Cancer-related fatigue is a persistent sense of tiredness or exhaustion in people with cancer. Most people receiving cancer treatment experience fatigue, and some cancer survivors have fatigue for months and sometimes years after finishing treatment. Cancer-related fatigue is different than other types of fatigue, such as what happens when a healthy person does not get enough sleep, because it does not completely improve with rest.
How fatigue affects your quality of life
Fatigue often negatively affects the overall physical, psychological, social, and economic well-being of a person with cancer. For some, it is slightly bothersome, while for others the experience can be overwhelming. Fatigue can influence your:
- Daily activities
- Hobbies and other enjoyable activities
- Social relationships
- Mood and emotions
- Job performance
- Feeling of well-being and sense of joy
- Attitude toward the future
- Ability to undergo treatment
Causes of fatigue
There are many causes of cancer-related fatigue, including cancer treatment. It is common for fatigue to appear after treatment at the following times:
- A few days after chemotherapy
- A few weeks after beginning radiation treatment
- After treatment with immunotherapy (also known as biologic therapy), such as interferon alpha (Alferon, Intron A, or Roferon-A) and interleukin (Proleukin)
Other common causes of cancer-related fatigue include:
- The cancer itself
- Appetite loss
- Anemia (a low number of red blood cells)
- Uncontrolled pain
- Lack of sleep / Insomnia (having trouble falling asleep or staying asleep)
- Lack of regular exercise
- Inadequate nutrition
- Co-existing medical conditions
It is important to talk with your health care team about any symptoms of fatigue you may experience, including any new symptoms or a change in symptoms. Diagnosing and relieving side effects, also called symptom management, palliative care, or supportive care, is an important part of your cancer care and treatment.
Not all of the causes of cancer-related fatigue are well understood, and your fatigue may be the result of more than one cause. To understand your fatigue, your doctor may ask you at what times you feel especially tired and whether the fatigue affects your ability to perform your regular activities. You may be asked to describe your fatigue on a scale from “no fatigue” to “most fatigue.” Your doctor may also take a blood sample to determine whether anemia or another problem may be causing fatigue.
Strategies to help cope with fatigue
Exercising. Researchers think that a regular exercise program is the best strategy to help relieve cancer-related fatigue. Athletes and physically fit individuals may be able to continue their regular exercise schedules while undergoing some cancer treatments. However, most people with cancer will experience some degree of deconditioning, making their regular exercise routine more difficult and, in some cases, dangerous. Talk with your doctor about modifying your exercise program to meet your needs. A gradual program will increase muscle tone and lead to a sense of well-being. Even people who are weak benefit from getting out of bed and walking around the house. Find tips for staying active.
Eating healthy. Eating well and drinking enough fluids are important to maintaining an adequate weight and meeting your body’s nutritional needs. Read more about the importance of hydration. If available, consider talking with a nutrition counselor or registered dietitian (RD) at your treatment center. He or she can provide helpful hints on eating a well-balanced diet, as well as on eating when there is a lack of taste and during times of nausea and vomiting. Find nutrition recommendations for during and after treatment.
Conserving your energy. Many people who complete treatment expect an immediate return to normal functioning. However, fatigue may take some time to resolve, so it is important to prioritize tasks and schedule periods of rest whenever possible. Plan your days so you are able to use the time when you have the most energy for the most important tasks. This includes exercise. It is important to get the rest you need, which may mean altering the times you sleep and the amount of sleep you need. Some people also experience mental fatigue, making it difficult to concentrate. Mental fatigue may also contribute to feelings of being overwhelmed and frustrated because your lifestyle has been disrupted. Talk with your doctor, nurse, or social worker about these concerns.
Sharing responsibilities with family and friends. It may be helpful to seek assistance with everyday activities and delegate some of these tasks to others. Maintaining certain household and family responsibilities, such as childcare, meal preparation, and food shopping, may become difficult. Some online communities offer tools to help coordinate caregiving tasks among family members and friends. Health care professionals, such as social workers, often counsel patients to ask for help from friends and family members.
Treating fatigue related to anemia. Many patients with cancer have anemia, which is a decrease in the amount of circulating red blood cells. Anemia may be caused by the cancer or cancer-related treatments. Patients who have anemia report a feeling of extreme and overwhelming fatigue. The treatment for anemia may include nutritional supplements, drugs, and/or blood transfusions.
Managing pain. Living with constant pain will almost always make a person feel exhausted. Many of the medications prescribed for the treatment of pain also cause drowsiness, sleepiness, and fatigue. Your doctor can help you understand the pain management options available and give you information about common side effects of pain medications. Learn more about managing and treating cancer pain.
Treating depression. In addition to physical reasons that contribute to fatigue, dealing with cancer can lead to feelings of distress and depression, which often increase feelings of exhaustion and complicate treatment. The first step in treating depression is to recognize it as a condition and then talk about ways to resolve it with your doctor. Treatment for depression can make a huge difference to patients who experience extreme sadness or hopelessness. Learn more about depression.
Getting enough sleep. Sleep is necessary for normal function and performance. Stress, pain, and worry can interfere with a person's ability to sleep through the night. In some cases, medications can also disturb normal sleep patterns. For those who are chronically tired, sleep may come in spurts at different times of the day or evening. Not feeling refreshed by sleep or being unable to sleep more than one to two hours will contribute to feelings of exhaustion and will likely affect your mood and ability to function. Talk with your doctor and nurse about any sleep problems, and read these strategies for a better night’s sleep.
Coping with fatigue in the workplace. Cancer-related fatigue can affect a person's ability to work. It is common for people undergoing cancer treatment to make changes to their work schedule and/or responsibilities. Even long-term survivors of cancer who still experience some fatigue may require changes in their work routine. If you are comfortable with your employer knowing about your cancer, talk with a human resources representative about the effects fatigue is having on your ability to maintain your job responsibilities and about any adjustments or accommodations that can be made. You may need to take prolonged sick leave or disability leave in some situations. It is important that you know your company's policy on sick leave and to understand the Americans with Disabilities Act and Family Medical Leave Act so you know your rights. Read more about cancer and workplace discrimination and going back to work after cancer.