Cancer Fatigue

What is cancer fatigue?

Cancer-related fatigue (sometimes, simply called “cancer fatigue”) is one of the most common side effects of cancer and its treatments.

Like fatigue, cancer fatigue is whole-body exhaustion that you feel no matter how much sleep or rest you get. Cancer fatigue takes exhaustion a step further: You feel physically, emotionally and mentally exhausted most of the time.

Cancer fatigue may last a few weeks (acute) or for months or years (chronic). Chronic cancer fatigue can harm your quality of life.

How common is cancer fatigue?

Cancer-related fatigue affects 80% to 100% of people with cancer.

What are the symptoms of cancer fatigue?

With cancer fatigue, you may feel exhausted for no clear reason. Or maybe you were extra-active or had an usually busy day. People who experience cancer fatigue describe it as paralyzing tiredness that doesn’t go away no matter how much rest or sleep they get.

What causes cancer fatigue?

The exact reason for cancer fatigue is unknown. Cancer fatigue may be related to both the disease process and treatments.

Fatigue from cancer

When you have cancer, your body’s immune system is working hard to fight the disease, so it’s constantly drawing on your energy stores. Other changes happen that can cause cancer fatigue, including:

• Daily routine: Many people try to keep their normal daily routine and activities despite (or maybe to spite) cancer, using up energy when they don’t have much extra to spare.
• Depression: A cancer diagnosis may make you feel depressed and anxious. But fatigue and depression often go together, with depression sometimes making you feel like you’ve lost the will to do anything but sleep or try to sleep.
• Insomnia: If you’re not getting eight hours of sleep a night and some extra rest during the day, you may experience mental and physical fatigue.
• Pain: Research shows that chronic, severe pain increases fatigue.
• Stress: You may stress from dealing with the disease, worrying about your future or simply trying to keep up with your typical tasks and responsibilities. Regardless of the cause, stress can worsen fatigue.
• Tumor-induced “hypermetabolic” state: Tumor cells compete for nutrients, often at the expense of the normal cell's growth and metabolism. Weight loss, decreased appetite and fatigue are common results.

Fatigue from cancer treatments

When you have cancer treatment, you’re receiving medication that targets cancer but may also affect healthy cells and tissue. When this happens, it can:

• Change how cells work.
• Cause inflammation.
• Make you feel nauseated and dehydrated.
• Change hormone levels.
• Damage tissues and cells.
• Reduce red blood cell levels, which leads to anemia.
• Boost cytokine production.

Cancer treatments commonly associated with cancer fatigue are:

• Chemotherapy: Any chemotherapy drug may result in fatigue that may last a few days, as long as you’re receiving treatment or even after you finish treatment.
• Radiation therapy: Radiation therapy can cause cumulative fatigue (fatigue that increases over time). Cancer fatigue usually lasts from three to four weeks after treatment stops, but can continue for up to two to three months.
• Immunotherapy: Immunotherapy stimulates your immune system to fight cancer. The treatment is also sometimes called biological therapy. Cancer fatigue from immunotherapy may last a few months to a year after you finish treatment.
• Stem cell (bone marrow) transplant: This treatment can cause cancer fatigue that lasts up to one year.

What are the complications?

Persistent cancer fatigue can interfere with your ability to take part in life’s activities. You may miss out on time with family and friends. It can affect your ability to concentrate and think clearly. Some people are too exhausted to continue working.

How is cancer fatigue diagnosed?

Your healthcare provider will do a physical examination and ask about your experience with fatigue, like whether it comes and goes or is constant or if any specific activity or medication makes you more tired.

They may ask you to keep a journal to track your levels of fatigue. They may ask you to note what you’re doing or experiencing when it gets worse. Your provider also may order blood tests to check for anemia, infection or other issues that may cause or increase fatigue.

How is cancer fatigue treated?

There is no single medication available to treat cancer-related fatigue. However, there are medications available that can treat some of the underlying causes.

For example, if you have anemia, your healthcare provider may prescribe treatments to increase red blood cell levels. If you have depression, they may prescribe antidepressants. Unfortunately, sometimes, cancer fatigue happens for multiple reasons, which makes it difficult to treat.

Palliative care may help. Palliative care experts may help you manage symptoms and side effects. They’re also able to connect you with spiritual support and mental health services.

What can I do to manage cancer fatigue?

It can be a challenge to manage cancer-related fatigue. Here are some suggestions that may help:

• Adopt healthy sleep habits: Build better sleep habits like going to bed at the same time each night and sleeping in a dark, quiet room. Take rest breaks during the day, but don’t sleep more than 30 minutes at a time, so you can fall asleep at night.
• Ask for help: Let family and friends run errands, fix meals or help with housework or childcare.
• Cut back on caffeine: Caffeine supplies provide a temporary pick-me-up. But it can also keep you up at night.
• Drink plenty of fluids: It’s important to stay hydrated, especially if you have treatment side effects like vomiting or diarrhea. Aim to drink 64 ounces of fluid daily. (Caffeine drinks don’t count.)
• Eat well: Fill your plate with protein, which helps rebuild and repair damaged body tissue. Cancer treatment can affect your appetite. If that’s your situation, ask to work with a nutritionist. They’ll help you to find ways to get the nutrition you need.
• Manage your medication: Make sure your healthcare provider knows if you’re taking over-the-counter medications or supplemental vitamins. Some medications and vitamins may not work well with cancer drugs.
• Move more: As surprising as it might sound, studies show that staying active is one of the best ways to fight fatigue. Going for a walk outdoors while breathing fresh air can be especially invigorating. Physical activity, including gentle exercises like yoga and tai chi, may also help you sleep better.
• Seek mental health support: Cognitive behavioral therapy (CBT) can help you cope with the range of emotions you may feel. Therapy can help you manage stress and may even improve sleep. It may help to take part in online support groups.
• Use mind-body strategies: Research suggests that mindfulness practices, such as yoga and acupuncture, lessen cancer fatigue. You may also see improvements with massage therapy, meditation and relaxing martial arts like qigong and tai chi.

Can cancer fatigue be prevented?

Unfortunately, there’s no way to keep cancer fatigue from happening. But the following suggestions may help make it easier to manage:

• Consult with your healthcare provider: Cancer fatigue is a cancer symptom. If you know that you have cancer, don’t hesitate to tell your provider if you feel exhausted no matter how much rest you get. That way, your provider can offer guidance and help you begin to manage cancer fatigue before fatigue takes over your life.
• Bank your energy: Think of your personal energy stores as a bank where you keep a healthy balance of energy deposits and withdrawals.
• Track your day: Spend one week noting the times of day when you have the most energy or you’re at the end of your energy supply. Noting what may contribute to your fatigue may help you keep it from taking over your day.
• Watch for warning signs: Stiff shoulders, tired eyes and legs and feeling weak are physical warning signs that you’re running out of steam. Emotional or mental signs may be anxiety, impatience, feeling irritable, nervousness or not being able to concentrate.

What can I expect if I have cancer fatigue?

Everyone’s experience with cancer fatigue is unique. For some people, fatigue lasts a few weeks. Others may feel exhausted for years. You may feel better when your cancer treatments stop, but often, fatigue lingers. For example:

• Bone marrow transplants can cause prolonged fatigue that lasts up to a year.
• Radiation therapy fatigue often gets worse as treatments progress. Fatigue should lessen a few months after you stop treatment.
• Surgery tends to cause temporary fatigue that goes away after you recover.
• Systemic treatments (medications that circulate in blood) can cause fatigue that comes and goes. You may be exhausted while taking the medications and feel better during the recovery phase (no medication). When treatment resumes, you can feel exhausted again. You should have more energy when you finish the treatment.

What can I expect while living with cancer fatigue?

You may have cancer-related fatigue throughout your treatment and for some time afterward. Depending on your situation, cancer fatigue may be an issue for several months up to a year. That’s a long time, so you may want to consider a formal plan for living. That plan may include setting priorities and controlling your environment.

Setting priorities

Remember that energy bank where you deposit and withdraw from your energy supplies? Setting priorities and pacing yourself is how you make sure you have energy when you need it. Decide what activities are important to you, whether that’s work, activities with family and friends or simply taking care of your household. Then, do the following:

• Target important tasks: Use your energy to carry out what’s most important to you, from a work project to a family activity to spending time with friends.
• Pace yourself: Tackling activities slowly is better than rushing through them. Plan your day so you have enough time and energy to complete your to-do list. Find ways to combine errands or even work around the house.
• Build in breaks: Frequent short rests help and remember to rest when you need to, before you feel exhausted, and not just when you think you can.

Control your environment to conserve your energy

There are ways to protect your body from strain that can increase cancer fatigue. Here are some examples:

• Alternate sitting and standing. When sitting, use a chair with good support.
• Adjust your workspace so you don’t need to bend over to reach items.
• Avoid strain. If you need to lift something, remember to bend at your knees and hips, not your back.

When should I see my healthcare provider?

Contact your provider if you:

• Can’t get out of bed.
• Experience depression, anxiety or other mood changes.
• Feel confused or have memory problems.
• Have severe pain.
• Struggle to breathe.
• Are unable to control the side effects (nausea, vomiting, diarrhea, loss of appetite) of cancer treatment.