Audio and slides for this presentation are available on YouTube: http://youtu.be/Tt8WlPsohCU Fatigue is a common side effect of cancer treatment. Fatigue from treatment can make everyday tasks and activities difficult to complete or enjoy. Join Jean Boucher, RN, an Oncology Nurse and Clinical Inquiry Specialist from the Nursing Department at Dana-Farber Cancer Institute, and discover how to manage cancer fatigue, improve sleep, mood, and nutrition habits, and boost energy levels.

1. Jean Boucher RN, Oncology Nurse
Clinical Inquiry Specialist
DFCI Nursing Department
The Phyllis F. Cantor Center

2.  Fatigue is #1 most frequent
symptom reported by cancer
patients.
 Impact:
• Physical
• Psychosocial
• Quality of Life

3.  Very subjective
 Varies based on type of cancer and treatments
• “Some days I feel great, other days I am exhausted…”
 A very different experience for each patient
• “I feel washed out…”
• “I’m so tired, I can’t concentrate…”
• “I have no desire to do anything…”
• “I can’t pinpoint when it will happen sometimes or why…”

4.  Cancer disease
 Treatments
 Chemotherapy
 Radiation
 Surgery

5.  Stress
 Can alter mood and create anxiety
 From everyday activities and coping with
cancer
 Work stress
 Life crisis
 Financial commitments
 Household obligations
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6.  Pain
◦ Fatigue can intensify pain
◦ Pain medication can increase fatigue
Must carefully balance the two
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7.  Lack of sleep
• Medication and treatment can disturb sleep or change
sleep patterns
• Sleep hygiene tips:
1. Avoid food two (2) hours before bed
2. Avoid caffeine later in the day
3. Avoid stimulation before bed
(computers, TV, phones, devices)
4. Relax before bed (reading, puzzles, journaling, meditation)
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8.  Low red cells
◦ Treatments decrease red cells
◦ Red cells carry oxygen throughout body
◦ Low levels may require transfusion
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9.  Medications
• Pain medications
• Treatment (chemo, surgery, radiation)
 Speak with your physician or treatment team about
balancing your medication with daily activity level
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10.  Lack of energy causing physical limits
and/or emotional distress
 Shortness of breath
 Chest discomfort
 Pain
 Insomnia

11.  Mood changes
• Depression
• Anxiety
• Irritability
• Uncontrolled Nervousness
 Inability to concentrate affecting lifestyle
(personal, family, work, social)

12.  Daily low impact activity
• walk, bike, swim, yoga
 Nutrition
 Eat healthy: protein foods help
 Fluids as 6-8 glasses a day (non caffeine)
 Talk to a nutritionist

13.  Lymphoma Patients Post Transplant
 Nurse-led education and monitoring with reinforcement
 Symptom & Fatigue Tool Use
• Daily Activity & Pedometer
• Symptom Self-Reporting Tool
• 72 hour follow-up education
• Every two week follow-up education

14.  Pace self
 Ask for help or delegate tasks
 Keep it simple
 Rest periods:
• 20 minutes at a time
• Avoid napping after mid afternoon
• Adequate sleep

15.  Housework
• Spread out tasks, avoid heavy work, take breaks
 Shopping
• Make a list, use carts, avoid heavy objects, bring
a friend, avoid busy times
 Meal preparation
• Keep it simple, prepare ahead
& freeze items, avoid heavy pans.
 Child care
• Do activities with children that involve
sitting, avoid lifting small children

16.  Ask for support from colleagues
 Avoid rush hour traffic
 Park near entrance (may need temporary handicap
plate)
 Take breaks, rest, drink fluids & snacks
 Work from home
 Avoid heavy physical exertion tasks

17.  Set realistic goals with your health care provider(s)
 Positive activities that you enjoy and avoid those
that create negativity or unwarranted guilt.
 Relaxation techniques
• Meditation (deep breaths or visualization)
• Music
• Massage therapy (check with your doctor or
MD or nurse)
• Yoga (low impact, avoid “hot” yoga)
 Support groups or counseling

18.  Provide help & positive support
 Listen, provide feedback, ask
questions with your loved-one
 Attend appointments and
treatment visits
 Talk to a social worker about
financial or care related issues.

19.  Keep a diary or journal to take
notes & write questions to ask
 Talk with your doctor, nurse
practitioner and nurse
 Self-reporting your symptoms
 Your provider may recommend
blood work or treatment if
appropriate to help

20. Does acupuncture
help fight fatigue?

21. What do you recommend for
weakness or tired muscles?
Check out Dana-Farber’s cancer fitness tips
and exercise classes for patients and survivors.
Contact Dana-Farber's exercise physiologist
Nancy Campbell at 617-632-4523.
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22. Why am still tired
after cancer treatment?
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23. What supplements and/or
foods help fight fatigue?
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24. Along with bone health, I’ve heard vitamin D
may help in cancer prevention and survivorship.
How can I get more
vitamin D in my diet?
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25. Does fatigue contribute
to a loss of appetite?
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26. If I’m hungry at night,
but I don’t want to affect my
sleep, what should I do?
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27. Why is it important to keep
a healthy weight during
and after cancer treatment?
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28. What’s important to
remember during treatment?
Who should I talk to?
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29.  Read more about cancer-related fatigue.
 Learn more about the Phyllis F. Cantor Center for
Research at Dana-Farber.
 Explore more support services at Dana-Farber.org.
Additional resources
◦ National Cancer Institute
◦ National Comprehensive Cancer Network
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