Fatigue

Approved by the Cancer.Net Editorial Board, 04/2020

Cancer and cancer treatment may cause fatigue. The medical term for this is "cancer-related fatigue." It is a feeling of physical, emotional, and mental exhaustion even though you are getting enough rest and sleep.

Cancer-related fatigue can affect your daily life. And, some people may experience this kind of fatigue for months or years after finishing treatment.

Talk with your health care team if you are experiencing fatigue. Share any new or changing symptoms or side effects on a regular basis. Managing symptoms, including fatigue, is an important part of your overall cancer care and treatment. This is called palliative care or supportive care.

How does cancer fatigue affect daily life?

For some people, cancer-related fatigue is a minor side effect. For others, fatigue can affect their day-to-day life. It can impact:

Mood and emotions
Daily activities
Hobbies and other activities
Relationships with friends and family
Ability to cope with treatment
Job performance
Hope for the future

How is cancer-related fatigue diagnosed?

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

Your doctor will ask about your experiences and history with fatigue to better understand what is causing or worsening your fatigue. These questions will help you describe your fatigue to your health care team:

How severe is the 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?

What causes cancer-related fatigue and how is it treated?

Cancer-related fatigue has several different causes:

Health changes related to cancer. Your doctor may take a blood sample or perform other tests. These results may show cancer-related causes of fatigue. Fatigue can be a symptom of the cancer itself or that the cancer is growing or spreading.

Cancer treatments. Certain cancer treatments contribute to fatigue. For example, people commonly experience fatigue at these times:

A few days after a chemotherapy treatment
A few weeks after starting radiation therapy
A few months after immunotherapy treatment

Pain. Living with constant pain is exhausting and stressful. And, many pain medicines cause drowsiness and fatigue. Ask your health care team about other ways to manage pain and its side effects.

Depression, anxiety, and stress. Managing stress and treating depression and anxiety can reduce your fatigue.

Sleeping problems. Stress, pain, and worry may contribute to insomnia. This 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 registered dietitian (RD) for nutrition counseling. These professionals can help you find ways to eat well, especially if you have taste issues, appetite loss, or nausea and vomiting.

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

Other medical/health conditions. People with cancer, especially those who are 65 years and older, may have other health conditions that contribute to fatigue. It is important to treat any medical conditions that are contributing to your fatigue. Your doctor may ask questions or recommend additional tests to find these causes. Other medical conditions may include:

Heart problems
Reduced lung and kidney function
Hormone problems
Arthritis
Nerve problems

How is cancer-related fatigue managed?

Lifestyle changes and help from your cancer care team may help you cope with fatigue. Talk regularly with your doctor if you are experiencing fatigue during and after your cancer treatment. Ask your health care team about these strategies:

Physical activity. Staying or becoming physically active can help relieve fatigue. Ask your doctor which types of physical activity and exercise are best for you and what level of 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 can help patients maintain and improve strength, minimize pain, and improve physical function.

You may also benefit from working with a personal trainer to develop a personalized exercise program. Research indicates that exercise is one of the most effective ways to treat fatigue.

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 causing fatigue.

Mind-body strategies. Evidence suggests that mindfulness practices, yoga, and acupuncture can reduce fatigue in cancer survivors. Other mind-body strategies that might be helpful, but that have not been fully studied by researchers, include:

Touch therapy, including reiki
Music therapy
Massage
Relaxation
Qigong, a type of relaxation and meditation

Ask your health care team for referrals to professionals who specialize in using these methods for cancer survivors.

Nutrition. Sometimes, cancer and its treatment may affect your ability to maintain a healthy diet. Consider talking with a registered dietitian to be sure you are meeting all your nutritional needs.

Medications and supplements. Some medications help people feel more alert and awake. They are most helpful for people who are currently receiving cancer treatment and people who have advanced cancer.

Some treatments may affect your hormone production from your thyroid gland or adrenal glands. If these levels are low, you may benefit from medicine to replace these hormones.

Your cancer care team may want to check for nutritional deficiencies like iron, vitamin B12, or vitamin D. If these levels are low, you may benefit from taking a supplement with the guidance of your cancer care team. Researchers have studied other supplements like ginseng, which seem to improve cancer-related fatigue. However, it is important to talk with your health care team before taking any dietary or herbal supplements to make sure they do not interact with your cancer treatment.

Questions to ask the health care team

You may want to ask your cancer care team the following questions.

Do you think my cancer treatment will cause cancer-related fatigue? If so, when?
If I'm experiencing fatigue, what do you think the reason is?
Will I need additional tests to find out more about my fatigue?
What can be done to help me cope with cancer-related fatigue?
Should I talk with a registered dietitian, counselor, physical therapist, or other health providers about ways to help me manage my cancer-related fatigue?