Fatigue

Approved by the Lineagotica Editorial Board, 08/2018

Cancer or cancer treatment may cause fatigue. This can feel like physical, emotional, and mental exhaustion that goes on for a long time. This type of fatigue is not the same as feeling tired after not getting enough rest.

  • It affects your daily life

  • It does not match your level of activity

  • It does not improve with rest

Most people receiving cancer treatment have fatigue. Some may have it for months or years after finishing treatment.

How fatigue affects quality of life

For some, cancer-related fatigue only slightly bothers them. Others find that it makes life hard and negatively affects 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

Managing symptoms, which can include fatigue, is an important part of cancer care and treatment. This is called palliative care or supportive care. Talk with your health care team about any symptoms you or the person you are caring for experience.

Screening and diagnosing fatigue

ASCO advises doctors to screen for and treat fatigue when cancer is first diagnosed. It is an important part of cancer care. In addition, your doctor will ask about your level of fatigue throughout treatment and recovery.

Several factors may cause or worsen your fatigue. Before creating a treatment plan, your health care team will look at the following:

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. The results may show cancer-related causes of fatigue.

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 treat medical conditions that contribute to your fatigue. These include:

Pain. Living with constant pain is often exhausting. What’s more, many pain medicines cause drowsiness and fatigue. Ask your health care team about other ways to manage pain. And ask about the common side effects of these options.

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

Insomnia. Stress, pain, and worry may contribute to insomnia, which means having trouble falling asleep or staying asleep. In addition, some medicines disturb normal sleep patterns.

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 changes or nausea and vomiting.

Anemia. Many people with cancer have anemia, which is when your red blood cell count is low. People with anemia may feel extreme and overwhelming fatigue. Anemia treatment may include nutritional supplements, drugs, or blood transfusions.

Treatment side effects. Certain types of treatment can cause fatigue. For example, people commonly experience fatigue at these times:

  • A few days after chemotherapy

  • A few weeks after starting radiation therapy

  • After immunotherapy

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 health care team which types of physical activity are best for you. And ask what level of physical activity could help you. The type and level of physical activity may change during and after cancer treatment.

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

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

  • 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. But researchers have not yet fully 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 people:

  • Those receiving cancer treatment

  • Those who have advanced cancer

In addition, researchers are studying whether supplements, such as ginseng and vitamin D, may help. Talk with your health care team about these options.

Related Resources

8 Ways to Cope with Cancer-Related Fatigue

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