Cancer-related fatigue is a persistent feeling of physical, emotional, or mental tiredness or exhaustion related to cancer and/or its treatment. This type of fatigue is different than other types of fatigue, such as when a healthy person does not get enough rest, because it interferes with a person’s usual functioning, does not reflect their level of activity, and does not improve with rest. Most people receiving cancer treatment experience fatigue, and some cancer survivors have fatigue that lasts for months and sometimes years after finishing treatment.
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.
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 may 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
Screening and diagnosing fatigue
ASCO recommends that you receive an evaluation of your level of fatigue when you are first diagnosed with cancer and that your level of fatigue is assessed throughout treatment and into recovery. In addition, your health care provider should perform this evaluation each year and any time you develop symptoms of fatigue. This evaluation is part of a comprehensive screening called distress screening that evaluates your emotional health and quality of life.
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 help find the best way for you to manage your fatigue, your doctor will work with you to look at several factors:
Fatigue history. As part of your fatigue history, you may be asked to describe your fatigue on a scale from “no fatigue” to “most fatigue.” Your doctor may also ask when the fatigue began, when you feel most tired, how long it lasts, if it has changed over time, and what makes it better or worse.
Health changes related to cancer. Your doctor may take a blood sample or perform other tests to learn more about potential cancer-related causes of your fatigue, such as if it is worsening, has spread, or has come back after treatment.
Other health conditions. Other factors can cause or worsen fatigue. Your doctor may ask questions or recommend tests to find out if another health condition is affecting your level of fatigue.
Treating the causes of fatigue
The first step in managing fatigue is to treat any medical cause of fatigue or any condition that is contributing to fatigue.
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.
Managing depression, anxiety, and stress. Dealing with cancer may lead to feelings of distress, depression, and anxiety, which often increase feelings of exhaustion and complicate treatment. Managing stress and treating depression and anxiety usually makes a huge difference in a patient’s level of fatigue.
Getting enough sleep. Stress, pain, and worry often interfere with a person's ability to sleep through the night. In some cases, medications may 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.
Eating healthy. Eating well and drinking enough fluids are important to maintaining an adequate weight and meeting your body’s nutritional needs. 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.
Treating 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 medication side effects. Medications used to treat cancer also contribute to fatigue. For example, 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, such as interferon alpha (Alferon, Intron A, or Roferon-A) and interleukin (Proleukin)
In addition, medications used to manage other side effects may contribute to fatigue, such as those used to manage pain (see above).
Co-existing medical conditions. People with cancer may also have other health conditions in addition to cancer, especially if they are older. These conditions can also cause or worsen fatigue and include heart problems, lowered lung and kidney function, hormone problems, arthritis, and nerve problems.
Other strategies to cope with fatigue
Along with treating and managing the medical causes of fatigue, many patients find that lifestyle changes can help them better cope with fatigue.
Physical Activity. Staying physically active or increasing your activity level can help relieve cancer-related fatigue. Start slowly and gradually increase your activity levels. Walking programs are generally considered safe for most survivors. Once you are healthy enough for physical activity, try to aim for or build up to 150 minutes of moderate activity, such as fast walking, cycling, or swimming per week plus two to three strength training sessions per week. Talk with your doctor about the level and types of physical activity best for you. Many survivors, particularly those who have a higher risk of injury due to the cancer, its treatment, or other health conditions, benefit from working with a physical therapist or exercise specialist who can find the best ways to increase or maintain their physical functioning.
Therapy and counseling. Talking with a therapist or counselor specially trained to work with cancer survivors can help reduce fatigue. Specifically, a type of counseling called cognitive behavioral therapy or behavioral therapy can help patients reframe their thoughts about fatigue and improve poor coping skills and/or sleep problems that could contribute to fatigue.
Mind-body strategies. There is some evidence that mindfulness-based approaches, yoga, and acupuncture can reduce fatigue in cancer survivors. Touch therapy, massage, music therapy, relaxation, a form of touch therapy called reiki, and a type of relaxation/meditation called qigong may also be beneficial for reducing fatigue, but more research is needed on these strategies. If you are interested in pursuing mind-body strategies to help manage your fatigue, talk with your health care team for a referral to professionals who specialize in using these methods for cancer survivors.
Medications and supplements. Some medications that make people feel more alert and awake may help manage fatigue for patients who are receiving cancer treatment or have advanced cancer. However, there is not much evidence that they are helpful for cancer survivors, but research on supplements, such as ginseng and vitamin D, is ongoing.
American Society of Clinical Oncology Clinical Practice Guideline Adaptation: Screening, Assessment and Management of Fatigue in Adult Survivors of Cancer