Around three in four men with prostate cancer (74%) will have fatigue at some point (Stone et al, 2000). For some it may be a short-term problem and manageable, for others it can be longer lasting and can impact quality of life. 

As health professionals, it can be a complex symptom to address as treatments or solutions may feel limited. Men say there is little discussion about their fatigue with health professionals and there may be differing perceptions of the impact of fatigue on quality of life (Sonn et al, 2013).  

The specialist nurses at Prostate Cancer UK are trained and experienced in helping men understand and better manage their fatigue. 

DEFINING FATIGUE 

Fatigue is a feeling of extreme tiredness that does not go away, even after rest. Ream and Richardson (1996) say that in people with cancer, fatigue is: 
 
Men seeking support from the specialist nurse telephone service consistently feedback that acknowledging the existence of their fatigue and having the opportunity to explore it in more detail with a health professional can be the most important part of the service: 
 

CAUSES 

The causes of fatigue are multifactorial and might include the stress of a diagnosis, sleep disturbance, depression, and social factors. Treatments for prostate cancer, such as radiotherapy and androgen deprivation therapy (ADT) are common causes of fatigue (Alibhai et al, 2006; Kyrdalen et al, 2010). The majority of men seeking fatigue support, are on, or recovering from ADT.

FATIGUE SUPPORT 

When men contact the specialist nurses, they can receive written information about fatigue management as well as a diary and planner. Completing a fatigue diary, including a fatigue scale, is a good way of looking for patterns in energy levels and the impact fatigue has had on day-to-day life. They can talk at length to a specialist nurse trained in fatigue management, with calls often taking up to an hour. A follow-up call may also be offered.  

Speaking to a nurse specialist provides the opportunity for men to discuss the effect fatigue has had on their ability to work, exercise, complete chores, as well as the impact on their relationships, social activities and hobbies. We discuss daily routine and how they have been managing their energy levels and consider the impact this has on their mood and motivation. 

Together the nurse and the caller start to develop a plan and set some small goals. Men are encouraged to complete a weekly planner to provide realistic expectations and a sense of control for the coming week. 

THE FIVE PS 

Using the five Ps to conserve energy provides a useful framework for discussion about fatigue management and making changes (Prostate Cancer UK; figure 1).  
 

Permission 

Men often talk of ‘battling through’ their fatigue. It can be helpful to start with permission to do things differently, for example to rest and recharge when needed.  
 

Prioritise 

Making a written list helps to prioritise what needs to be done, what could be delayed or where help could be sought to complete jobs or chores. Hobbies and interests may be neglected when suffering from fatigue. It is also important to prioritise things to look forward to and provide a boost. 
 

Plan 

The fatigue diary might highlight energy levels that are better at certain times of the day and help men to plan activities. There needs to be a careful balance of activity and rest. After a meal is a good time to plan a rest. If men find a nap helpful, we suggest limiting it to 30 minutes and before 3pm to avoid it affecting sleep at night. 
Men coping with fatigue at work might find extra challenges. Employers should ensure reasonable adjustments are made (Macmillan Cancer Support, 2019).  
 

Pace 

It might be necessary to break down chores and longer activities into manageable chunks. Exercise has been shown to be beneficial for people with cancer related fatigue and has particular benefit in managing the side effects of ADT (Schmitz et al, 2010; Taaffe et al, 2017). We consider how men can remain active and enjoy exercise safely.  
 

Position 

We consider how a task can be made easier. Can it be done sitting rather than standing or are there any aids or equipment that could help? 

Specialist nurse service 

 Our specialist nurses have a broad experience across urology, oncology and palliative care. They provide support and information to people on a range of prostate cancer topics, such as prostate-specific antigen (PSA) testing. They also provide support to health professionals.  

To find out more: prostatecanceruk.org/get-support/our-specialist-nurses