhelmed and more in control, potentially leading to better adherence to their treatment and therapy. They can also help people with managing anxiety and depression and deliver coping strategies for dealing with pain, which may also be contributing to their fatigue.
Registered Massage Therapists
Registered massage therapists (RMTs) are trained professionals who use various techniques to manipulate muscles and soft tissues in the body. They aim to improve physical function, relieve pain, and promote relaxation. Their expertise in understanding body mechanics and muscle anatomy allows them to tailor treatments to individual patient needs, especially those dealing with cancer-related symptoms.
Fatigue Treatment and Management: RMTs employ techniques such as Swedish massage, deep tissue massage, and lymphatic drainage to alleviate muscle tension, enhance blood circulation, and promote relaxation. These methods can significantly reduce fatigue in cancer patients by easing physical discomfort and improving overall well-being.
Fatigue Prevention: Regular massage therapy sessions can help maintain muscle health, reduce stress, and improve sleep quality, all of which are crucial in preventing the onset of fatigue. By promoting a balanced state of physical and mental relaxation, massage therapists aid in sustaining higher energy levels.
RMTs play a vital role in the comprehensive care of cancer patients by addressing the physical and emotional aspects of fatigue. Their interventions help mitigate the side effects of cancer treatments, such as pain and stress, thereby enhancing patients’ quality of life. Additionally, they work closely with other healthcare professionals to ensure a holistic approach to managing and preventing fatigue, integrating their therapies into broader care plans.
Social Workers
Social Workers help support families and patients throughout and after their cancer experience. They are trained to offer supportive counselling to help patients process their thoughts and feelings, as well as caregiver and family support.
Fatigue Treatment and Management: Social workers provide resources and support to help patients navigate healthcare systems and access services that alleviate stress and fatigue.
Fatigue Prevention: By offering emotional support and practical assistance, social workers help prevent fatigue by reducing the overall burden on patients and their families.
Social workers provide tools and resources to help manage cancer and cancer fatigue-related stresses, such as help with navigating personal finances during treatment and transportation. They are also experts at community resources and referrals to local programs.
Summary: The Importance of Working Collaboratively
No matter the profession, it is essential to always put the patient first and communicate openly and honestly with all other healthcare team members. Remember that no one knows their body better than the patient. As healthcare professionals, we must always give people the opportunity to talk and be listened to regarding their individual goals for living with and beyond cancer and its treatments. Involving patients in their care and allowing them to make critical decisions is essential for patients to become more independent and advocate for their health.
As a caregiver of someone living with and after cancer, you may be attending medical appointments and dealing with a variety of healthcare professionals who are directly involved in their medical care, known as their Circle of Care. Knowing how to communicate and manage relationships with this team of professionals effectively can help streamline treatments, avoid redundancies, and create a more harmonized treatment experience for the person you are supporting. Here are some suggestions to encourage meaningful communication between you and Circle of Care team members, as well as tips on advocating for the person you support.
Being an Advocate for the Person You Support
Receiving a cancer diagnosis can be overwhelming. As a caregiver of someone diagnosed with cancer, it may be your desire or responsibility to ensure you become a primary point of contact for a Circle of Care team to allow the person you support to focus on their treatment and recovery. Healthcare professionals within their Circle of Care may even rely on you to share health status updates for the person you support.
The details of these updates may include:
Collecting day-to-day symptom, status or treatment information
Transportation to and from appointments
Ensuring all lab tests are done and following up (if needed)
Picking up, preparing, and delivering medications
Researching certain treatment options and risks
Managing insurance (if needed)
However, patients and caregivers sometimes do not feel heard by the healthcare team. If you feel that professionals are not valuing you or your loved one’s opinion, you must advocate to ensure they are getting the best possible care.
Advocating for the person you support may require that you:
Prepare. Have a list of questions or notes printed off and ready to discuss with the healthcare team. This shows that you are organized and will minimize the chance that you forget what you want to say.
Be assertive. This can be difficult, but it does not mean being rude or showing aggression. Be respectful and direct, and tell the team that you do not feel valued or heard.
Mobilize resources.
Ask for a team meeting involving more members of your loved one’s family or friend care team.
Enlist a social worker. Social workers are healthcare professionals who specialize in navigating the healthcare system and organizing care delivery with the best possible specialists, always with the patient prioritized.
Communicating with Healthcare Teams
Write down all relevant talking points or things you would like to discuss. This may include, but is not limited to, documenting new symptoms or changes in behaviour, questions about upcoming procedures, or concerns about prognosis and condition progression.
Record the answers (either written or on your phone) or ask if you can use an audio recording device.
Be thorough and honest with the healthcare team, and make sure you tell them all the therapies and medications your loved one may be on, so they have a full picture of the health of the patient.
Be brief. Medical professionals are busy, and communicating concisely is important and can allow for more discussion to be had.
Gather all medications and put them in a bag to bring to the appointment, including the dosages. This should include all prescription medication and over-the-counter drugs, such as herbal supplements, vitamins and minerals.
Bring insurance information (if applicable). While many services in Canada are covered, there may be outstanding accessory services that may accept private payment options that insurance may cover fully or partially.
Record any upcoming appointments in your phone or with a calendar.
Caregivers and Patient Privacy
Some laws protect sensitive patient information, the most important of which is the Personal Health Information Protection Act (PHIPA). It applies to almost all healthcare providers in Ontario.
This law outlines patient’s rights, including:
How patient information is collected, used and disclosed by their provider
The right to copy or view patient healthcare records
How patient information is shared (and with who)
Under PHIPA, caregivers and the healthcare team can share information about a patient as long as the patient has consented to it. Make sure you have a conversation with the person you support before attending any medical appointments and that they understand that they may withdraw this consent at any time.
Summary
Acting as a caregiver for someone living with and after cancer can be challenging. Knowing how to best prepare for discussions with the healthcare team can help manage this stress. Contact us today if you have any questions about how to communicate or manage relationships with any Circle of Care team member involved in fatigue-related care for a person you support.
When a loved one is diagnosed with cancer, navigating the complexities of communication can be daunting. The fear of saying or doing the wrong thing often leaves many feeling awkward and uncertain. Maintaining open and thoughtful communication with people living with and after cancer is critically important, providing a sense of support, connection, and reduced isolation during such a challenging period. It is about finding the right balance—offering support to uplift and comfort the individual, acknowledging their struggle without amplifying their distress.
Let’s navigate through this together.
1. Active Listening
Active listening involves being fully present in the moment, paying attention to both verbal and nonverbal cues, and responding with empathy and validation. It involves putting aside your own thoughts and opinions and truly listening to the other person’s perspective. A cancer diagnosis may be accompanied by feelings of isolation, fear, or anger, and by active listening, you create a safe space for your loved one to express their concerns and emotions without feeling judged or minimized.
THE DOS of Active Listening
THE DO NOTS of Active Listening
DO clear the room of distractions by turning off the television or music
DO focus entirely on your loved one, maintain eye contact, lean in, and adopt an open posture to convey your full attention.
DO paraphrase their words using your own and summarize their sentiments to show you are grasping the depth of their feelings.
DO Use open-ended questions to invite deeper sharing, which ensures they feel heard without feeling judged and rushed
DO NOT glance at your phone or devices, which signals disinterest and makes your loved one feel undervalued and isolated
DO NOT discuss advice or stories or other people’s experiences. This can minimize your loved one’s feelings and divert attention away from their needs
DO NOT interrupt or finish their sentences, which can be perceived as dismissive and reduce their willingness to share their feelings
DO NOT share your own experiences. While contributing may seem helpful, it is not the time to do so and may make your loved one feel unheard. Listen and share stories if your loved one requests you to do so.
2. Words of Support
Choosing the right words when communicating can significantly impact your loved one’s emotional well-being. Here are some tips on what to say and not say to support them during this challenging time:
THE DOS of Communication
THE DO NOTS of Communication
DO reassure them of your unwavering support, saying things like, “I am here for whatever you need. You are not alone.”
DO acknowledge that one of the most challenging aspects of cancer can be the waiting periods between appointments, testing, and treatments. Avoid saying, “Relax”, and instead say “Waiting is the worst.”
DO ask open-ended questions that invite your loved one to express their thoughts and emotions at their own pace.
DO NOT say, “You’re so brave” or “Stay strong”. This may pressure someone to suppress their true feelings, and the reality is that your loved one may have negative days during their treatment, where they are more vulnerable.
DO NOT compare and minimize their experience with phrases such as, “At least it isn’t worse” or “I know how you feel”. Instead, say things such as, “I can’t possibly understand how you feel, but I will be here.”
DO NOT use the terms “battle”, “warrior”, or “fight”, which can put too much emphasis on either winning or losing against cancer.
3. Actions Talk!
Offering help is always a nice gesture; however, many people do not want to become a burden on their friends and family and may decline the offer. Instead of asking, “What can I bring you today?” send a gift card to a local restaurant or drop off food. You can also speak to them about driving to and from their appointments, doing small errands such as grocery shopping, or taking their pet for a walk. During cancer and its treatments, day-to-day tasks may seem overwhelming, and practical help from loved ones can bring enormous comfort and relief.
However, do not make decisions without their input, assuming you know best. This can diminish their sense of control and autonomy. Additionally, never surprise your loved one with a visit or gathering without prior communication. Although well-intentioned, these can be overwhelming and exhausting to the individual, who may already have limited energy.
THE DOS of Active Support
THE DO NOTS of Active Support
DO prepare meals that are not only nutritious but also cater to their changing tastes and dietary needs, underscoring your thoughtfulness towards their well-being.
DO take the initiative to handle daily chores or errands, alleviating the stress of mundane tasks and allowing them more time to rest and recuperate.
DO offer physical comfort through actions like giving a gentle massage or arranging comfortable seating. This provides relief from physical discomfort and a sense of closeness.
DO NOT make decisions without their input, assuming you know best. This can inadvertently diminish their sense of control and autonomy.
DO NOT surprise them with visits or gatherings without prior communication. While well-intentioned, these can be overwhelming and exhaust their limited energy.
DO NOT neglect to ask before helping with personal tasks. What seems helpful can sometimes feel invasive if not discussed beforehand.
Conclusion: Communicating with a loved one diagnosed with Cancer
In conclusion, navigating communication with a loved one during or after their cancer and its treatment requires empathy, patience, and understanding. By acknowledging the challenges they face, we can offer support and compassion. Remember to actively listen, validate their emotions, and provide practical assistance. At Cancer Fatigue Services, we understand the toll cancer can take on both individuals experiencing it and their caregivers, and offer personalized help and resources to all parties’ unique needs. Reach out to us today to learn more.
Cancer-related fatigue is a prevalent yet extremely challenging condition to deal with that may occur during or after your cancer and cancer treatments. It is different from normal fatigue, as cancer fatigue is typically much more severe and is not relieved with any amount of sleep. As a result, many people feel frustrated and hopeless about their cancer-related fatigue. However, there are established tips and techniques you can use throughout the day to minimize energy expenditure and help you cope with cancer-related fatigue as best as you can.
5 Tips for Conserving Your Energy While Experiencing Cancer Fatigue:
#1. Plan Ahead
One thing many individuals experiencing fatigue find beneficial is planning their days and weeks to ensure that they have the energy to do the things that are most important or that they want to do the most. For example, scheduling doctor’s appointments early in the day and allowing time for rest after may help avoid fatigue later in the afternoon or evening.
#2. Track Your Energy
Documenting your energy levels as you complete tasks during the day can help you identify previously unrecognized patterns (e.g., when you have the most energy and what activities are most draining). This practice is often referred to as keeping a “Fatigue Diary” and can assist you in planning your days and weeks. Using your diary in this way may help you optimize your productivity and have enough energy to participate in the activities that matter to you the most.
#3. Take Naps
Short naps and rests can help, especially after completing an activity. However, it is important not to become too inactive and rest too much, as this can weaken your muscles and may actually exacerbate your fatigue. It is also important to ensure that your daytime rest and sleep are not preventing you from sleeping well at night.
#4. Pace Yourself
Pacing yourself will help you to have enough energy to complete tasks and activities and allow you to recover faster. This involves maintaining a slow and steady pace with movement and breaking up activities into smaller tasks or spreading them out throughout the day. For example, if you climb 5 steps and then rest for 30 seconds, you won’t need a long rest at the top and will not feel as tired. Conversely, if you climb all the stairs at once, you may need to rest for 10 minutes after and feel sore and tired the rest of the day. Pacing can also involve taking breaks and sitting when you are out and about running errands.
#5. Ask For Help
If appropriate and available, it may be helpful to ask friends or family members for assistance with daily tasks. Building a support network can make a huge difference, both from an energy conservation and emotional health perspective. Oftentimes, people are more than happy to help out a loved one in need.
4 Practical Tips to Deal with Your Everyday Tasks
Along with the above tips, there are some very small, practical things you can do to assist with your fatigue throughout the day. Here are some suggestions to help you deal with everyday tasks:
#1. Housekeeping
Plan your tasks over the week and do a little bit of housework every day rather than lots all at once. Balance light and heavy tasks.
Sit down after or during certain tasks, such as drying dishes.
Use long-handled dusters, mops and dustpans to avoid awkward stretching and bending.
Make one side of the bed at a time and sit to change pillowcases and fold linen.
Clean one room at a time rather than all at once.
Slide rather than lift objects.
Keep a trash can in each room to avoid too much walking.
Buy more than one of each item around the house. For example, keep the sink cleaner in the bathroom and kitchen.
#2. Shopping
If possible, go grocery shopping with someone for extra help.
Make a list prior to going to the store so you do not waste time or energy.
Always use a shopping cart rather than a basket, which can get heavy.
Shop at less busy times, such as in the morning or during the day.
Ask for help from shop staff to carry heavy items to your vehicle.
#3. Cooking
Have premade meals on hand to have when you are most fatigued.
Prepare extra meals or double portions and freeze anything leftover to have when you are more tired.
When applicable, cook and bake in steps to reduce energy use.
Gather all ingredients and utensils prior to cooking or baking.
Use electronic appliances, such as a food processor, to avoid doing too much manual preparation.
#4. Washing and Dressing
Always sit down when getting dressed.
Organize and lay out your outfit the night before.
Avoid bending or reaching, and use a reacher, sock aid, or long-handled shoe horn to lift your legs up onto a bed or chair.
If you have weakness issues, it is easier to dress the weaker limb first and undress the strong one first.
Wear clothes that are easy to put on and take off. For example, use shoes with velcro instead of laces or small buttons.
Avoid using any sort of scented products, which can irritate your lungs and cause shortness of breath.
Use warm, and not hot water, which may cause shortness of breath from a buildup of steam and condensation.
To conserve energy, sit down in the bath rather than standing in the shower or install a seat in the shower.
Need some more advice to manage your Cancer Fatigue symptoms efficiently?
Managing your symptoms can seem daunting, and identifying the correct coping mechanisms can be challenging. Many tips, tools and techniques are available to help you better manage your cancer-related fatigue. Contact us today to discuss more options that are tailored to you.
Cancer fatigue is a common side effect of cancer and its treatments, and it can be a debilitating symptom that can affect almost every aspect of a person’s life. It is estimated that up to 95% of people experience fatigue at some point during or following their cancer treatment.
The causes of cancer fatigue can be complex and multifactorial. Cancer itself can cause fatigue, as can the treatments used to fight it, such as chemotherapy, radiation therapy, and surgery. Additionally, the emotional and psychological toll of cancer can contribute to fatigue.
Recognizing the profound impact cancer fatigue has on daily life, it becomes essential to understand its roots and explore effective strategies for managing it. Living with cancer fatigue requires a multifaceted approach that encompasses medical interventions and lifestyle adjustments. In this article, we explore practical ways to mitigate symptoms and enhance quality of life.
Managing & Coping with Cancer Fatigue
Cancer-related fatigue can be effectively managed and treated through a combination of lifestyle changes, dietary adjustments, and medical interventions. Due to the complex nature of cancer-related fatigue, a treatment that works for one individual may not necessarily work for another. It is crucial for patients to collaborate with their healthcare providers in order to develop a personalized plan that caters to their unique needs. Patients should consider the following tips:
Exercise: Based on the latest and most rigorous research, exercise therapy is overwhelmingly the most effective therapy for treating and preventing cancer-related fatigue. This may seem counter-intuitive; however, the broad health benefits of performing regular exercises, such as walking, biking, or strength training, work together to simultaneously address virtually all of the treatable causes of cancer-related fatigue. In addition to directly reducing fatigue itself, other benefits of exercise therapy reported in clinical studies include increased cancer survival, improved cardiovascular and muscular health, reduced risk of cancer recurrence, fewer and less severe symptoms during therapy, and improved mood, quality of life, and physical performance. With appropriate guidance from your healthcare team, exercise therapy is a safe and effective treatment for almost everyone.
Psychological Interventions: Psychological interventions, such as counselling, cognitive behavioral therapy and relaxation techniques, may help reduce fatigue, treat several of the main causes of fatigue, and improve overall quality of life in people living with and after cancer. Anxiety, depression and feelings of hopelessness are commonly associated with cancer-related fatigue, and studies have demonstrated a strong correlation between emotional challenges and fatigue. Counselling, psychotherapy and cognitive behavioural therapy by licensed healthcare professionals can help with coping strategies and alleviate stress associated with fatigue. Like exercise therapy, behavioural therapies benefit most individuals during and after cancer treatment.
Diet: A healthy diet during and after cancer treatment may help prevent and reduce fatigue by providing the body with nutrients it needs to function optimally. For some individuals, consultation with a registered dietician to discuss strategies and meals appropriate for you may help with fatigue-related symptoms. Patients should aim for a balanced diet with plenty of fruits, vegetables, whole grains, and lean protein. Some studies suggest that certain vitamins, such as vitamin D and B12, may also help alleviate fatigue in cancer patients.
Sleep: Many people living with and after cancer also report significant disturbances in sleep patterns that may be exacerbating their fatigue. Although cancer-related fatigue is NOT caused by a lack of sleep, meaning that no amount of sleep will make you feel rested, good sleep hygiene, such as going to bed at a consistent time and having a good pre-bed routine, can help reduce some symptoms of fatigue. Sleep-supporting therapies, such as cognitive-behavioural therapy, counselling and educational, can provide information on how to best address your sleep throughout the day and during the night that may assist in fatigue management.
Physical Therapies: Cancer and its treatments may also cause pain, contributing to fatigue. Tumours can cause pain as they grow and damage parts of your body or press on organs, nerves or bones. Cancer treatments and medical tests can also cause pain, depending on which areas are treated. Physiotherapy, acupuncture, and massage therapy can help manage musculoskeletal, joint, and neurological pain through physical modalities and rehabilitative exercises. If pain is causing a decrease in your functional status, occupational therapy may be useful to give you strategies and/or tools to help with your daily activities.
Medication: Many medications used to treat cancer, manage the symptoms caused by cancer treatments, or manage other health conditions (e.g. heart conditions) may directly or indirectly contribute to your fatigue. Occasionally, medications may be prescribed, such as stimulants, antidepressants, or sleeping medication, that may be useful in helping to address some of the underlying causes of fatigue or manage its symptoms. It is important to maintain open communication and work closely with your oncologist/family doctor to explore opportunities to adjust medication types and doses if the benefits of changing outweigh the risks. Importantly, research has found medication to be the least effective therapy at addressing cancer-related fatigue, with little evidence to support the efficacy of stimulants and attention-supporting drugs.
Discover How We Address Fatigue at Cancer Fatigue Services
Just as every cancer case is distinct, so is our tailored approach to patient care. Before Cancer Fatigue Services, no dedicated multidisciplinary medical management services were available to address cancer-related fatigue in Canada.
At Cancer Fatigue Services, we are dedicated to enhancing the lives of those affected by cancer, aiming to lessen their fatigue, rekindle their energy, and renew their optimism for a purposeful life. Our approach is compassionate and utilizes a precision medicine model consisting of a detailed fatigue assessment, personalized care plan, and advanced fatigue treatment and support services designed to meet the unique needs of each individual we serve.
Cancer-related fatigue is one of the most common side effects of cancer and its treatments. Characterized by profound physical, cognitive, and emotional exhaustion, cancer-related fatigue represents a significant challenge for patients and healthcare providers alike.
In this article, we delve into 10 surprising facts about cancer-related fatigue, offering insights into its complexities and implications for those navigating the journey of cancer care.
10 important facts about cancer-related fatigue:
#1. Cancer fatigue is VERY common
Some research has shown that upwards of 95% of people living with and after cancer experience some degree of cancer-related fatigue.
#2. The exact cause of cancer-related fatigue is unknown
Cancer-related fatigue is a misunderstood and often overlooked condition that is unique for every individual. Several of the established causes of cancer fatigue include tissue and organ damage or dysfunction from cancer treatments (e.g. chemotherapy- or radiotherapy-induced heart or lung damage), anemia, emotional challenges (e.g. anxiety, stress or depression), malnutrition, medication complications, immune system dysfunction, hormonal issues, pain, and sleep disturbances. In order to truly understand your cancer-related fatigue and how to prevent it from getting worse, a comprehensive and individualized assessment is needed to identify the unique risk factors and causes of your fatigue, which become the main treatment targets within your fatigue care plan.
#3. Cancer fatigue is different from “normal” fatigue
Cancer-related fatigue is not the same as regular fatigue. “Fatigue” is defined as tiredness resulting from mental or physical exertion. Almost everyone will experience fatigue at some point in life, as it is the body’s natural way of showing that rest is required. However, exhaustion that lasts for prolonged periods of time is not normal. Cancer-related fatigue is more severe, lasts longer, and can lead to other symptoms, such as brain fog or muscle wasting.
#4. Cancer tiredness is NOT relieved by more sleep
Cancer-related fatigue is not relieved by any amount of sleep and you may feel like you are exhausted for no reason. In fact, some people experience cancer fatigue even if they are sleeping more than usual.
#5. It can last for years following cancer diagnosis and treatment
It is a common misconception that once treatment is over, you will feel back to normal. Cancer-related fatigue affects individuals long after their cancer treatment is complete and can be extremely frustrating for individuals experiencing it.
#6. Cancer fatigue can be debilitating
Some people say cancer-related fatigue is the most challenging side effect of cancer and its treatment and can severely impact aspects of your daily life. Chronic, cancer-related fatigue can even make it challenging to do the small things in your life, such as getting ready in the morning or cleaning, which can lead to feelings of frustration, anxiety and depression.
#7. Symptoms look different for everyone
One of the challenges of diagnosing cancer-related fatigue is that every person presents completely differently. Cancer-related fatigue depends on several factors, such as the type and stage of cancer, treatment(s) received, and the overall health of the individual. Symptoms may include some or all of the following: having little or no energy, feeling mentally exhausted, achy muscles, pain, feelings of weakness, difficulty concentrating, sleeping too little or too much, little enjoyment or interest in daily activities, or feelings of irritability.
#8. Exercise therapy is the BEST treatment
As surprising as it sounds, research shows that staying active is the best way to prevent and treat cancer-related fatigue. Exercise therapy can improve cardiovascular endurance, muscle strength, increase appetite, and be beneficial for mood. It is always important to consult with a medical professional before starting an exercise program.
#9. Treatment will involve multiple therapies
While exercise therapy is the single best treatment for cancer-related fatigue, most fatigue treatment plans include several different and complementary therapies. Many individuals find counselling and cognitive behavioural therapy helpful, while others may benefit from nutritional advice, massage, support groups, or acupuncture.
#10. Cancer fatigue does NOT need to be your new normal
While it can seem overwhelming, there are steps you can take to improve or prevent cancer-related fatigue and there are many causes that are treatable. A thorough understanding of the exact causes behind your fatigue can allow healthcare professionals to give you a concrete, unique care plan to best address these factors.
From understanding to treating Cancer-Fatigue
In conclusion, understanding the silent struggle of cancer fatigue is crucial for both patients and their loved ones. Providing effective support for people living with cancer-related fatigue begins with recognizing its debilitating impact on the lives of those experiencing it. Remember, cancer fatigue is not just tiredness; it’s a complex health condition that requires personalized medical care.
At Cancer Fatigue Services, we understand the unique challenges faced by individuals with cancer fatigue. We offer personalized medical care and support to effectively treat fatigue and optimize the quality of life of everyone entrusted to our care. Connect with us today to get started on your path to reclaiming your energy and your life!
Cancer fatigue or cancer tiredness is experienced by up to 95% of people who have been diagnosed with cancer. It is a complex health condition that is caused by physical, mental, emotional, behavioural, and social factors.
Cancer-related fatigue is more than just being tired!It is defined as a persistent and often overwhelming feeling of tiredness, exhaustion, and lack of energy that is different from normal fatigue because it is not relieved by rest or sleep. Without treatment, cancer fatigue can greatly limit a person’s ability to engage in normal daily activities and lead a fulfilling life.
Who is at risk?
Currently, there are no great ways to predict who will develop more severe levels of cancer-related fatigue and who will not. However, many of the recognized risk factors for developing cancer-related fatigue are modifiable (treatable). The main cancer fatigue risk factors are:
Modifiable Risk Factors
Non-Modifiable Risk Factors
Chronic health issues Increased body weight Pain Depression Insomnia Neuroticism (frequent agitation, stress & worrying) Physical inactivity Low performance status (decreased function & independence)
Increasing age (e.g. >55 years) Female sex Greater cancer stage (II-IV) >1 type of cancer treatment
How to know if you, your loved one, or your patient has cancer-related fatigue
Constant exhaustion is not the only sign that someone is experiencing cancer-related fatigue. The symptoms of cancer-related fatigue can be as different as the people experiencing them. However, some of the more common symptoms of cancer-related fatigue include:
Strong and constant feelings of tiredness and exhaustion
Decreased energy levels
Decreased ability to carry out normal daily activities
Decreased motivation and interest in activities
Changes in sleep patterns
Changes in appetite
Decreased mental alertness, concentration and memory
Irritability and mood changes
An unpredictable health problem
The causes, severity, timing and impact of cancer-related fatigue are different for everyone. These factors may also change unpredictably within people over time.
In general, cancer-related fatigue:
is caused and influenced by more than one factor;
is more intense in people who are actively receiving or who recently completed cancer treatments;
can develop, get worse, or come back again at any time following a cancer diagnosis;
can last for just a couple of days or may continue for many years; and,
may be very troublesome (intense and long-lasting) for people living with chronic or advanced stages of cancer who are receiving long-term maintenance treatment protocols.
In fact, cancer-related fatigue can be more challenging to predict and treat compared to other health problems because there is no single cause or major contributing factor.
What are the main treatable causes of cancer fatigue?
Many of the physical, mental, emotional, behavioural, and social factors that are known to cause and contribute to cancer-related fatigue are commonly experienced by people living with and after cancer. Fortunately, many of the main causes of cancer fatigue are treatable, including:
Anemia: Anemia is a common side effect of cancer and its treatments that is characterized by a low red blood cell count. Cancer and anticancer therapies can cause anemia by affecting the bone marrow’s ability to produce red blood cells – reducing the body’s ability to transport oxygen and produce energy.
Sleep disturbances: Difficulty falling and staying asleep, as well as poor sleep quality, can result in decreased energy levels, physical and mental performance, and immune function – all of which can contribute to cancer-related fatigue.
Nutritional problems: Deficiencies in certain nutrients also contribute to cancer-related fatigue by affecting the body’s energy production and delivery systems (e.g. anemia). Poor nutrition is shown to cause decreased energy levels, physical and mental performance, and immune function – leading to fatigue.
Emotional challenges: Depression and anxiety are common mental health conditions experienced by people living with and after cancer that contribute to cancer-related fatigue in several ways. Depression can cause feelings of sadness, hopelessness, and a loss of interest in activities that were previously enjoyed. Anxiety can cause feelings of worry, nervousness, and fear. These negative feelings often result in decreased energy levels, physical activity, and mental alertness – all of which contribute to cancer-related fatigue.
Hormone imbalance: Hormones play a crucial role in controlling your body’s metabolism, energy levels, and physical and mental performance. Cancer and cancer treatments typically cause hormone imbalances by affecting the production and regulation of hormones in the body which negatively impact the body’s energy production and delivery systems.
Exercise intolerance: Exercise intolerance is a common issue in people living with and after cancer that makes it more difficult for people to engage in exercise and perform physical activities that were previously routine (e.g. walking, climbing stairs, carrying groceries). Cancer and its treatments can cause exercise intolerance by impairing the body’s energy production and delivery systems as well as causing muscle weakness and wasting – which directly contribute to cancer-related fatigue.
Immune dysfunction & Infections: Cancer and cancer treatments can directly impair the function of the immune system (e.g. damaging or decreasing the number of white blood cells), which increases inflammation and the risk of infections. When this happens, the body has to work harder (use more energy) to control the inflammation, repair the immune system, and fight infections.
Chronic pain: Cancer and cancer treatments cause pain by damaging tissues and nerves and by increasing inflammation. The resulting pain can contribute to cancer-related fatigue by causing physical and emotional stress and by disrupting physical activity behaviour, mental alertness, and sleep.
Medication complications: Some medications directly contribute to cancer-related fatigue by affecting the body’s energy production and delivery systems (e.g. anemia). Other medications indirectly contribute to cancer-related fatigue through their impact on sleep quality and duration as well as appetite. Other side effects include decreased alertness, energy levels, and physical and mental performance.
Cognitive challenges: Cancer, cancer treatments, and common symptoms experienced by people living with and after cancer can interfere with people’s memory, language, word finding, multitasking, organizing and planning, taking initiative, mental calculations, and concentration. Challenges in any of these areas can be mentally exhausting and can contribute to a person’s overall fatigue.
REFERENCES: Bower J, Nat Rev Clin Oncol, 2014; Mortimer et al., J Nat Comp Cancer Network, 2010; O’Higgins et al., Support Care Cancer, 2018; Thong et al., Curr Treat Options Oncol, 2020; Tian et al., Oncologist, 2016; Uslu and Canbolat, Sem Oncol Nursing, 2021; Wan, X. Clin J Oncol Nursing, 2008
Timing & severity of cancer-related fatigue
Cancer-related fatigue can be very unpredictable and can first develop at any time following a cancer diagnosis. It may also worsen or come back without warning in people with stable fatigue or in those who were previously affected by it.
According to the Canadian Cancer Society, 25-30% of cancer patients experience fatigue that lasts for months or years after treatment. The duration of cancer fatigue is influenced by various factors such as a person’s cancer type and stage, the types of cancer treatments people are exposed to, the presence or development of health conditions that contribute to fatigue, and, importantly, whether or not people receive treatment for their fatigue. In some cases, fatigue may persist even after cancer treatment has ended. Bone marrow transplants, for example, can cause prolonged fatigue that lasts up to and beyond one year.
It’s crucial to understand that cancer-related fatigue differs from the normal tiredness felt after a day’s activities, and can be a major burden that necessitates medical intervention. Studies have shown that cancer-related fatigue is more likely to get worse or come back in people who initially experience higher levels of fatigue. Therefore, even if you are experiencing some level of fatigue, getting help to prevent your fatigue from getting worse could dramatically impact your fatigue levels for years to come.
Typical patterns of cancer-related fatigue
Impact of cancer-related fatigue
Cancer-related fatigue can make it difficult for you to:
care for yourself and loved ones
cope with your treatments
plan for your future
maintain and/or return to your work, school and social life
honour your personal, professional and community commitments
live a life of quality, passion and purpose
The good news is, living with cancer-related fatigue DOES NOT need to be your “new normal”!
Get the answers you need and the care you deserve
Nervous about developing cancer-related fatigue? Tired of being tired?
Trying to address problems that you do not completely understand is a waste of your time and energy!
As your healthcare partner, Cancer Fatigue Services provides comprehensive and convenient fatigue assessment services to ensure that you have all the information you need to make informed decisions about your health and fatigue-related care. We work for you to ensure that you receive the high-quality, efficient, and effective care you need to relieve your fatigue and restore your hope for enjoying a life not limited by it.
If you are newly diagnosed, currently receiving treatment, living with cancer, or living beyond it, we can help you maintain and retake control of your life!
