What is fatigue?

Fatigue is a feeling of tiredness or exhaustion. It can be caused by the cancer itself, or the side effects of treatments. As many as 9 out of 10 people with cancer get cancer-related fatigue.

Cancer-related fatigue usually gets better after treatment finishes. But it may continue for months or even years. Everyone is different and there is no way to know how long fatigue may last for each person.

Some common effects of fatigue include:

• Difficulty doing simple things, such as brushing your hair or getting dressed
• Feeling you have no energy or strength
• Difficulty concentrating and remembering things
• Difficulty thinking, speaking or making decisions
• Feeling breathless after light activity
• Feeling dizzy or lightheaded
• Difficulty sleeping (insomnia)
• Losing interest in sex
• Feeling low in mood and more emotional than usual.

This may have an impact on your work, relationships and social life, but there are things that can help. It is possible to manage fatigue. Here are some resources to support you to manage fatigue here:

• Tiredness (fatigue) and cancer | Macmillan Cancer Support
• Rest and relax – Penny Brohn UK
• Lift Up Your Everyday - Managing energy - RCOT
• Fatigue Home - SWAG Cancer Alliance

If you need more support, your cancer clinical nurse specialist or cancer support worker may refer you to a Physiotherapist, an exercise programme or to an Occupational Therapist to help with managing tiredness.

© North Bristol NHS Trust. This edition published February 2025. Review due February 2028. NBT003765c.

Nutrition has a real impact on your body’s ability to manage health and resilience for treatment

It is important to eat well when preparing for, during, and after treatment, and when you are living with cancer. 

Choosing a wide variety of foods and well-balanced meals can help you feel better and optimise your energy levels. Trying to lose weight is generally not encouraged.

‘Eating well’ means choosing a wide variety of foods, which provide enough nutrients to maintain a good nutritional status and maintain your weight. Eating well will also help you to keep up your strength and energy levels, support your immune system, and improve your general well-being.

General advice on ‘eating well’ can be found here:

• Healthy eating and cancer video Macmillan Cancer Support
• Eat well - NHS
• Healthy eating and cancer | Benefits of a healthy diet | Macmillan Cancer Support

Difficulty eating and unplanned weight loss

You may have difficulty eating before, during, and after treatment for a variety of reasons including:

• Dry mouth.
• Taste and smell changes.
• Nausea and vomiting.
• Diarrhoea.
• Constipation.
• Swallowing difficulties.
• Poor appetite.
• Fatigue. 

Managing at home 

These pages have some information about how you can manage difficulty eating and unplanned weight loss at home, including how to boost calories and protein in your diet to 

• Cancer and weight loss - the building-up diet | Macmillan Cancer Support
• Eating problems and cancer booklet | Macmillan Cancer Support

If you are having difficulty eating, let your doctor or nurse know, as they may be able to help with symptoms or refer you to the dietitian. 

Referral to a dietitian 

You can refer yourself to a dietitian who can help with the following: 

• Eating well to support your future health.
• Managing weight after finishing of cancer treatment.
• Coping with a poor appetite, or unintentional weight loss.
• Nutritional support for cancer/treatment related side-effects.
• Altered texture diets due to swallowing difficulty
• Making dietary changes because of cancers affecting the gastrointestinal tract.

There are some referral criteria which will be discussed with you. 

© North Bristol NHS Trust. This edition published February 2025. Review due February 2028. NBT003765e. 

Physical activity is any type of exercise or movement that uses your muscles. This includes everyday activities like walking, housework, and gardening. Any activity will help maintain or improve your fitness, health, and well-being.

Is it safe to exercise when you have cancer?

It is usually safe to start doing some physical activity before, during, or after treatment. It can be hard to think about exercise when you are dealing with the symptoms of cancer or side effects of treatment, but becoming more active may help you cope with this.

If you decide to do some physical activity, it is important to do it safely. Even if you did regular physical activity before you were diagnosed with cancer, you may need more advice and support now.

Tips for exercising safely

• Start slowly and gradually build up the activity.
• Don't exercise if you feel unwell or have symptoms that worry you.
• If you have bone problems, avoid uneven services and activities that increase the risk of you falling. You should also avoid high-impact activities like running.
• Wear comfortable trainers or walking shoes.
• Drink plenty of water so you don't get dehydrated.
• Protect yourself in the sun.
• Have a health snack after exercising, like a banana.
• Having some soreness or stiffness for a couple of days after exercise or being tired is common. If you feel very sore or very tired, try to do a bit less next time. 

Stop exercising if you get any sudden symptoms including:  

• Feeling dizzy.
• Chest pain.
• A racing heart.
• Breathing problems.
• Feeling sick.
• Unusual back or bone pain.
• Unusual muscle pain.
• A headache that does not go away.

Speak to a doctor straight away if you notice these or any other symptoms. 

Information and advice about exercising 

Visit Macmillan Cancer Support website for more information about: 

• The benefits of physical activity and exercise when you have cancer.
• How physical activity affects cancer.
• Being active before, during, and after treatment.
• How much activity to do.
• Who can help you get started. 

Physical activity and cancer | Macmillan Cancer Support

Being active before treatment

For specific advice about being active before treatment visit the Macmillan Cancer Support page about prehabilitation. 

Prehabilitation videos for people living with cancer | Macmillan Cancer Support

How to be more active when you have limited mobility

Online exercise videos

Exercise if you have a brain tumour

Pelvic floor exercises

Exercises to help prevent falls and improve balance

Exercises after surgery

More resources to support you to maintain or increase your activity levels

Exercise if you have osteoporis

© North Bristol NHS Trust. This edition published February 2025. Review due February 2028. NBT003765b.

The Pre Operative Assessment Clinic at Southmead Hospital is located at the end of Donal Early Way, past the Central Delivery Suite and through the car park. You can also walk there from the Brunel main entrance.

Patients will be notified if they are required to be seen at the clinic.

Pedestrian route from the Brunel main entrance:

1. Exit the Brunel building through the main doors and turn right to follow the path alongside the building.
2. Reach the road and look to your right. You will see a hedge with a gap and the beginning of a path. Cross the road and proceed to the path.
3. Follow the path. You will see the Willow Café on your right. Just past the café, you should start seeing signs for "Pre-operative assessment".
4. Continue on the path to the right, and then around to the left.
5. In the distance, you will see another sign near a Zebra crossing. Once you reach the Zebra crossing, cross it and follow the sign to the left, past the Rosa Burden Centre, towards the Antenatal Clinic.
6. You will come to another sign near a car park barrier. Follow the path around to the right and you should see an archway. Proceed through the archway.
7. On the other side, you will see another sign guiding you to the left.
8. Follow the winding path that ends at Weston Clinic, Pre-operative Assessment.

Driving route from Monks Park Way entrance:

1. Continue on Monks Park Way until you reach the roundabout by the Brunel main entrance.
2. Turn left at the roundabout onto Dorian Way.
3. Take the first left onto Donal Early Way.
4. You will pass the Rosa Burden Centre before reaching the Antenatal Clinic.  
5. Take the left hand fork at the Antenatal Clinic which will lead round to a car park with a barrier for cars.
6. Turn right into the car park.
7. Continue through the carpark following it all the way around the buildings to the Pre Operative Assessment Clinic entrance.
8. The Pre Operative Assessment Clinic is at the very end of the car park so if in doubt, keep following this car park.

Specialist Toxicology, Therapeutic Drug Monitoring and Trace Metal Service

The specialist and manual techniques section provides specialist analysis of toxic compounds, therapeutic drugs and trace metals.  This is supported by guidance on appropriate test selection and sample requirements.  Interpretative advice on results is always available to clinicians, pathologists and coroners.  However please note we are not able to deal directly with patients or members of the public.

Service Details:

Clinical Toxicology Service

Emergency toxicology analysis is available in cases of suspected acute poisoning, with analysis of ethylene glycol and methanol available on-site. These requests must be discussed fully the Duty Biochemist or on-call consultant out of hours prior to samples being taken.  Subsequent ethanol monitoring can also be arranged if not available locally.

Drugs of abuse testing of urine samples is offered mainly to monitor drug dependency treatment programmes, but is also available for other clinical applications.  Appropriate confirmation of positive results is also available.  If this is required on an urgent basis, this must be discussed with the Duty Biochemist.

Post Mortem Toxicology for Coroners and Pathologists

A non-forensic post-mortem toxicology service is provided to pathologists and coroners within the Southwest region. Measurement of drug levels in blood is carried out using up to date mass spectrometry techniques. Routine analysis includes alcohol and commonly encountered drugs of abuse, with targeted analysis for therapeutic drugs guided by the case information provided.  Biochemical analysis of vitreous humour is also available, for example in cases of suspected ketoacidosis. Each case is reported with a full interpretation; in the majority of routine cases reports are available within two to four weeks.  In more complex cases samples may be referred externally for specialised drug analysis, allowing us to provide a comprehensive toxicology report.

Therapeutic Drug Monitoring

We also provide a therapeutic drug monitoring (TDM) service primarily for the immunosuppressant drugs tacrolimus, cyclosporin and sirolimus.  Other TDM assays are available in the biochemistry automated laboratory.

Trace Metal Analysis

Trace metals analysis (including lead, copper, zinc, selenium, cobalt and chromium) is available for clinical applications, environmental exposure and occupational monitoring. This is provided using inductively coupled plasma mass spectrometry (ICP MS).

Please see below for responses to our most recent user survey

Service Leads

Peter Beresford
Consultant Clinical Scientist
Telephone: 0117 4148415

Nicola Crabbe
Lead Biomedical Scientist
Telephone: 0117 4148450

Would you like to meet with a clinical psychologist?

Having a long-term health condition can be stressful, upsetting, and difficult to manage. 

Why are there clinical psychologists in the medical teams? 

Trying to fit a health condition into everyday life including work, family, and a social life is a challenge. It can be difficult to manage at times, and family can also worry. Sometimes it can feel difficult to come to terms with limitations and changes to daily life. There can be a sense of loss and grief.

Talking to a clinical psychologist can help you adjust and to understand what is going on in your life, and to live with the condition.

A clinical psychologist can help with:

• Strong emotions such as sadness, fear, anger - especially when first diagnosed.
• Anxiety relating to your condition (for example panic attacks, worry, and avoidance).
• Feeling down or depressed; having no energy or lack of sleep.
• Learning to live with and managing your condition.
• Support and technique to help you make lifestyle changes.
• Support around self-care issues.
• Managing stress and feeling overwhelmed.
• Relationship issues, sex life.

Should I contact my GP, mental health services or the Clinical Psychology team? 

If you have experienced long term mental health difficulties or your main concern is not related to your health condition, then your GP or NHS Talking Therapies are likely to support you best. NHS Talking Therapies offers a variety of short-term psychological therapies for a range of mental health difficulties.

Phone: 0333 200 1892

NHS Talking Therapies also has some free, instant-access, self-help resources on the website: NHS Talking Therapies - North Somerset & South Gloucestershire

If you feel your emotional distress relates specifically to your physical health then the Clinical Psychology Team at NBT might be able to support you, or suggest something which could help. 

If you would like to make an appointment with our Clinical Psychology team

Phone 0117 414 6407

Email psychologymedicine@nbt.nhs.uk

Please leave your name, phone number, and date of birth. Once you have contact us, we will arrange a conversation with you as soon as possible. When you meet the clinical psychologist for the first time you will be able to discuss what would be most helpful for you, and agree the next steps together. This can be done in person (in Southmead Hospital), or over the phone if you prefer.

© North Bristol NHS Trust. This edition published March 2025. Review due March 2028. NBT003227

The Haematology Nurse Specialist (CNS) Team

The Haematology Clinical Nurse Specialists are experts in haematology cancer care; we work as part of the Cancer Support Team and Multidisciplinary team (the different professionals working together to provide the appropriate care for you). We can answer your questions and give you information about your diagnosis, treatment, and support available during and after your care.

Cancer Support Worker (CSW) 

The Cancer Support Team also has Support Workers who work alongside the haematology team. They are trained to provide support and non-clinical information about physical, emotional, and practical concerns during your diagnosis, treatment, or monitoring, up until discharge from our care.

The Cancer Support Worker will help you to self-manage through your recovery and/or monitoring, helping you return to a healthy lifestyle as soon as possible. The Cancer Support Worker can help refer you to services such as dietitians, physiotherapy, and psychology which are available free of charge through Macmillan, and also inform you about the support available in the community that might help reach your goals.

Personalised Care and Support Planning (PCSP)

Personalised Care and Support Planning is a conversation and assessment you will be offered with your Clinical Nurse Specialist and/or Cancer Support Worker, to help discuss your health and wellbeing in relation to your cancer. It will assess your individual needs and concerns, to understand what matters to you. This can be done by: 

• Using a holistic needs assessment, a questionnaire that will prompt you to think about areas that might be of concern you.
• Developing an agreed plan of care to address your concerns. 

Personalised Care and Support Planning includes sharing information with you about diet, physical activity, fatigue and other practical information relevant to you. This can include anything from emotional support to signposting you to local support services, such as benefits advice.

Making decisions about your healthcare

At NBT we encourage you to be a partner in your healthcare. When patients work with healthcare professionals to make decisions about their healthcare plan and treatment, this is called shared decision making. Shared decision making makes sure you are supported to make decisions that are right for you. This means supporting you to choose tests and treatments based on medical evidence, as well as your individual preferences, beliefs, and values.

It can be helpful to write down questions you have for your healthcare team. You should bring these, and a pen and paper to make any notes when you have appointments.

Some questions that might be helpful to ask:

• What are my options?
• What are the possible benefits and risks of those options?
• What support and information is available to help me make my decision?

Shared decision making matters to us. Tell us what matters to you.

NGS Macmillan Wellbeing Centre 

We offer help and information about different kinds of cancers and treatments. We also talk about money, benefits you might get, what to eat, and exercises to do. If you have concerns or just want to talk with one of the team, we have time to listen and help you. The centre offers ‘drop-ins’ for coffee and a chat or appointments for specific needs.

Opening times: Monday to Friday, 08:30 - 16:15 
Phone: 0117 414 7051

Cancer Information Session 

As part of your routine care you may be invited to a group education and support session at, or soon after the time of a cancer diagnosis. 

The session provides:

• Information about cancer and related topics that help you participate in your care and recovery.
• The opportunity to meet other people with similar experiences.
• Help to enable you to make choices best suited to you.

Venue: NGS Macmillan Wellbeing Centre, Southmead Hospital
Days and times: Monday 13:30 - 14:30, Thursday 10:00 – 11:00

How to contact us

© North Bristol NHS Trust. This edition published January 2025. Review due January 2028. NBT003164

Pituitary

Adrenal

Thyroid & Parathyroid

Pancreas

Gonadal

Neuroendocrine

Clinical updates

As part of the changes to the Clinical Biochemistry testing platform and reference ranges, we have taken the opportunity to align further with the Royal College of Pathologists - The communication of critical and unexpected pathology results, which will be replacing our previous Out of Hours protocol.

Previous communications about test changes

• Feeling stressed or worried about diabetes?
• Feeling frustrated, angry or burnt out?
• Is diabetes impacting work, studies or relationships?
• Are you struggling with moving to adult services?
• Do you feel alone with diabetes or as if no-one gets it?

The Young People’s Diabetes Group at Southmead Hospital offers an opportunity for young individuals who attend the young person’s diabetes clinic to learn more about managing diabetes and, to connect with others who share similar experiences.

The six-sessions are 90 minutes each and are led by a clinical psychologist where participants can gain valuable support in a safe and understanding environment. Plus, the convenience of joining via computer or mobile phone makes it accessible to everyone.

To join, speak to your diabetes nurse or consultant, or email the psychology team with your name and hospital number at psychologymedicine@nbt.nhs.uk.