CRF can be complex and early intervention is important to reduce the impact it can have on your life, so discuss how you are feeling or any concerns you have with your GP or treating team as soon as possible. They will be able to provide you with direct support and/or refer you to specialist services such as the following, who can help in a variety of ways:

• Exercise physiologists and physiotherapists
• Dietitians
• Social workers and psychologists
• Occupational therapists

Exercise and physical activity improves CRF in several ways. It helps break the fatigue cycle by increasing strength and fitness, and improves sleep and emotional wellbeing.

The irony is that exercise is often the last thing that people with CRF feel like doing. Fortunately there are healthcare professionals (namely exercise physiologists and physiotherapists) and a range of strategies that can assist you with resuming or commencing exercise and physical activity. These strategies are outlined in the topic on ‘Exercise & Getting Active’, but some simple ones specific to fatigue include:

Eating a well-balanced, nutritional diet and ensuring you remain hydrated can make a huge difference to your energy levels, but this can be challenging given cancer and its treatment can affect your dietary habits, appetite, swallowing and sense of taste and smell. The ‘Diet & Nutrition’ topic provides some recommendations to assist you with overcoming these challenges and dietitians can provide you with tailored advice if needed.

Many young people with cancer experience a range of concerns that can affect their emotional health and wellbeing which may contribute to CRF. It is important to address these practical and emotional concerns and develop effective coping strategies. The ‘Emotional Health & Wellbeing’ topic offers plenty of advice, and healthcare professionals such as social workers and psychologists can provide you with individualised support.

CRF is linked to cognitive challenges such as problems with concentration and attention, following conversations, and remembering the right word or someone’s name. Many young people find this quite distressing and frustrating, but it usually improves within the first year following treatment, and your healthcare team can provide strategies to assist. You may also find this resource helpful.

Getting the support you need is so important given the significant impact CRF can have on your life. Talk to your healthcare team, but discuss how you are feeling with others as well- this may include your parents, friends, teachers, lecturers or managers.

It’s common to feel uncomfortable or uncertain with how to start a discussion or what you should say- the topics on ‘Relationships’ and ‘School, Study & Work’ provide some suggestions and your healthcare team can also provide guidance.

It’s important that you spend your energy on the tasks and activities that you want and need to perform. It’s also important that you don’t overdo it as this may completely deplete your energy stores and leave you feeling exhausted. The Triple P approach outlined below can be useful.

Occupational therapists can also provide advice on a range of other fatigue management strategies that are specific to your needs.

Our bodies respond extremely well to daily structure and routine. It assists with regulating our internal body clockOur internal body clock is a 24-hour cycle known as a circadian rhythm. It controls our sleep-wake cycle by regulating biological patterns like body temperature and the release of sleep hormones such as melatonin., reducing stress, improving sense of control and coping with change. The significant disruption to routine that cancer often causes can continue well after treatment ends, particularly if you have not yet returned to study or work.

To get your routine back on track, it can be helpful to develop a weekly timetable that includes the tasks and activities you need to finish each day and by end of the week. There are many great calendar and planning apps you can use for this, or you might prefer a paper-based version that looks something like this one, posted in a clearly visible place:

Just like daily routines, our bodies respond extremely well to regular sleep habits. This includes going to bed and waking up at the same time every day (weekends too, and even if you had a poor night’s sleep), which helps with setting your body clockOur internal body clock is a 24-hour cycle known as a circadian rhythm. It controls our sleep-wake cycle by regulating biological patterns like body temperature and the release of sleep hormones such as melatonin..

Exposure to light also assists with setting our body clock. Natural light in the morning can help us to feel alert and softer light at night can assist with relaxation and preparing our bodies for sleep.

Developing good sleep habits (known as sleep hygiene) can be hard at first, as it usually takes at least 2 months before a new behaviour becomes automatic. However, it is worth persisting as you will almost certainly see and feel the benefits. There is also a range of healthcare professionals (including GPs, psychologists and occupational therapists) who can assist you if needed.

BEFORE BEDTIME:

• Avoid alcohol, cigarettes and stimulants (which include coffee, tea, chocolate, soft drinks, energy drinks) after lunchtime
• Avoid high intensity exercise approximately 3 hours prior to bedtime
• Spend some time writing down any of your concerns or worries (preferably at least 2 hours before bedtime) given they often arise and appear far worse in the middle of the night- you can then review in the morning and raise with family, friends or healthcare professionals if needed

ESTABLISH A PRE-BEDTIME RITUAL:

• Have a shower or bath 1-2 hours before bedtime as this raises body temperature which creates sleepiness once it drops back down again
• Set an alarm for approximately 30 minutes before you want to be in bed to commence preparation - this may include brushing your teeth (this can often wake you up if you do it immediately before bed) and turning on your bedside light so you don’t have to enter a bright room
• Practice relaxation, meditation or mindfulness - you may need to try a few approaches to find the one that is right for you. These apps and resources are all great places to start: Smiling Mind, Headspace, Calm, Insight Timer.

CREATE THE RIGHT SLEEP ENVIRONMENT:

• Ensure your bedroom is dark, quiet and cool (ideally around 18 degrees)
• A comfortable bed and pillow is important

ONCE IN BED:

• Try to avoid electronic devices like phones and tablets if possible - that said, they can be a useful source of relaxation and distraction, so if using, dim their brightness and avoid things that will make you alert
• Ban yourself from clock-watching - this will likely make you feel stressed and reinforce negative thoughts (“Gaah, look how late it is, I’ll never get to sleep and will feel terrible tomorrow!”)
• If you’re not asleep after 20-30 minutes, move to another room and do something relaxing until you feel sleepy