Feeling Tired (Fatigue)

Fatigue refers to the feeling of being very tired. Many factors may contribute to fatigue, including the cancer itself or the treatments used for cancer. Unlike normal fatigue which usually does not last long and gets better with rest, cancer-related fatigue may not be completely relieved by sleep or rest. The degree of fatigue varies from person to person, but it can have a negative impact on quality of life.

Causes of Fatigue

Cancer
Treatment side effect (Surgery, chemotherapy, radiation therapy, immunotherapy)
Depression, anxiety and stress
Pain or other uncontrolled symptoms
Certain medications (e.g. antihistamines, antidepressants, opioids)
Co-existing medical conditions (e.g. heart/lung/kidney problems, hormone problems)
Insufficient sleep
Poor nutrition or dehydration
Low red blood cell count (anaemia)

What you need to look out for

Feeling weak or tired
Difficulty concentrating
Loss of appetite
Feeling moody or down
Headaches, dizziness, or problems with vision (e.g. blurriness)
Increased irritability, impatience or anxiety

How it can be treated

The treatment of fatigue depends on its cause. For instance, fatigue caused by cancer pain will improve with pain control medications. Your doctor or nurse will ask you some questions about your fatigue, including when it started and whether it affects your daily life. Further tests may also be done to look for causes of fatigue that can be treated. Your doctor or nurse may also refer you to the rehabilitation physician, who can recommend a fatigue rehabilitation or exercise program that may help improve your fatigue.

What you can do

Although cancer related fatigue may persist, simple lifestyle changes may be useful in relieving or helping you cope with it. Some practical tips are as follows:

Have a regular routine of activities and rest, as changes in routine make the body use up more energy. Do things that relax you (e.g. taking a bath or reading) before bedtime so that you can sleep better. Lie in bed for sleep only, and naps should be no longer than 1 hour

Exercising regularly can help. Start with light activities and build up little by little. Choose an exercise that you enjoy. Mind and body exercises (e.g. qigong, tai chi and yoga) may also be helpful

Take well-balanced meals and drink sufficient water. This helps with energy production and make you feel less tired

Identify the time of the day when you are most fatigued or have the most energy. You can plan and pace your activities according to your energy level. Do not overtire yourself. Rest when energy is low and delegate work wherever possible

Place items that you use often within easy reach to save your energy

Participate in activities that distract you from your fatigue (e.g. reading, watching movies), or learn relaxation techniques (e.g. deep breathing) to reduce stress and reduce fatigue

Do not be afraid to get help from your family or friends when you need it

Avoid staying in bed after waking up

Avoid stimulating activities (e.g. exercise) right before bed as it will make it harder for you to fall asleep

Avoid noise (e.g. television, radio) during sleep

Avoid alcohol or caffeine in the evenings

When to call your cancer care team

Please inform your doctor or nurse if you are breathless, unwell or are unable to do your daily activities because of your fatigue.

If you have any questions regarding the above, please call the Cancer Helpline at +65 6225 5655 or approach your doctor or nurse for further details.

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The above contents are made available as part of TEMASEK FOUNDATION-ACCESS (Accessible Cancer Care to Enable Support for Survivors) PROGRAMME, a holistic care programme to support cancer patients during their care and recovery journey.

The contents have been approved by the Cancer Education Information Service, National Cancer Centre Singapore (NCCS), for people with cancer and their families and caregivers. However, this information serves only as a guide and should not be used as a substitute for medical diagnosis, treatment or advice. For specific medical conditions, please seek expert medical advice from your healthcare team.

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