Managing cognitive fatigue during and after cancer

A major issue for many people undergoing cancer treatment is fatigue. Right along with the "I am so tired that I can't get off the couch" kind of fatigue is cognitive exhaustion. This can be caused by medications, stress, physical exhaustion, and treatment (surgery or radiation) to the brain itself. This almost always improves once treatment is completed, but, even then, some people continue to fell mentally exhausted and less sharp.

This wonderful list of suggestions comes from my thoughtful and terrific patient, Steve, who is dealing with treatment for a glioblastoma.

• Balance the daily routine with quiet times, rests, or restful activity. Building in whatever rest time you need, whether a short nap or a longer sleep time.
• Help family and friends to understand cognitive fatigue and know that it is as a result of the brain damage. It's not laziness or deliberate.
• Plan ahead to allow opportunity for sleep and rest. Program this into your daily plan before fatigue occurs.
• Work out what time of day is best for activity. In planning to minimize fatigue, it is important to consider whether you are a morning, afternoon or evening person.
• Allow extra time to complete work that requires extra concentration and effort.
• Plan ahead for demanding activities or special events. Allow for extra rest time and / or quieter routines before and after.
• Use aids, equipment, and technology to reduce effort wherever possible. For instance, if you have mobility aids, use them to minimize fatigue.
• If you think it would be helpful, see about shorter days for school or work; and with frequent breaks according to need.
• Say no to activities or demands that are not important, or that would overly fatigue you.
• If there are a number of activities or things to do on a day, work out priorities and tackle the important or interesting tasks first.
• As much as possible have familiar routines and surroundings, which reduces the effort and need to concentrate.
• Take notice of factors that contribute to fatigue and work out how to manage these as much as possible. This might include the effect of medication, weather, or illness, people, places.
• Be aware that sensory overload can impact fatigue. Limit or avoid these situations, such as a busy shopping center with lights and noise.
• Maintain optimal health and fitness. Don't undertake exercise that in itself causes fatigue.
• Develop ways to manage fatigue if and when it occurs, whether you are at home or out.
• Caregivers and friends can help minimize fatigue by assisting where necessary and appropriate: Carrying out tasks, understanding what needs to be done, assisting to maintain agreed rest routines.

When looking at ways to manage fatigue remember it is better for a person to try and manage cognitive fatigue before rather than after it happens. Plan to prevent rather than manage after fatigue occurs.

Each person will have different needs and different responses. This may change over time. Consistency is a key. Please share any successful (or unsuccessful ways) you might have seen cognitive fatigue managed.