Contents

About this ebook

Fatigue and its effects

Fatigue and cancer

The effects of fatigue

Causes of fatigue

Cancer treatments

Anaemia

Eating problems

Cytokines

Pain

Other cancer symptoms

Other medical problems

Psychological effects of cancer

Managing your fatigue

Diet

Physical activity and exercise

Sleep

Relaxation

Complementary therapies

Counselling

Support groups

Spiritual support

Planning your life around fatigue

Planning

Coping with fatigue at home

Driving

Coping with fatigue at work

Talking to your doctor or nurse

Preparing for your appointment

Drug treatments for fatigue

Looking after someone who has fatigue

Other help

Who can help?

Financial help and benefits

Insurance

Further information

Order what you need

Other formats

Help us improve our information

Other ways we can help you

Talk to us

Talk to others

The Macmillan healthcare team

Help with money worries

Help with work and cancer

Other useful organisations

Complementary therapy organisations

General cancer support organisations

Support for young people

Support for older people

Disclaimer, thanks and references

Can you do something to help?

About this ebook

This ebook is about fatigue due to cancer or its treatment. Fatigue means feeling very tired or exhausted all or most of the time. The tiredness is not relieved by rest and can affect you physically, psychologically and emotionally.

People who have fatigue have little or no energy and find it difficult to do simple, everyday things that we usually take for granted.

We hope this ebook answers some of your questions about fatigue and helps you find ways of coping with it. We’ve also listed other sources of support and information, which we hope you’ll find useful.

The ebook contains a lot of information, so you may find it difficult to read all in one go if you’re feeling tired. Instead you can use the contents list to nagivate to different sections that are most relevant to you.

In this ebook, we’ve included comments from people who have fatigue, which you may find helpful. Some are from members of our online community (macmillan.org.uk/community). We’ve also taken some quotes from our cancer information videos. You can watch Denton’s video about fatigue at macmillan.org.uk/fatigue

If you’d like to discuss this information, call the Macmillan Support Line free on 0808 808 00 00, Monday–Friday, 9am–8pm. If you’re hard of hearing, you can use textphone 0808 808 0121, or Text Relay. For non-English speakers, interpreters are available. Alternatively, visit macmillan.org.uk

The Other useful organisations section of this ebook has some useful addresses and websites. If you find this ebook helpful, you could pass it on to your family and friends. They may also want information to help them support you. We can produce our information for you in a number of different formats.

Fatigue and its effects

Fatigue and cancer

Fatigue is a very common problem for people with cancer. As many as nine out of ten people with cancer (90%) may feel fatigued at some time. Cancer-related fatigue (CRF) may be due to the cancer itself or may be a result of symptoms caused by the cancer. It can also be a side effect of treatment.

Fatigue can be especially difficult to deal with when you’re already trying to cope with cancer. You may feel very tired or exhausted all or most of the time. This can be frustrating and feel overwhelming at times. Many people find their fatigue is as distressing and disabling as the other side effects of cancer treatment.

Cancer-related fatigue is different from the tiredness and fatigue that someone without cancer may get. People with cancer may get tired much more quickly after less activity. When healthy people get fatigued, it’s usually relieved by rest and sleep, whereas cancer-related fatigue isn’t. The fatigue usually gets better after treatment finishes, but it may continue for many months, or sometimes years.

It‘s important to tell your doctors and nurses about your fatigue and how it makes you feel, without playing it down. There are ways they may be able to help. For example, treating the causes of fatigue, such as anaemia or sleeplessness, can help.

There are also things you can do for yourself that may help you cope. Research tells us that one of the best things you can do to help manage your fatigue is to stay active.

We have tips for treating the causes of fatigue and how to manage it in the Causes of fatigue and Managing your fatigue sections of this ebook.

The effects of fatigue

Fatigue can affect all areas of your life. You may be too tired to take part in daily activities, relationships and social events. It affects everyone differently and can cause many different symptoms. Some people find their fatigue is very mild and doesn’t interfere much with their daily life. But for others, it’s very disruptive.

The different levels of fatigue are described in the fatigue diary at the centre of this ebook. Some of the more common effects of fatigue include:

- Difficulty doing the smallest chores. Even everyday activities such as brushing your hair, showering or cooking can seem impossible.

- A feeling of having no energy, as if you could spend the whole day in bed.

- A feeling of having no strength to do anything.

- Lack of concentration.

- Having trouble thinking, speaking or making decisions.

- Difficulty remembering things.

- Feeling breathless after only light activity.

- Dizziness or a feeling of light-headedness.

- Difficulty sleeping (insomnia).

- Loss of sex drive.

- Feeling more moody and emotional than usual.

Fatigue can affect the way you think and feel. You may find it impossible to concentrate on anything, which can affect school or your job. If you’re having trouble concentrating, it can also affect things that you usually enjoy doing. Even reading or watching TV can be difficult.

‘My concentration level was upside down. Just actually getting out of bed was hard. Going downstairs was hard. Simply washing my hands or turning the tap was hard.’

Denton

Money may become a problem if you need to take time off work or stop working completely. Fatigue can affect your relationships. You may spend less time with friends and family, or spend more time sleeping. It may make you become impatient with people around you, or you may avoid going out or being with friends because it’s too much effort.

Getting help and support from your healthcare team may help to prevent or relieve some of these effects, and improve your quality of life. We hope the information in this ebook also helps you cope with the effects of fatigue.

Causes of fatigue

Cancer treatments

Before treatment starts, many people already feel tired from the tests and investigations used to diagnose the cancer. They may also be tired from trying to cope with different emotional effects. The cancer itself can also make you feel tired. The treatment for cancer can make the tiredness worse, but it may also improve things if the cancer is making you feel tired. People who are older, have other medical problems, or have more than one type of treatment are more likely to be affected by cancer-related fatigue.

Surgery

Many people feel tired after surgery and need to take things easy for a while. This effect is usually temporary. However, some types of surgery may cause continuing problems with fatigue (for example, if surgery to the stomach leads to problems with absorbing food).

Chemotherapy and radiotherapy

Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. Radiotherapy treats cancer by using high-energy rays to destroy cancer cells.

Fatigue caused by chemotherapy or radiotherapy usually improves after treatment, but sometimes it can be more of a long-term problem. Many people find their normal levels of energy return within 6–12 months of the treatment ending. However, some people find they still feel tired and have low energy levels a year or so later. Sometimes, tiredness can continue for two years or more, although this is far less common.

Hormonal therapies

Hormonal therapies are treatments that can stop or slow the growth of some cancer cells. They either alter the levels of particular hormones in the body or prevent the hormones from being absorbed by cancer cells. These are often given for several years. Some hormonal therapies can cause fatigue.

Targeted (biological) therapies

Targeted therapies use substances that target the growth of cancer cells. Some of them can cause fatigue.

Apart from treatment-related anaemia, doctors are still trying to find out exactly why cancer treatments cause fatigue. It’s thought that fatigue may occur after having cancer treatment because:

- the body needs extra energy to repair and heal

- there is a build-up of chemicals as the cancer cells are destroyed

- the body’s immune system is affected.

Anaemia

Anaemia is a possible cause of fatigue in people with cancer. It is a shortage of haemoglobin in the blood. Haemoglobin (or Hb) is found in red blood cells and carries oxygen around the body. As red blood cells circulate in the body, they give energy by carrying oxygen to all of the body’s cells.

If the number of red blood cells is low, there is less Hb, so less oxygen reaches the cells. If the level of Hb in your blood drops below normal, you may feel tired and have less energy.

Doctors regularly check the levels of blood cells in people who have cancer and cancer treatments.

People who have anaemia may also find that they:

- are breathless

- feel dizzy and light-headed

- have a worsening of angina (chest pain due to heart problems).

Causes of anaemia

Chemotherapy reduces the production of red blood cells and is a common cause of anaemia. Radiotherapy can also cause anaemia if it’s given to an area of the body that contains bone marrow. The bone marrow is where red blood cells are made. Radiotherapy given to the breastbone (sternum), the hip bones or the long bones of the arms and legs is most likely to reduce the production of red blood cells.

If you’re having cancer treatment, you may find it helpful to write down your Hb levels in the fatigue diary at the centre of this ebook. This may help you see how they affect your everyday life and your level of fatigue. It’s important to let your doctor know if you think your Hb level is making you feel tired. If you are anaemic, your doctor may be able to give you treatment that will make you feel better.

Treatment for anaemia depends on the cause. The main treatment is a blood transfusion, which involves a drip (transfusion) of red blood cells given directly into the bloodstream. It can quickly raise the number of red blood cells that circulate the body.

We can send you information about blood transfusions. Call us on 0808 808 00 00 to order it.

Eating problems

Our bodies get energy from the food we eat. Fatigue can occur if the body doesn’t get enough food or if there are changes to the way the body is able to use the food. In cancer, this can happen because:

- you can’t eat the same amount of food as you normally do

- your body needs more energy than it did before

- your body may not be able to absorb and use all the nutrients from the food.

If you feel sick (nausea), you may not get enough energy from food because you are likely to be eating less. If you actually are sick (vomit), your body doesn’t absorb the food and essential nutrients it needs. This can also make you feel weak and tired, and you may also become dehydrated. If you have nausea or vomiting, your doctor can prescribe anti-sickness (anti-emetic) drugs, which usually help. They should be taken regularly so that the sickness doesn’t come back. Some anti-sickness drugs can cause tiredness and may make you feel drowsy. Let your doctor know if this is a problem.

Chemotherapy can cause changes in appetite and taste, which may cause you to eat less. If you find that some foods no longer appeal to you, try something different. Your doctor, nurse or hospital dietitian may be able to help.

It can help to get someone else to prepare food for you. Otherwise, you may find that you use all your energy to cook and then feel too tired to eat. You could also buy some ready-made meals or place an order with an organisation that delivers ready-made meals to your home. Wiltshire Farm Foods deliver frozen meals to homes throughout the UK. Visit wiltshirefarmfoods.com or call 0800 773 773 for more information. You can also contact your council’s social services department to find out if you qualify for their ‘meals on wheels’ service.

If you don’t feel like eating, you could try ready-made, high-calorie drinks. These are available from any chemist. Some are available on prescription. Unflavoured high-energy powders, which add calories to food without adding bulk, are also available on prescription.

Our booklet Eating problems and cancer has helpful tips.

Cytokines

Cytokines are proteins produced by the body. They act as chemical messengers and help regulate a wide variety of functions in the body. Studies have shown that cytokine levels are often raised in people with cancer-related fatigue, and these high levels may actually cause some of the symptoms people have. However, the exact way cytokines cause fatigue is not yet fully understood.

Pain

Many people with cancer don’t have pain, but for those who do, it can cause fatigue. Painkillers and other treatments such as relaxation and acupuncture, can help relieve pain and reduce fatigue.

We have a booklet called Controlling cancer pain, which discusses various ways of relieving pain.

Other cancer symptoms

Other symptoms such as breathlessness or fluid retention are also common causes of fatigue. If you have an infection or fever (high temperature), your body needs more energy and this may lead to fatigue. Treating the different symptoms that are causing your fatigue can often help to relieve it, so let your doctor or nurse know about any symptoms you have.

We have a booklet called Controlling the symptoms of cancer, which you might find helpful.

Other medical problems

Other medical problems, for example diabetes, heart problems or low thyroid function may also make the symptoms of fatigue worse. These medical conditions may not have been obvious before the cancer was diagnosed, but they may come to light during or after cancer treatment. Some medicines for conditions other than the cancer can also make you feel tired.

Psychological effects of cancer

Anxiety, depression, stress and tension, as well as a poor sleeping pattern, can all contribute to fatigue. It’s common for people to have anxiety or depression when they’re first diagnosed with cancer. However, these feelings generally get easier to manage as you come to terms with what has happened.

You may find it helpful to discuss how you feel with your partner, a family member or close friend. Some people find it helpful to talk to other people at a local support group, or join an internet support group.

If you find that your mood is low and continues to be low most of the time, you may have depression. If you have depression, your GP will discuss possible treatments with you. They can refer you to a counsellor and can prescribe medicines to help if necessary.

We have more information about emotional and psychological support under Support groups in the Managing your fatigue section of this ebook.

Our booklet How are you feeling? The emotional effects of cancer discusses ways of dealing with the emotions you may have.

Managing your fatigue

Diet

Eating well can help to boost your energy levels. Here are some useful hints:

- Keep a diary of what and when you eat every day to see if you have more energy after certain meals.

- Try to take advantage of the times when your appetite is best.

- Drink plenty of fluids.

- If your taste changes, try different foods or eat the foods that taste best to you.

- Ask your doctor or nurse for any booklets or leaflets that give dietary advice.

- Ask your doctor to refer you to a dietitian, who can give you helpful ideas.

Our booklets about diet and eating problems have helpful hints.

Physical activity and exercise

‘One of the main debilitating side effects of treatment is fatigue. Contradictory to what you may think, by being active you become less tired.’

Dr Anna Campbell

There’s good evidence that physical activity, such as gentle strengthening exercises combined with some walking, can actually help to reduce the symptoms of fatigue. Being active may help to boost your appetite, give you more energy and improve your general well-being, so it’s important to try to exercise a bit, even if you don’t feel like it. It’s best to try to get a good balance between being active, exercising and getting plenty of rest.

Before you start to do any physical activity or increase the amount you do, it’s important to get advice from a healthcare professional.

It’s best to choose an activity or exercise that you enjoy. Try to maintain the amount of activity you do. However, if you have fatigue, this may not always be possible. Remember that some exercise is always better than no exercise. Simple goals such as walking from the front door to the back door may be an achievable goal for you. But try to increase your level of activity and build up the amount of exercise you do a bit at a time.

Always talk to your cancer specialist or GP before you start. They can advise you on the type and amount of exercise that’s safe for you. It’s also important to discuss any other medical conditions you have, such as high blood pressure, diabetes or lung problems, as these may be affected by physical activity.

You might find it helpful to get advice about exercise from a specialist cancer physiotherapist. Your GP or cancer specialist can arrange a referral for you. A physiotherapist can help you:

- build up your physical fitness

- improve your energy, strength, joint range, coordination and balance

- manage the side effects of treatment

- set some realistic goals for keeping active.

The physiotherapist may suggest referring you for a supervised group exercise programme. These groups are run by healthcare professionals or experienced fitness trainers. Many people find the social side of being in a group enjoyable, and it may also help give you a bit more motivation to exercise.

General suggestions for exercise

It’s helpful to set yourself some personal goals using the simple steps below. Try not to do too much, too soon.

- Plan some activity or light exercise into your day.

- Try some regular, light exercise such as walking, and simple strengthening exercises like standing up and sitting down. These have been shown to reduce fatigue, and can help some people sleep better.

- Exercises such as yoga, qigong and tai chi may be particularly good as they involve gentle movement, stretching, breathing and balance.

- If exercise is impossible, try to stay active in your daily routine.

- Pay attention to how your body reacts to activity and exercise. How did you feel? How well did you sleep afterwards?

- Drink plenty of fluids before, during and after exercise.

- Keep a record of your activities so that you and your healthcare team can monitor your progress. You could write them down on the fatigue diary in the centre of this ebook.

- Allow your muscles time to recover after activity by balancing activity with rest.

- Don’t exercise if you feel unwell, are in pain or have any other symptoms that worry you, such as feeling breathless. Let your doctor know if you feel unwell or have worrying symptoms.

We can send you our booklet Physical activity and cancer treatment if you’d like more information about exercise. We also have a video on our website about the benefits of being active. Visit macmillan.org.uk/benefitsofbeingactive

Sleep

It’s very important to try to keep to a normal sleep routine, even though your fatigue may make you feel like sleeping all the time. There are many ways to overcome fatigue, which your nurse or doctor can discuss with you. In the meantime, the ten point plan below might help you to make the most of your rest periods.

A ten point plan for better rest

Good-quality sleep is very important and may help to relieve fatigue, as well as reduce your need to sleep during the day.

1. Sleep for just long enough to feel refreshed the following day, but don’t sleep for longer than you need. Spending too much time in bed is likely to affect the quality of your sleep.

2. Exercise regularly if you can, as this may help you sleep better in the long term.

3. Wake up at the same time every day and go to bed at the same time so you get into a good sleep routine.

4. Keep your bedroom for sleeping. If you wake during the night, go to another room in the house. If you need to sleep during the day, go to your bed to sleep.

5. Reduce light and noise at night-time as this will disturb your sleep. Even occasional loud noises (such as an aircraft flying overhead) affect sleep. If there’s too much light, try using a heavier pair of curtains or an eye-mask. If your bedroom is noisy, you could try using ear plugs.

6. Keep the temperature in your bedroom comfortably warm. If your room is very warm or very cold, your sleep may be affected.

7. Have a bedtime snack but avoid stimulants and limit your alcohol intake at night-time. Hunger may disturb sleep. Have a light bedtime snack, warm milk or a hot drink before going to bed if you find it helps you sleep, but avoid food and drinks that contain stimulants such as caffeine for a few hours before bedtime. While alcohol can help people to fall asleep more quickly, the sleep tends to be disturbed. It may also give you a dry mouth and an unpleasant taste that can wake you up, so it’s best to limit your intake of alcohol near bedtime.

8. Be aware of how naps affect you. Some people find that daytime naps help them sleep better at night, while others sleep less well after them. Find out what suits you best.

9. Get out of bed if you can’t sleep. Rather than lying in bed tossing and turning, get up and watch television or read a book. You could try listening to audiobooks, which are available from most bookshops and libraries, or can be downloaded from the internet. Wait until you feel tired again and then go back to bed.

10. Keep a worry book. If you wake at night and are worrying about things, write them down. You can then work through your list during the day and get support and advice from relatives, friends or from your doctor or nurse.

Mental exercises can also help you to sleep. Here are a few mental exercises that you may like to try. They usually take about 10 minutes to do:

- Try to remember the lines of a song or poem.

- Make alphabetical lists of girls’ or boys’ names, countries, trees or flowers.

- Relive in detail a favourite experience.

- Write a letter in your mind.

- Use a relaxation exercise. We give you some examples of these exercises next, under Relaxation.

You can get more information on sleeping well from the Royal College of Psychiatrists (rcpsych.ac.uk), which produces a range of useful information leaflets.

We can send you more information about difficulty sleeping. Call us on 0808 808 00 00 to order it.

Relaxation

Making time for activities that help you relax is very important in dealing with and preventing fatigue. Stress uses up energy and can make you feel more tired. It’s very likely that you will feel more stressed than usual when you start your cancer treatment. The following suggestions may help you relax:

- Talk to others about anything that is worrying you.

- Try an activity such as reading, seeing friends and listening to music. This may help take your mind off worrying thoughts.

- If you can, try to avoid situations that make you anxious.

- If you can, take regular light exercise such as walking.

Many people find it hard to relax and unwind, especially if the stresses and strains of the day are difficult to forget. Using specific relaxation techniques can help to relieve tension and boost your energy levels.

There are two types of relaxation exercises:

- physical ones, which work on tension in your body – these include tensing and releasing each part of your body in turn and breathing exercises

- mental ones, which help to relax your mind – these include imagery exercises.

You may want to experiment until you find the best exercise for you. You can ask if there is a nurse or other healthcare professional, such as an occupational therapist or psychologist, who can help you find the technique that’s best for you. Using relaxation CDs or DVDs can be a good way to learn different exercises. When you’re ready to try a relaxation exercise, find a quiet, warm, dimly lit, relaxing place where you won’t be disturbed, then lie or sit in a well-supported position. You’ll get the maximum benefit from these techniques if you practise them for 5–15 minutes each day.

Complementary therapies

There are a number of different complementary therapies that may help you cope with fatigue. They include:

- meditation

- acupuncture

- reflexology

- aromatherapy

- massage

- music therapy.

You may need to pay for these but they are sometimes available on the NHS. Your GP, specialist nurse or a palliative care nurse may be able to refer you. You may also be able to get them through a cancer support group.

Some doctors have been reluctant for their patients to use complementary therapies, mainly because they have not been properly tested in clinical trials. But many people who use them find that they’re relaxing and help improve their general well-being. They can also help you feel more in control of their health and of what’s happening to them.

We have a booklet called Cancer and complementary therapies, which has detailed information about various therapies and relaxation exercises.

Counselling

If you find it difficult to cope with your fatigue, or you feel anxious or depressed, you may find counselling helpful. Counsellors are trained to listen, and can help you talk through your feelings and find ways of dealing with them. They won’t give advice or answers, but will help you find your own answers. You may find counselling particularly helpful if you aren’t able to discuss your feelings and emotions with people close to you.

Many hospitals have counsellors or staff who are specially trained to provide emotional support and counselling. You can ask your hospital doctor or nurse what services are available and ask them to refer you. Some GPs have counsellors in their practice, or they can refer you to one.

If you would like to find out more about counselling, our cancer support specialists on 0808 808 00 00 can tell you more and let you know about services in your area. Not all counselling services are available on the NHS, so you may need to pay for them.

Support groups

Some people find it helps to talk to other people who’ve had fatigue. You may find talking to other people at the hospital helpful, or you could join a local support group.

Most areas in the UK have cancer support groups. They are sometimes led by a healthcare professional. Other members of the group may be in a similar position to you. Some support groups have counsellors.

Some people find groups helpful and they form close relationships with other members. However, other people get embarrassed or uncomfortable when talking about personal issues with strangers. Don’t worry if groups aren’t for you.

Our cancer support specialists on 0808 808 00 00 can let you know about support groups in your area or you can find them at macmillan.org.uk/supportgroups

Online support

You may find it helps to join an online support group or chat room. There are a number of online groups for various cancers, where you can chat to other people. If you prefer, you can stay anonymous and just read other people’s posts. Online groups and chat rooms can be very supportive, as you’ll find that other people have similar thoughts, emotions and experiences to you. The groups and chat rooms are often available 24 hours a day, so there may be people online you can chat to when you really need support the most. Online groups are easy to join and leave, without any need for personal contact or explanations.

Our online community at macmillan.org.uk/community is a site where you can chat to people in our forums, blog about your experiences, make friends and join support groups. You can share your thoughts and feelings and get support from others.

Spiritual support

Some people find comfort in religion during times when they feel anxious or depressed. You may find it helpful to talk to a local minister, hospital chaplain or other spiritual or religious adviser. Don’t be put off if you’ve never talked to one before, or if you don’t have any particular faith. They are used to supporting people in times of need.

Planning your life around fatigue

Planning

If you have fatigue, planning ahead is important. Plan your day so that you have time to do the things you want to do most. It’s important to be realistic about what you can do.

A fatigue diary can help with planning. It can be as simple as a weekly calendar with space to note down any treatment you are using and your haemoglobin level. When you’re having cancer treatment, the doctors will be checking this regularly and can tell you what your level is. You can use the diary to write down the times when you feel your best and when you feel most tired. This may help you to plan your activities.

‘It has helped me to keep a fatigue diary. It can be really easy to forget what you’ve done in the day, and if you look back after a couple of weeks, you may see a difference. I’ve been doing the diary for a few weeks now and I can see an improvement. Most days I write down what I’ve done and I think I’m doing a few more bits and pieces around the house than before.’

Catherine

Keeping a note of your energy levels will help you identify the days and times when you have more energy. However, you may have to accept that you won’t be able to do everything you used to do. It may help to decide early on which activities you’re prepared to give up, at least until you feel more able to do them again.

While some people feel less tired in the mornings, others cope better in the afternoon. Try to plan bigger tasks to fit in with the time of day when you feel least tired. Pace yourself, and plan enough rest and sleep periods. It makes sense to plan a period of rest after a period of activity. Some people also find that they need to rest after meals.

Short naps and rest periods are useful, however, you need to balance them with some activity or exercise. Too much rest isn’t always a good thing as your muscles can weaken, which can make your fatigue worse. It’s important that any daytime rest doesn’t stop you from sleeping at night. It’s also important to plan your days around your treatment. Try to avoid anything energetic or stressful for 24 hours before and after your treatments. If you feel less well on a particular day, it’s okay to be less active and to rest more.

Doing things for yourself can be very important, but try not to feel guilty if you have to ask other people to help. Often friends and relatives want to help and are pleased to be asked.

You may also find it helpful to see an occupational therapist from the hospital or from social services. They can help you find ways of saving your energy and may be able to visit you at home.

Coping with fatigue at home

Managing day-to-day activities

You may find that some of the following suggestions help you deal with everyday tasks. Remember that family, friends, neighbours and social workers can all help you with your everyday activities.

Housekeeping

- Spread tasks out over the week.

- Do a little bit each day rather than a lot in one go.

- Ask other people to do heavy work where possible.

- Sit down to do chores whenever you can.

- If you can afford it, employ a cleaner. If not, you can ask for home help from social services. Depending on your circumstances, you may need to pay for this.

- Use long-handled dusters, mops and dustpans where possible to avoid stretching and bending.

- Ask someone to take your rubbish bags out for you.

- Ask someone to cut your grass for you and to tidy the garden.

‘I set myself goals. To start off with I’d get out of bed, go to the toilet, and then eventually I started doing different things around the house. Just bits at a time.’

Denton

Shopping

Ask others to do your shopping. If you don’t have anyone who can do it for you, or you would rather shop yourself, these suggestions may help:

- Make a list before you start.

- Write the shopping list following the layout of the store, so you don’t walk around more than necessary.

- Use a shopping trolley for support.

- Use a wheeled shopping bag to carry supplies and shopping.

- Shop at less busy times.

- Ask for help in the shop/supermarket with packing and carrying groceries to the car, or ask them to deliver them to your home.

- Shop with a friend for extra help.

- Do your shopping online and have it delivered at a time that suits you.

Meal preparation

- Try cooking simpler meals to reduce the amount of time you spend in the kitchen.

- Eat convenience/precooked meals.

- Try eating little and often. Eat small meals and snacks throughout the day.

- If you can, sit while preparing meals.

- Prepare extra dishes or double portions when you’re feeling less tired and freeze them for when you need them.

- Use oven dishes you can serve from to save on washing up.

- Don’t lift heavy pans. Where possible, dish food out near the stove.

- Ask others to move heavy items to the table.

- Avoid bending and stretching when preparing food.

- Let dishes soak rather than scrubbing them, and leave them to dry on a draining board.

- Use a dishwasher if you have one.

- Use place mats instead of tablecloths – they’re easier to put on the table and to clean.

Washing and dressing

- Have a bath rather than a shower, or sit down in the shower.

- Wear clothes that are easy to put on and take off. Sometimes wearing pyjamas is easier if you’re not going out.

- Sit down when getting dressed.

‘Stay positive and just focus on each day at a time. If my mum found one day she wanted to sleep for the day she did. If she felt like getting up and having a shower she did. Listen to your body and it will tell you what it needs.’

Helen

Leisure

- Listen to audiobooks if you feel too tired to read.

- Listen to the radio rather than watching the TV.

- Explain to family and friends that there may be times when you can’t see them, or that short phone calls and visits may be better.

Laundry

- Where possible, use a trolley to move your washing to and from the washing machine.

- Get help to hang up washing.

- Use a foldaway drying rack for smaller items.

- Use a lightweight iron and sit down to iron if you can.

- Wear clothes that don’t need to be ironed.

- Slide the iron on to a heatproof pad to avoid lifting it.

Childcare

One of the hardest aspects of fatigue can sometimes be feeling that you’re letting your family down. This can be especially upsetting when you have children. No one is suggesting that you must ask others to take over caring for your children. However, there are things that you can do to make things a bit easier:

- Start by explaining to your child(ren) that you’re feeling tired and won’t be able to do as much with them as before. You may be surprised at how well they respond.

- Plan activities with your children that can be done while sitting down.

- Try planning activities where there are places for you to sit while the children enjoy themselves.

- Try to avoid lifting smaller children. Use a pram or pushchair if you have to transport them from place to place.

- Try to involve your children in some household chores.

- Accept offers of help from people you trust. This may include someone else taking your children to and from school or looking after them occasionally.

- Ask people to babysit from time to time so you can do some of the things you enjoy doing or need to do.

Driving

Driving can be difficult and dangerous if you feel very tired. You may be less alert than normal, and less able to concentrate. Your reaction time will also be reduced. You might find the following tips helpful:

- If you feel very tired it may be better to avoid driving.

- If possible, ask a family member or friend to drive you.

- If you have to get to hospital appointments, ask your nurse

- or doctor if there is any help available so that you don’t have to drive.

- If you have to drive, plan any trips for when you know you usually feel more alert. It may also help to avoid driving at times when the roads are busier than usual.

- If you have to make a long journey, plan to break it up with regular stops or an overnight stay somewhere.

- If you feel yourself falling asleep while driving, stop in a safe place and take a break.

Coping with fatigue at work

You may find that you can’t continue working due to your fatigue, or that you have to reduce the amount of time you spend at work. It can help to talk to your employer or personnel/human resources (HR) department and let them know that you may need some time off.

Don’t feel that you have to work if you’re too tired. If you do want to carry on working, you may be able to find ways of making your work less tiring for a while. Anyone with cancer is protected by the Equality Act 2010, which prevents employers from victimising or discriminating against people with a disability. The act also states that employers are expected to make reasonable adjustments to support employees in the workplace. You may want to make suggestions for adjustments that could help to support you.

Things that your employer can do to help include:

- changing your hours so that you can travel to and from work at less busy times (outside the rush hour)

- asking colleagues to be supportive and to help with some of your work

- finding you a parking place near to your place of work

- letting you take short breaks to lie down and rest

- allowing you to work from home (if this is possible)

- finding you lighter work if your job involves physical exertion or heavy lifting.

If you’re self-employed, it can help to visit gov.uk to see what benefits you may be entitled to claim. Preparing for your appointment

Our booklets Work and cancer and Self-employment and cancer have more detailed information and useful tips for coping with fatigue at work.

Talking to your doctor or nurse

Preparing for your appointment

Prepare for your next appointment with your doctor or nurse by writing down any questions that you want to ask. We give some examples of what these questions could be later in this section. Don’t be embarrassed to ask them to repeat or explain anything that you don’t understand. It may help to take a relative or friend with you and to have a notebook to jot down any information, as it can be difficult to remember what’s been said when you have fatigue.

It can sometimes be difficult for your healthcare team to understand how much fatigue is affecting your life and how distressing it is. It’s important to describe your symptoms to them. You may need to emphasise to your doctors and nurses the difficulties that fatigue is causing. Tell them about the activities you find difficult, such as climbing stairs, cooking or bathing. Let them know if anything makes the fatigue better or worse. If you have kept a fatigue diary, you can take it with you and show it to the healthcare professionals looking after you. Your doctor will look for any causes of your fatigue that can be treated. They may examine you and may organise some blood tests.

It can often be difficult to discuss emotions, especially when you are ill, for fear of upsetting yourself and others. Try not to let embarrassment stop you discussing your feelings with your doctors and nurses.

Here are some specific questions you may like to ask:

- What could be causing my fatigue?

- What treatments may help?

- How can I cope with my fatigue?

- What help is available?

- What can I do to help reduce my fatigue?

Drug treatments for fatigue

At the moment, there aren’t any licensed drug treatments to help prevent or improve fatigue. Steroid drugs, such as dexamethasone, can sometimes be helpful. Your specialist can discuss this with you.

Research into other drug treatments is ongoing. You may be asked to take part in a trial. Your doctor or specialist nurse can give you further information about any drug trials that you may be suitable for.

Our website has links to databases where you can search for clinical trials. Visit macmillan.org.uk/clinicaltrials

Looking after someone who has fatigue

If you’re caring for someone with fatigue, there are a number of simple things that you can do to help:

- Understand the different ways of dealing with fatigue. Reading the information in this ebook should help.

- Encourage your relative or friend to use the fatigue diary in the centre of this ebook, or help them to fill it in. Write down how fatigue affects their life as well as how it affects yours.

- Encourage your relative or friend to keep a fatigue diary. This can be as simple as using a calendar to mark off the days when they are feeling fatigued and days when they are not. Write down how fatigue affects their life as well as how it affects yours.

- Use the fatigue diary to find out what times the person you care for has more energy to do things such as shopping or having visitors around. Plan to make the most of these times.

- Try reducing fatigue by helping your relative or friend make simple improvements to their sleep, diet and exercise habits. We have some tips on how to do this in the Managing your fatigue section of this ebook.

You can go with your relative or friend on their visits to hospital and take the fatigue diary with you. Discuss with the doctors and nurses:

- how the fatigue is affecting both of you

- what could be causing the fatigue

- what techniques you’ve tried to reduce fatigue and what has or hasn’t been helpful

- other ways the doctors may be able to treat the fatigue.

Caring for another person can be exhausting. You may also become tired if you have lots to worry about. It’s important that you also look after yourself and avoid getting too tired. This can be difficult when you have a lot to do and you don’t want to let your relative or friend down.

You may need to involve other people or organisations to help with the caring, especially if you also have an illness that makes you feel tired. Try not to feel guilty if you do need extra help, and try to remember it’s not helpful if you both feel tired. We give details for some organisations that you might find useful in the section of this ebook called Other useful organisations.

You may find it helpful to read our booklet Hello, and how are you? which was written by carers, for carers. We also have a booklet called Let’s talk about you, which gives advice for young carers. You might also like to read Working while caring for someone with cancer.

Other help

Who can help?

Many people are available to help you and your family.

District nurses work closely with GPs and make regular visits to patients and their families at home if needed.

The hospital social worker can give you information about social services and benefits you may be able to claim, such as meals on wheels, a home helper or hospital fares. The social worker may also be able to arrange childcare for you during and after treatment.

In many areas of the country, there are also specialist nurses called palliative care nurses. They are experienced in assessing and treating symptoms. Palliative care nurses are sometimes known as Macmillan nurses. However, many Macmillan professionals are nurses who have specialist knowledge in a particular type of cancer. You may meet them when you’re at a clinic or in hospital.

Marie Curie nurses help care for people approaching the end of their lives in their own homes. Your GP or hospital specialist nurse can usually arrange a visit by a palliative care or Marie Curie nurse.

There’s also specialist help available to help you cope with the emotional impact of fatigue, cancer and its treatment. You can ask your hospital doctor or GP to refer you to a doctor

or counsellor who specialises in supporting people with cancer and their families. Our cancer support specialists on 0808 808 00 00 can tell you more about counselling and can let you know about services in your area.

Financial help and benefits

If you are struggling to cope with the financial effects of cancer, help is available.

If you cannot work because you are ill, you may be able to get Statutory Sick Pay. Your employer will pay this for up to 28 weeks of sickness. If you qualify for it, they cannot pay you less.

Before your Statutory Sick Pay ends, or if you do not qualify for it, check whether you can get Employment and Support Allowance (ESA). This benefit is for people who cannot work because they are ill or disabled.

There are two different types of ESA: contributory – you can get this if you have made enough national insurance contributions

- income-related – you can get this if your income and savings are below a certain level.

From October 2013, a new benefit called Universal Credit is replacing income-related ESA. This is for people who are looking for work or who are on a low income.

Personal Independence Payment (PIP) is a new benefit for people under 65 who find it difficult to walk or look after themselves (or both). You must have had these difficulties for at least three months, and they should be expected to last for the next nine months. Since April 2013, PIP has started to replace a similar older benefit called Disability Living Allowance.

Attendance Allowance (AA) is for people aged 65 or over who find it difficult to look after themselves. You may qualify if you need help with things like getting out of bed, having a bath or dressing yourself. You don’t need to have a carer, but you must have needed care for at least six months.

If you are terminally ill, you can apply for PIP, DLA or AA under the ‘special rules’. This means your claim will be dealt with quickly and you will get the benefit you applied for at the highest rate.

Help for carers

Carers Allowance is a weekly benefit that helps people who look after someone with a lot of care needs. If you don’t qualify for it, you can apply for Carer’s Credit. This helps you to build up qualifying years for a State Pension.

More information

The benefits system can be hard to understand, so it’s a good idea to talk to an experienced welfare rights adviser. You can speak to one by calling the Macmillan Support Line on 0808 808 00 00. We’ve just listed some benefits here, but there may be others you can get.

You can find out about state benefits and apply for them online at gov.uk (England, Wales and Scotland) and nidirect.gov.uk (Northern Ireland). These websites have information about financial support, your rights, employment and independent living. In England, Scotland and Wales you can also get information from the relevant Department for Work and Pensions helplines or Citizens Advice. In Northern Ireland, you can call the Benefit Enquiry Line Northern Ireland on 0800 220 674. We give some more details about these organisations in the section of this ebook called Other useful organisations.

Our booklet Help with the cost of cancer has more detailed information. You might also find our video at macmillan.org.uk/gettingfinancialhelp useful.

Insurance

People who have, or have had, cancer, may find it hard to get certain types of insurance, including life and travel insurance. A financial adviser can help you look at your needs and find the best deal for you. You can find a financial advisor by contacting one of the organisations in the Other useful organisations section of this ebook.

Our booklets Insurance and Getting travel insurance may also be helpful.

Further information

We provide expert, up-to-date information about cancer. And all our information is free for everyone.

Order what you need

You may want to order more leaflets or booklets like this one.

Visit be.macmillan.org.uk or call us on 0808 808 00 00.

We have booklets on different cancer types, treatments and side effects. We also have information about work, financial issues, diet, life after cancer and information for carers, family and friends.

All of our information is also available online at macmillan.org.uk/cancerinformation There you’ll also find videos featuring real-life stories from people affected by cancer, and information from health and socialcare professionals.

Other formats

We also provide information in different languages and formats, including:

- audiobooks

- Braille

- British Sign Language

- Easy Read booklets

- large print

- translations.

Find out more at macmillan.org.uk/otherformats If you’d like us to produce information in a different format for you, email us at cancerinformationteam@macmillan.org.uk or call us on 0808 808 00 00.

Help us improve our information

We know that the people who use our information are the real experts. That’s why we always involve them in our work. If you’ve been affected by cancer, you can help us improve our information.

We give you the chance to comment on a variety of information including booklets, leaflets and fact sheets.

If you’d like to hear more about becoming a reviewer, email reviewing@macmillan.org.uk You can get involved from home whenever you like, and we don’t ask for any special skills – just an interest in our cancer information.

Other ways we can help you

At Macmillan, we know how a cancer diagnosis can affect everything, and we’re here to support you. No one should face cancer alone.

Talk to us

If you or someone you know is affected by cancer, talking about how you feel and sharing your concerns can really help.

Macmillan Support Line

Our free, confidential phone line is open Monday–Friday, 9am–8pm. Our cancer support specialists can:

- help with any medical questions you have about your cancer or treatment

- help you access benefits and give you financial advice

- be there to listen if you need someone to talk to

- tell you about services that can help you in your area.

Call us on 0808 808 00 00 or email us via our website, macmillan.org.uk/talktous

Information centres

Our information and support centres are based in hospitals, libraries and mobile centres. There, you can speak with someone face to face.

Visit one to get the information you need, or if you’d like a private chat, most centres have a room where you can speak with someone alone and in confidence.

Find your nearest centre at macmillan.org.uk/informationcentres or call us on 0808 808 00 00.

Talk to others

No one knows more about the impact cancer can have on your life than those who have been through it themselves. That’s why we help to bring people together in their communities and online.

Support groups

Whether you are someone living with cancer or a carer, we can help you find support in your local area, so you can speak face to face with people who understand. Find out about support groups in your area by calling us or by visiting macmillan.org.uk/selfhelpandsupport

Online community

Thousands of people use our online community to make friends, blog about their experiences and join groups to meet other people going through the same things. You can access it any time of day or night. Share your experiences, ask questions, or just read through people’s posts at macmillan.org.uk/community

The Macmillan healthcare team

Our nurses, doctors and other health and social care professionals give expert care and support to individuals and their families. Call us or ask your GP, consultant, district nurse or hospital ward sister if there are any Macmillan professionals near you.

Help with money worries

Having cancer can bring extra costs such as hospital parking, travel fares and higher heating bills. If you’ve been affected in this way, we can help.

Financial advice

Our financial guidance team can give you advice on mortgages, pensions, insurance, borrowing and savings.

Help accessing benefits

Our benefits advisers can offer advice and information on benefits, tax credits, grants and loans. They can help you work out what financial help you could be entitled to. They can also help you complete your forms and apply for benefits.

Macmillan Grants

Macmillan offers one-off payments to people with cancer. A grant can be for anything from heating bills or extra clothing to a much-needed break.

Call us on 0808 808 00 00 to speak to a financial guide or benefits adviser, or to find out more about Macmillan Grants.

We can also tell you about benefits advisers in your area.

Visit macmillan.org.uk/financialsupport to find out more about how we can help you with your finances.

Help with work and cancer

Whether you’re an employee, a carer, an employer or are self-employed, we can provide support and information to help you manage cancer at work. Visit macmillan.org.uk/work

Other useful organisations

Complementary therapy organisations

British Acupuncture Council

63 Jeddo Road, London W12 9HQ

Tel 020 8735 0400

www.acupuncture.org.uk

Regulatory body for the practice of traditional acupuncture. You can download a list of practitioners from the website.

The British Complementary Medicine Association (BCMA)

PO Box 5122, Bournemouth BH8 0WG

Tel 0845 345 5977

Email office@bcma.co.uk

www.bcma.co.uk

An umbrella organisation of complementary medicine therapists. All listed therapists and organisations are members of the BCMA and must meet its code of ethics.

British Holistic Medical Association

West Barn, Chewton Keynsham, Bristol BS31 2SR

www.bhma.org

An organisation of health professionals, complementary and alternative medicine practitioners, and members of the public who want to adopt a more holistic approach to their lives. Produces self-help books and CDs.

British Reflexology Association

Monks Orchard, Whitbourne, Worcester WR6 5RB

Tel 01886 821 207

Email bra@britreflex.co.uk

www.britreflex.co.uk

The representative body for reflexology practitioners. You can search for practitioners on the website. Also sells books and DVDs about reflexology.

General cancer support organisations

Cancer Black Care

79 Acton Lane, London NW10 8UT

Tel 020 8961 4151

Email info@cancerblackcare.org.uk

www.cancerblackcare.org.uk

Offers information and support for people with cancer from ethnic communities, their friends, carers and families. Cancer Focus Northern Ireland

40–44 Eglantine Avenue, Belfast BT9 6DX

Tel 0800 783 3339 (Mon–Fri, 9am–1pm)

Email hello@cancerfocusni.org

www.cancerfocusni.org

Offers a variety of services to people affected by cancer, including a free helpline, counselling and links to local support groups.

Cancer Support Scotland

Calman Cancer Support Centre, 75 Shelley Road, Glasgow G12 0ZE

Tel 0800 652 4531

Email info@cancersupportscotland.org

www.cancersupportscotland.org

Runs cancer support groups throughout Scotland. Also offers free complementary therapies and counselling to anyone affected by cancer.

Irish Cancer Society

43–45 Northumberland Road, Dublin 4, Ireland

Tel 1800 200 700 (Mon–Thu, 9am–7pm, Fri, 9am–5pm)

Email helpline@irishcancer.ie

www.cancer.ie

National cancer charity offering information, support and care to people affected by cancer. Has a helpline staffed by specialist cancer nurses.

Maggie’s Centres

1st Floor, One Waterloo Street, Glasgow G2 6AY

Tel 0300 123 1801

Email enquiries@maggiescentres.org

www.maggiescentres.org

Maggie’s Centres provide information about cancer, benefits advice, and emotional or psychological support.

Penny Brohn Cancer Care

Chapel Pill Lane, Pill, Bristol BS20 0HH

Tel 0845 123 2310 (Mon–Fri, 9.30am–5pm)

Email helpline@pennybrohn.org

www.pennybrohncancercare.org

Offers a combination of physical, emotional and spiritual support, using complementary therapies and self-help techniques.

Tenovus

Head Office, Gleider House, Ty Glas Road, Cardiff CF14 5BD

Tel 0808 808 1010 (Mon–Sun, 8am–8pm)

www.tenovus.org.uk

Aims to help everyone get equal access to cancer treatment and support. Funds research and provides support such as mobile cancer support units, a free helpline, an ‘Ask the nurse’ service on the website and benefits advice.Support for carers

Carers Trust (Princess Royal Trust for Carers in Scotland)

Tel (England) 0844 800 4361

Tel (Scotland) 0141 221 5066 Tel (Wales) 0292 009 0087

Email info@carers.org

www.carers.org and

www.youngcarers.net

Provides support, information, advice and services for people caring at home for a family member or friend. You can find details for UK offices and search for local support on the website. Carers UK

Tel (England, Scotland, Wales) 0808 808 7777

Tel (Northern Ireland) 028 9043 9843 (Wed–Thu, 10am–12pm and 2–4pm)

Email advice@carersuk.org

www.carersuk.org

Offers information and support to carers across the UK. Can put people in contact with support groups for carers in their area.

YCNet (Young Carers Net)

Carers Trust, 32–36 Loman Street, London SE1 0EH Tel 0844 800 4361

Email help@carers.org

www.youngcarers.net

Provides information and support for young carers, online discussion forums, and advice for young people aged 18 and under, who help to look after a family member.Counselling and emotional support

British Association for Counselling and Psychotherapy (BACP)

BACP House, 15 St John’s Business Park, Lutterworth LE17 4HB

Tel 01455 883 300

Email bacp@bacp.co.uk

www.bacp.co.uk

Promotes awareness of counselling and signposts people to appropriate services. You can search for a qualified counsellor at itsgoodtotalk.org.ukEquipment and advice on living with disability

Assist UK

Redbank House, 4 St Chad’s Street, Manchester M8 8QA

Tel 0161 832 9757

Email general.info@assist-uk.org

www.assist-uk.org

A UK-wide network of Disabled Living Centres. Staff can give advice about the products, which are designed to make life easier for people who have difficulty with daily activities.

British Red Cross

44 Moorfields, London EC2Y 9AL

Tel 0844 871 11 11

Email information@redcross.org.uk

www.redcross.org.uk

Offers a range of health and social care services such as care in the home, a medical equipment loan service and a transport service.

Support for young people

CLIC Sargent

Horatio House, 77–85 Fulham Palace Road, London W6 8JA

Tel 0300 330 0803

www.clicsargent.org.uk

Provides clinical, practical, financial and emotional support to children with cancer.

Teenage Cancer Trust

3rd Floor, 93 Newman Street, London W1T 3EZ

Tel 020 7612 0370

www.teenagecancertrust.org

A charity devoted to improving the lives of teenagers and young adults with cancer. Runs a support network for young people with cancer, their friends and families.

Support for older people

Age UK

Tel (England and Wales) 0800 169 6565

Tel (Scotland) 0845 125 9732

Tel (Northern Ireland) 0808 808 7575 (Daily, 8am–7pm)

www.ageuk.org.uk

Provides information and advice for older people across the UK via the website and advice line. Also publishes impartial and informative fact sheets and advice guides. Financial or legal advice and information

Benefit Enquiry Line Northern Ireland

Tel 0800 220 674 (Mon–Wed and Fri, 9am–5pm, Thu, 10am–5pm)

Textphone 0800 243 787

www.nidirect.gov.uk/money-tax-and-benefits

Provides information and advice about disability benefits and carers’ benefits in Northern Ireland.Citizens Advice

Provides advice on a variety of issues including financial, legal, housing and employment issues. Find details for your local office in the phone book or on one of the following websites:

England and Wales

www.citizensadvice.org.uk

Scotland

www.cas.org.uk

Northern Ireland

www.citizensadvice.co.uk

You can also find advice online in a range of languages at adviceguide.org.uk

Department for Work and Pensions

Disability Benefits Helpline 08457 123 456

Textphone 0845 722 4433

Personal Independence Payment Helpline 0845 850 3322

Textphone 0845 601 6677

Carer’s Allowance Unit 0845 608 432

Textphone 0845 604 5312

www.gov.uk/browse/benefits

Manages state benefits in England, Scotland and Wales. You can apply for benefits and find information online or through its helplines.

GOV.UK

www.gov.uk

Has comprehensive information about social security benefits and public services.

Personal Finance Society – ‘Find an Adviser’ service

www.findanadviser.org

Use the website to find qualified financial advisers in your area.

Disclaimer, thanks and references

Disclaimer

We make every effort to ensure that the information we provide is accurate and up to date but it should not be relied upon as a substitute for specialist professional advice tailored to your situation. So far as is permitted by law, Macmillan does not accept liability in relation to the use of any information contained in this publication, or third-party information or websites included or referred to in it.

Thanks

This ebook has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been approved by Tim Iveson, Consultant Medical Oncologist and Macmillan Chief Medical Editor. With thanks to: Dr Jackie Gracey, Lecturer in Physiotherapy; Theresa Mann, Community Palliative Care CNS; Dr Oliver Minton, Honorary Consultant in Palliative Medicine; and the people affected by cancer who reviewed this edition.

Sources

We’ve listed a sample of the sources used in this publication below. If you’d like further information about the sources we use, please contact us at bookletfeedback@macmillan.org.uk

Improving Supportive and Palliative Care for Adults with Cancer: The Manual. March 2004. National Institute for Health and Care Excellence (NICE).

Cramp F, Byron-Daniel J. Exercise for the management of cancer-related fatigue in adults. 2012. The Cochrane Library. Minton O, et al. Drug therapy for the management of cancer-related fatigue. 2010. The Cochrane Library. Goedendorp MM, et al. Psychosocial interventions for reducing fatigue during cancer treatment in adults. 2009. The Cochrane Library.

Peuckmann-Post V, et al. Pharmacological treatments for fatigue associated with palliative care. 2010. The Cochrane Library.

Can you do something to help?

We hope this booklet has been useful to you. It’s just one of our many publications that are available free to anyone affected by cancer. They’re produced by our cancer information specialists who, along with our nurses, benefits advisers, campaigners and volunteers, are part of the Macmillan team. When people are facing the toughest fight of their lives, we’re there to support them every step of the way.

We want to make sure no one has to go through cancer alone, so we need more people to help us. When the time is right for you, here are some ways in which you can become a part of our team.

Share your cancer experience

Support people living with cancer by telling your story, online, in the media or face to face.

Campaign for change

We need your help to make sure everyone gets the right support. Take an action, big or small, for better cancer care.

Help someone in your community

A lift to an appointment. Help with the shopping. Or just a cup of tea and a chat. Could you lend a hand?

Raise money

Whatever you like doing you can raise money to help. Take part in one of our events or create your own.

Give money

Big or small, every penny helps. To make a one-off donation see over.

Call us to find out more 0300 1000 200

macmillan.org.uk/getinvolved