Fatigue

Approved by the Lineagotica Editorial Board, 03/2017

Cancer or cancer treatment may cause fatigue. This type of fatigue may feel like persistent physical, emotional, and mental exhaustion. Cancer-related fatigue is different than feeling tired after not getting enough rest.

  • It interferes with daily life.

  • It does not match the person’s level of activity.

  • It does not improve with rest.

Most people receiving cancer treatment experience fatigue. Some will have fatigue that lasts months or years after finishing treatment.

If you experience fatigue, talk with your health care team. Share any new symptoms or changes in symptoms. Diagnosing and relieving symptoms and side effects is an important part of your cancer care. This is called supportive care or palliative care.

How fatigue affects quality of life

For some, cancer-related fatigue is slightly bothersome. Others find that it makes life difficult, negatively affecting these aspects of life:

  • Mood and emotions.

  • Daily activities.

  • Job performance.

  • Hobbies and other types of recreation.

  • Social relationships.

  • Ability to cope with treatment.

  • Hope for the future.

Screening and diagnosing fatigue

ASCO advises health care teams to evaluate fatigue when you are diagnosed with cancer. In addition, your doctor will ask about your level of fatigue throughout treatment and recovery.

Multiple factors may cause or worsen your fatigue. Before creating a treatment plan, your doctor will look at several factors:

Fatigue history. These questions will help you describe the fatigue to your health care team:

  • How severe is it? Rate it on scale from “no fatigue” to “most fatigue.”

  • When did the fatigue begin?

  • When do you feel most tired?

  • How long does it last?

  • Has it changed over time?

  • What makes it better or worse?

Health changes related to cancer. Your doctor may take a blood sample or perform other tests. Test results may show cancer-related causes of fatigue. These may include the following:

  • Cancer that is worsening.

  • Cancer that has spread.

  • Cancer that has come back after treatment.

Other health conditions. Health conditions other than cancer may cause or worsen fatigue. Your doctor may ask questions or recommend tests to find them.

Treating the causes of fatigue

First, it is important to address medical conditions that contribute to your fatigue. These include the following:

Pain. Living with constant pain is often exhausting. Moreover, many medicines prescribed for pain cause drowsiness and fatigue. Ask your doctor about options for managing pain. And ask about the common side effects of these options.

Depression, anxiety, and stress. These conditions can increase exhaustion and complicate treatment. Managing stress and treating depression and anxiety often reduces fatigue.

Insomnia. Stress, pain, and worry may contribute to insomnia. This means having trouble falling asleep or staying asleep. Additionally, some medicines disturb normal sleep patterns. Ask your health care team for help managing insomnia.

Poor nutrition. A well-balanced diet may help reduce fatigue. Consider talking with a nutrition counselor or registered dietitian (RD). These professionals can help you find ways to eat well. Especially when you have taste issues or nausea and vomiting.

Anemia. Many patients with cancer have anemia. This is a decrease in the amount of red blood cells. Patients with anemia may feel extreme and overwhelming fatigue. Anemia treatment may include nutritional supplements, drugs, or blood transfusions.

Treatment side effects. Certain treatment types contribute to fatigue. For example, people commonly experience fatigue at these times:

Co-existing medical conditions. People with cancer, especially those who are older, may have other health conditions. These may include:

  • Heart problems.

  • Reduced lung and kidney function.

  • Hormone problems.

  • Arthritis.

  • Nerve problems.

Other strategies to cope with fatigue

Lifestyle changes may help you cope with fatigue. These include:

Physical activity. Staying or becoming active can help relieve cancer-related fatigue. Ask your doctor which types of physical activity are best for you. And ask about recommended levels of physical activity. These recommendations may change during and after cancer treatment.

Some people may benefit from working with a physical therapist, particularly if they have a higher risk of injury. This may be due to cancer, cancer treatment, or other health conditions. Physical therapists help patients increase or maintain physical functions.

Counseling. Talking with a counselor may help reduce fatigue. For example, cognitive behavioral therapy may help you do the following:

  • Reframe your thoughts about fatigue.

  • Improve coping skills.

  • Overcome sleep problems that contribute to fatigue.

Mind-body strategies. Evidence suggests that these can reduce fatigue in cancer survivors:

  • Mindfulness practices

  • Yoga

  • Acupuncture

In addition, the following methods may be helpful. However, researchers have not yet thoroughly studied the results of these strategies.

  • Touch therapy

  • Massage

  • Music therapy

  • Relaxation

  • A form of touch therapy called reiki

  • A type of relaxation and meditation called qigong

If you are interested, talk with your health care team. Ask for referrals to professionals who specialize in using these methods for cancer survivors.

Medication and supplements. Some medications help people feel more alert and awake. They seem most helpful for 2 types of patients:

  • Those receiving cancer treatment

  • Those who have advanced cancer

Additionally, researchers are studying whether supplements, such as ginseng and vitamin D, may help.

Talk with your doctor about these options.

More Information

8 Ways to Cope with Cancer-Related Fatigue

ASCO Answers Fact Sheet: Cancer-Related Fatigue (PDF)

Side Effects

ASCO Clinical Practice Guideline Adaptation: Screening, Assessment and Management of Fatigue in Adult Survivors of Cance

Additional Resources

National Cancer Institute: Fatigue

LIVESTRONG Foundation: Fatigue