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Giving Yourself the Gift of Rest

Coping with cancer-related fatigue during the holidays.

Key points

  • Holiday activities can require a significant amount of energy, particularly for those recovering from cancer treatment.
  • Cancer-related fatigue is common and can make it challenging to engage in holiday activities.
  • Research demonstrates that activity pacing is an evidence-based way to manage cancer-related fatigue.
RonTech3000/Shutterstock
Source: RonTech3000/Shutterstock

The holidays are a stressful time for many people. All of the cooking, shopping, planning, and time with family can become overwhelming, particularly if you or a family member are in or recovering from cancer treatment. Fatigue is the most common symptom reported by cancer survivors, with estimates as high as 62% in some patient groups.1 Cancer-related fatigue is more intense and long-lasting than other types of fatigue and can persist even beyond treatment completion. This type of fatigue is different than just feeling “tired” and typically, rest and sleep don’t improve the fatigue.2 There are numerous factors that may explain cancer-related fatigue, including disruption of sleep-wake cycles, recovery from tissue damage related to treatments, anemia, dehydration, interruption of good nutrition, and depression, just to name a few.3 Regardless of the specific cause, it is essential to balance activity and rest to effectively manage cancer-related fatigue.

In the field of chronic pain, a strategy referred to as “activity pacing” is often recommended to help manage pain.4 Individuals struggling with chronic pain may find themselves getting stuck in a “boom-bust” cycle of activity. On a “good day,” when pain is less intense, people often want to push themselves to do more to take advantage of the period of time when they are feeling well (boom) followed by days of increased pain and less activity as they recover (bust). If this pattern continues, over time, it can take longer and longer to recover and increases the likelihood of getting trapped in a cycle that may impact levels of pain over time.

Source: Brian Haver, used with permission
Boom-Bust
Source: Brian Haver, used with permission

Activity pacing helps interrupt this cycle by encouraging two main priorities: conserving energy for activities you value—instead of those you feel you “should” do—and planning and pacing activity so that “high energy” activities are mixed with “low energy” activities alongside periods of rest.3

Source: Brian Haver, used with permission
Pacing
Source: Brian Haver, used with permission

Researchers of cancer-related fatigue have found this “boom-bust” cycle also occurs in cancer recovery, and activity pacing can be very helpful for managing fatigue effectively. Setting limits before your body tells you to stop can go a long way toward avoiding the boom-bust cycle.

Try these tips for balancing activity and rest this holiday season:

  • Acknowledge that this year is different: Even if treatment is over, things may not be “back to normal.” Patients and caregivers alike can benefit from recognizing that they may not be 100% this holiday season and manage activities accordingly.
  • Practice saying “maybe not this year”: You don’t have to accept every invitation or fulfill every expectation. Choose what you can handle and enjoy without feeling overwhelmed or exhausted.
  • Re-think traditions: If you have always prepared elaborate dinners or spent days decorating your home, it can be difficult to consider that things may be different this year. A cancer diagnosis can also make the future seem uncertain, increasing the pressure that some feel to make the holidays “perfect.” Prioritize which holiday activities are most important to you and adapt. For example, if you host a yearly party, ask for help with planning, cooking, and cleaning so you don’t become overwhelmed. If a typical tradition seems to require too much energy this year, start a new one. There is no “right” way to celebrate.
  • Think ahead: More time with family and friends may mean addressing questions about diagnosis and treatment. Try to come up with a quick statement in response to these questions that you feel comfortable with. Practicing a standard, short reply can decrease some of the worry around not knowing what to say or how to say it.
  • Don’t stop self-care: It’s important to stay engaged in the routines that make you feel good—adequate sleep, limiting alcohol and heavy foods, and getting exercise are the building blocks of managing stress and fatigue. Try not to let the busy holiday schedule interrupt your healthy routines.
  • Seek support: Asking for help is instrumental in managing fatigue. Whether you find support through friends, family, or a helping professional, you don’t have to manage this all alone.
  • Practice self-compassion: Remember, pacing your activity is the best way for you to take good care of yourself in the long run. You may feel frustrated or guilty—this is to be expected when we are trying to adjust to new circumstances. Being kind to yourself in that process conserves emotional energy as well as physical energy.

References

Al Maqbali, M., Al Sinani, M., Al Naamani, Z., Al Badi, K., & Tanash, M.I. (2021). Prevalence of fatigue in patients With cancer: A systematic review and meta-analysis. Journal of Pain Symptom Management, 61(1), 167-189.

Bower, J. E. (2019). The role of neuro-immune interactions in cancer-related fatigue: Biobehavioral risk factors and mechanisms. Cancer, 125, 335-364.

University Hospitals Bristol and Weston NHS Foundation Trust. (202). Managing cancer-related fatigue. Retrieved from: http://www.uhbristol.nhs.uk/media/3763134/fatigue_presentation.pdf.

Andrews, N.E., Strong, J., Meredith, P.J. (2012). Activity pacing, avoidance, endurance, and associations with patient functioning in chronic pain: a systematic review and meta-analysis. Arch Phys Med Rehabil., 93(11):2109-2121.

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