Cancer and its treatment often make people feel very tired and weak. Fatigue affects everyone differently and can have many different signs. Some people find that their fatigue is very mild and does not interfere much with their work, however for others it is very disruptive. Some of the more common effects of fatigue are:

• difficulty doing the smallest tasks (everyday activities like brushing your hair or cooking can seem impossible)
• a feeling of having no energy (you feel as if you could spend whole days in bed)
• a feeling of having no strength
• having trouble thinking, speaking, or making decisions
• difficulty in remembering things
• breathlessness after only light activity
• dizziness or a feeling of light-headedness
• feeling more emotional than usual

Fatigue can affect the way you think and feel. You may find it impossible to concentrate on anything. This may greatly affect your work. Fatigue may also affect your relationships with your employer or colleagues, as it can make you become impatient with people around you, or can lead you to avoid socialising because it is too much effort.

You may find that you cannot continue working due to fatigue, or that you have to work shorter hours. It can help to talk to your employer, occupational health department or human resources department to let them know that you may need some time off due to the cancer or its treatment.

Don’t feel that you have to work if you are too tired. If you do want to carry on working you may be able to find ways of making your work less tiring for a while.

Good planning can help you to do the things that are most important to you when you feel least tired.

It can help to keep a diary of your fatigue levels so that you can track how your treatment affects your energy. You can then plan to do important work activities at a time when your energy levels are higher. Keeping a note of your energy levels helps you to identify the days when you are best able to work, so that you can discuss this with your employers.

Cancerbackup has a section with tips on coping with fatigue.

You could use a diary to keep a record of your energy levels.

Energy levels can be described as:

1. No fatigue
2. Mild fatigue – but able to do normal activities
3. Some fatigue – but able to do some activities
4. Moderate fatigue – able to do some activities but need rest
5. Severe fatigue – difficulty walking or doing activities such as shopping or hoovering
6. Extreme fatigue – needing to rest or sleep for most of the day.

• Talk to your employer and colleagues about deadlines and what you can manage.
• Talk to your Occupational Health service if you have one. Their doctors and nurses have a responsibility to help you to be able to do your job and to help you with any health or medical problems that affect your work.
• Keep a diary of how you feel and see if patterns emerge – this will help you to judge peak performance hours.
• Talk to your employer about a change of duties if necessary.
• Plan a reduced or more flexible schedule – look at the days you are needed at work and schedule your time around this.
• Delegate work when possible.
• If appropriate and possible, name a person to assess which phone calls you need to take, forward important emails, etc.
• Work from home when possible.
• Let colleagues know how you will manage things, how to contact you, and when you will check in with them.
• Talk to your doctors about the best times for appointments and treatments: for example, Friday afternoons to allow you to recover over the weekend.
• Try meditation/complementary therapies/massage to reduce stress (see Cancerbackup’s section on complementary therapies).
• Eat as well as you can to boost energy (see Cancerbackup’s section on eating well).
• Plan a period of rest after a period of activity. Short naps and rest periods are useful.
• Some people find that they need to rest after meals.
• It is also important to plan your days around your treatment. Try and avoid anything energetic or stressful for 24 hours before and after your treatments, or if you have a high temperature or low blood counts.

Your employer can help by:

• changing your hours so that you can travel to and from work at less busy times (outside the rush hour)
• asking colleagues to be supportive and to help with some of your work
• finding you a parking place near to your place of work
• allowing you to take a short break every now and again to rest or lie down
• allowing you to work from home, if possible
• finding you lighter work if your job involves physical exertion or heavy lifting

Some cancer treatments, particularly chemotherapy, can reduce the production of white blood cells which fight infection in your body. If the number of your white blood cells is very low, you are more likely to get an infection. Your doctor or nurse can tell you if your white count is low. If your count is very low, you may not be able to work and you may need to warn your employer about this.

If your level of white blood cells is low, it is a good idea to avoid people who have sore throats, colds, flu, diarrhoea and vomiting, or other kinds of infection, such as chickenpox. If you come into contact with anyone who has an obvious infection, it is best to ask your hospital doctor or specialist nurse for advice as soon as possible. You may need to take medicines to prevent you from getting the infection.

During, or after, cancer treatment, it is important to go outside to get some exercise and fresh air, but it is good to avoid crowds where possible. This includes avoiding using public transport, particularly during the rush hour, and crowded workplaces where you may be mixing with people who may have an infection.

Some chemotherapy drugs have an effect on the nerves in the hands and feet known as peripheral neuropathy. This can cause increased sensitivity of the hands and feet, pins and needles or numbness. The sensations and numbness can make it difficult to hold things or to write or type. This can sometimes mean you take longer to carry out your normal tasks at work. Some people may find it difficult to carry on working if they have this side effect.

Some people find that they have other effects such as soreness or pain, feeling sick or problems with eating. If you have any symptoms or side effects due to your treatment, your doctors can usually prescribe medicines to help reduce these. If the effects are not helped by the medicines, let your doctor know so that more effective treatments can be prescribed. Sometimes, changing the time you take the medicines can make them more effective, so you can discuss this with your doctor or nurse.