A tired formula: beating cancer fatigue

In 1998 the physiotherapist Karen Livingstone found that she was getting many referrals from people who were weak after cancer treatment. She realised that the same patients were also separately seeing a dietician or occupational therapist. There was a strong case for an education group that allowed exhausted patients to find support and guidance in one place.

She formed the Fatigue Management Service at the Neil Cliffe Cancer Centre in Manchester.  Patients attend a four week course which begins with filling out a questionnaire on their level of fatigue using the Revised Piper Fatigue scale.  During the course, patients are able to share their experiences together and realise that they should not feel guilty if they had less energy for their families and friends.  They are also taught techniques for coping with their fatigue - including reflexology, massage and the use of essential oils.

Exhaustion makes it difficult for patients to shop and cook and therefore patients often don't eat well.  The Centre uses the Food Standards Agency's healthy plate model to help the attendees make better choices.  Patients also plan a tailored exercise programme, since keeping fit can help to lessen tiredness.

Patients can begin the course feeling desperate. One woman recalls  'I had come through the worst of the trauma and should be feeling more positive and 'grateful to be alive'.  Instead I felt a burden to my family and friends.  Everyone was busy trying to eradicate the cancer from my body and no-one warned me I would feel this way.  I felt so weary and unable to cope.'  In the weeks after the course, most find that their fatigue scores have decreased by 35% - with the expectation that they will decrease further with time. 

Many former patients are evangelical about the course.  One says 'it was the first time since I was diagnosed with cancer that a Health Care Professional  had acknowledged my fatigue.'

No single element of the Fatigue Management Course seems revolutionary in itself - it's the joined-up thinking that makes it such a good service.  Now Karen Livingstone has been asked to write about the model in a new book for oncology physiotherapists, so there's a chance that its healing formula will be replicated elsewhere.