Cancer-related fatigue (tiredness)

Overview

• Triple-negative breast cancer treatment runs for most of a year (about six months of chemo-immunotherapy, surgery, radiotherapy, then pembrolizumab alone), so tiredness builds. Macmillan says physical activity such as brisk walking is one of the best ways to reduce fatigue, to keep a regular sleep routine and to plan the day around what matters most; Cancer Research UK says radiotherapy tiredness tends to worsen through the course and can carry on for some weeks afterwards before improving.
• Pancreatic cancer: Pancreatic Cancer UK says fatigue is extreme tiredness that is not always linked to activity and that the cancer, its symptoms and its treatments all cause it. Macmillan says gentle strengthening exercise and walking reduce fatigue, that anaemia is a treatable cause, and that tiredness can also be a sign of depression worth raising. Poor digestion and untreated diabetes are two pancreatic-specific causes the dietitian can check.
• Bowel cancer: Bowel Cancer UK's sleep and fatigue page treats tiredness as a symptom to report rather than something to endure, because anaemia, poor sleep, low mood and the treatment itself are separate and separately treatable causes. Gentle activity, a routine and a conversation about anaemia are the first steps; the ESMO fatigue guideline puts exercise and psychological support ahead of stimulant drugs.
• Lung cancer: Cancer Research UK says tiredness and feeling lethargic much of the time are common during treatment and for some months afterwards, and also when the cancer has spread, and that resting but also doing some gentle physical activity can help. Breathlessness and anaemia are separate, treatable contributors: Macmillan says low red blood cells make you tired and breathless and may need a blood test and sometimes a transfusion, so tiredness is worth reporting rather than absorbing.
• Prostate cancer: NICE NG131 (1.4.18) says to tell people starting androgen deprivation therapy that fatigue is a recognised side effect of the therapy and might not be because of their cancer, and (1.4.19) to offer supervised resistance and aerobic exercise at least twice a week for 12 weeks to reduce fatigue and improve quality of life. That is an offer the guideline makes, so asking for the referral is asking for something you are owed.
• Lymphoma: Lymphoma Action describes cancer-related fatigue as extreme tiredness that is physical, mental and emotional, that is not relieved by sleep as ordinary tiredness is, and that can begin during treatment and continue for months or years. It appears in the charity's material both as a side effect and as a late effect. Several contributors are separately treatable, including anaemia and an underactive thyroid, and after radiotherapy to the neck a thyroid blood test is done once a year.