Approved by the Cancer.Net Editorial Board, 02/2016

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 tiredness from not getting enough rest. Cancer-related fatigue:

  • Causes problems with a person’s usual functioning

  • Does not reflect their level of activity

  • Does not improve with rest

Most people receiving cancer treatment experience fatigue. Some cancer survivors have fatigue that lasts for months and sometimes years after finishing treatment.

Talk with your health care team about any symptoms of fatigue you may experience. This includes any new symptoms or a change in symptoms. Diagnosing and relieving side effects is an important part of your cancer care and treatment. This is called symptom management or palliative care.

How fatigue affects your quality of life

Fatigue often 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 cope with treatment

Screening and diagnosing fatigue

ASCO recommends that your health care team evaluate your level of fatigue as part of a distress screening. This is a thorough evaluation of your emotional health and quality of life. In general, your doctor will ask about your level of fatigue throughout treatment and recovery. However, a thorough evaluation is recommended:

  • When you are first diagnosed with cancer

  • Each year and any time you develop symptoms of fatigue

Not all of the causes of cancer-related fatigue are well understood. Multiple factors may cause or worsen your fatigue. To help find the best way for you to manage fatigue, your doctor will look at several factors:

  • Fatigue history. As part of your fatigue history, you should be prepared to describe the fatigue, including:

    • How severe it is, on a scale from “no fatigue” to “most fatigue”

    • When the fatigue began

    • When you feel most tired

    • How long it lasts

    • Whether it has 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 to look for cancer-related causes of fatigue. These causes may include cancer that 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 learn if another health condition is affecting your fatigue.

Treating the causes of fatigue

The first step in managing fatigue is to treat any medical causes or conditions that are contributing to fatigue.

  • Managing pain. Living with constant pain will almost always make a person feel exhausted. Many of the medicines prescribed for pain also cause drowsiness, sleepiness, and fatigue. Your doctor can help you understand your options for managing pain. And, he or she can tell you about the common side effects of these options.

  • Managing depression, anxiety, and stress. Dealing with cancer may lead to feelings of distress, depression, and anxiety. These feelings can add to exhaustion and complicate treatment. Managing stress and treating depression and anxiety often make 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. Some medicines 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 1 to 2 hours contributes exhaustion. Lack of sleep can also 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 you have the option, 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. An RD can also help you manage eating when you have a lack of taste and/or nausea and vomiting.

  • Treating anemia. Many patients with cancer have anemia. Anemia is a decrease in the amount of red blood cells. Cancer or cancer-related treatments can cause anemia. 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. Medicines used to treat cancer also contribute to fatigue. For example, it is common for fatigue to appear after treatment at the following times:

    Also, medicines used to manage side effects may contribute to fatigue, such as those used for 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

    • Nerve problems

Other strategies to cope with fatigue

Along with treating and managing the medical causes of fatigue, lifestyle changes may help you cope with fatigue.

  • Physical Activity. Staying active or becoming more active can help relieve cancer-related fatigue. Start increasing your activity levels slowly. Walking programs are generally safe for most survivors. Once you are healthy enough, aim for or build up to 150 minutes of moderate activity each week. Moderate activity includes fast walking, cycling, or swimming. Also, aim for or build up to 2 to 3 strength training sessions per week. Talk with your doctor about the level and types of physical activity best for you. Many survivors benefit from working with a physical therapist or exercise specialist. These professionals can find the best ways for patients to increase or maintain physical functioning. This is especially important for those who have a higher risk of injury due to the cancer, its treatment, or other health conditions.

  • 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 may be beneficial . This type of therapy can help patients reframe their thoughts about fatigue. And, it can help improve coping skills and/or sleep problems that contribute to fatigue.

  • Mind-body strategies. There is some evidence that the following strategies can reduce fatigue in cancer survivors:

    • Mindfulness-based approaches

    • Yoga

    • Acupuncture

    In addition, the following methods may be helpful. However, more research is needed on these strategies.

    • Touch therapy

    • Massage

    • Music therapy

    • Relaxation

    • A form of touch therapy called reiki

    • A type of relaxation/meditation called qigong

    If you are interested in mind-body strategies to help manage your fatigue, talk with your health care team. They can give you 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. They seem most helpful for patients who are receiving cancer treatment or have advanced cancer. There is not much evidence that they are helpful for cancer survivors. But, research on supplements, such as ginseng and vitamin D, is ongoing.  

More Information

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

Side Effects

Integrative Medicine

American Society of Clinical Oncology Clinical Practice Guideline Adaptation: Screening, Assessment and Management of Fatigue in Adult Survivors of Cancer

Additional Resources

National Cancer Institute: Fatigue

LIVESTRONG Foundation: Fatigue