March 2019

#1. Understand Cancer Related Fatigue

Cancer related fatigue (CRF) layers on top of normal tiredness and exhaustion.  Up to 90% of patients treated with radiation and up to 80% of those treated with chemotherapy experience fatigue. (Hoffman M. et al, 2007). 90% of cancer patients rank it more troublesome than pain and anxiety. CRF is different from normal fatigue as it is not relieved by rest or a good night’s sleep. It can persist for months or years after cancer treatment. Being chronically fatigued affects critical aspects of your life including your relationships, job performance and participation in social activities.

#2. Talk to your doctor.

Many different conditions can also cause fatigue such as pain, emotional distress, sleep disturbance, anaemia, and hypothyroidism. (Mock, V et al, 2000) So talk to your doctor who may be able to treat it medically.

#3. Do a CRF Self-efficacy Program ….. they work.

Research shows that self-efficacy focused programs result in less fatigue, improved quality of life, exercise compliance and general self-efficacy. Reif, K. et al (2007). Self-Efficacy is the belief that you yourself have the knowledge, attitude and skills to reduce your CRF. These types of programs, typically include 6, 90 minute sessions. Groups of similarly affected people learn about their CRF and identify ways to improve their self-care by problem-solving, setting realistic goals and reflecting on and tracking their progress.

#4. Score your CRF.

Doctors don’t have a blood test for pain nor for CRF. Both are scored by the patient using the VAS scale of 0 to 10, when 0 is no fatigue and 10 is the worst fatigue you can imagine. When scores are 4/10 or higher it is highly recommended that you talk to your doctor.

#5. Exercise daily.

Being active is one of the top two practices of people who manage their CRF well. Reif, K. et al (2012). Research shows that people with CRF who exercise feel less tired. The American Cancer Society recommends that cancer survivors take part in regular physical activity and aim to exercise at least 150 minutes per week and include strength training exercises at least 2 days per week. ACS (2014).

#6. Ask your Cancer Rehab Physio to make you a exercise plan.

The Cancer Rehab Physio will work with you to establish your baseline and to develop a progress plan. For example a person with severe CRF might start with a 2 minute walk each day for week 1, 4 minute walks for week 2, progress to 6 minute walks for week 3 and so on until by week 15 they are walking for 30 minutes.  Vallance, J. et al, (2006)

#7. Get good at energy conservation.

Practicing energy conservation is the other top practice of people who manage their CRF well. Research on energy conservation programs shows that patients feel less tired when they can effectively prioritise, plan and pace their life’s activities. Packer, T et al (1995) and Reif, K et al (2007).  Contact your local Cancer support centres or National Cancer Society for information about Energy Conservation Programs. Topics covered include:

(a) the value of rest;

(b) budgeting and banking energy;

(c) incorporating rest periods throughout the day;

(d) learning to communicate personal needs to others;

(e) using good body mechanics and posture;

(f ) using energy-efficient appliances and organizing stations of activity;

(g) separating fatiguing tasks into components;

(h) prioritizing and setting standards for activities;

(i) planning rest periods with self-care, productivity, and leisure activities so that a balance can be maintained; and

(j) reviewing course principles and setting short-term and long-term goals.

#8. Make priorities.

Take the time to list your priorities and decide which priority is first second, third etc. then design your week around these priorities. A simple example of a priority would be, you would like to reconnect with your friends. On that day you could conserve energy by doing less work and having a rest before going out so you are alert and comfortable throughout the evening.

#9. Pace yourself.

Pacing takes practice and can be a major adjustment for those who were very busy people before cancer treatment. Pacing is linked to your priorities. The more adaptive and flexible you are the better. In the group classes people are given time to process how well they are pacing and class mates share their experiences and wisdom with each other.

#10. Stay positive.

Research shows that these self-care skills are much improved with a positive attitude. So stay positive, believe in yourself and give yourself the best chance to conquer your cancer related fatigue.


  1. Reif, K et al, 2012. A patient education program is effective in reducing cancer-related fatigue: A multi-centre randomised two-group waiting-list controlled intervention trial. European Journal of Oncology Nursing. Vol 17, Issue 2. April 2013. Pages 204-213
  2. Hofman, M et al (2007) Cancer-Related Fatigue: The Scale of the Problem. doi: 10.1634/theoncologist.12-S1-4The OncologistMay 2007 vo 12 Supplement 1 4-10
  3. Mock, V et al, NCCN Practice Guidelines for Cancer-Related Fatigue (PMID:11195408). Oncology (Williston Park, N.Y.)[01 Nov 2000, 14(11A):151-161]
  4. Vallance, al, (2007) Randomized Control Trial of the Effects of Print Materials and Step Pedometers on Physical Activity and Quality Of Life in Breast Cancer Survivors. Journal Clinical Oncology, 25, 17 (June 10), 2352-2359.