What is fatigue?
Fatigue can be confused with tiredness. Everyone gets tired. It's an expected feeling after certain activities or at the end of the day. Usually, we know why we're tired, and a good night's sleep will solve the problem.
Fatigue is different. Fatigue is a daily lack of energy — an unusual or excessive whole-body tiredness that is not relieved by sleep. It can be acute (lasting a month or less) or chronic (lasting from one to six months or longer). Fatigue can have a profoundly negative impact on a person's ability to function and quality of life.
What is cancer-related fatigue?
Cancer-related fatigue (CRF, sometimes simply called "cancer fatigue") is one of the most common side effects of cancer and its treatments. Many people who are chronically ill feel tired. But cancer-related fatigue goes beyond the usual tiredness. People who experience cancer fatigue often describe it as "paralyzing." Usually, it comes on suddenly and is not the result of activity or exertion. With this type of fatigue, no amount of rest or sleep helps. 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.
Who might have cancer fatigue?
Symptoms and Causes
What causes cancer fatigue?
- Change how cells work.
- Cause inflammation.
- Make you nauseated and dehydrated.
- Change hormone levels.
- Damage tissues and cells.
- Reduce blood counts, leading to anemia.
- Stimulate the production of cytokines (toxic cell proteins).
The exact reason for cancer fatigue is unknown. Cancer fatigue may be related to both the disease process and treatments, including surgery, chemotherapy, radiation therapy and immunotherapy. Cancer treatments commonly associated with cancer fatigue are:
- Chemotherapy. Any chemotherapy drug may result in fatigue. This may vary from person to person. Some people say it lasts only a couple of days. Others feel the fatigue persists through and beyond the completion of treatment. Drugs such as vincristine, vinblastine, and cisplatin often cause cancer fatigue.
- Radiation therapy. Radiation therapy can cause cumulative fatigue (fatigue that increases over time). This can occur regardless of treatment site. Cancer fatigue usually lasts from 3-4 weeks after treatment stops, but can continue for up to 2-3 months.
- Immunotherapy. Immunotherapy stimulates your immune system to fight cancer. The treatment is also sometimes called biological therapy.
- Bone marrow transplant. This aggressive form of treatment can cause cancer fatigue that lasts up to one year.
- Biologic therapy. Cytokines are natural cell proteins, such as interferons and interleukins, which are normally released by white blood cells in response to infection. These cytokines carry messages that regulate other elements of the immune and endocrine systems. In high amounts, these cytokines can be toxic and lead to persistent fatigue.
Cancer and its treatment can also make you prone to these issues that may contribute to cancer fatigue:
- Anemia. Anemia can result from blood counts that are reduced by treatment. These lowered blood counts reduce the oxygen-carrying ability of the blood (hemoglobin). About 7 in 10 patients experience anemia during chemotherapy.
- Combination therapy. People experiencing more than one treatment at the same time or one after the other may experience more cancer 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.
- Decreased nutrition from the side effects of treatments (such as nausea, vomiting, mouth sores, taste changes, heartburn and diarrhea).
- Hypothyroidism. If the thyroid gland is underactive, your metabolism may slow so that your body doesn't burn food fast enough to provide adequate energy. This is a common condition in general but may happen after radiation therapy to the lymph nodes in your neck.
- Medications used to treat side effects such as nausea, dehydration, pain, depression, anxiety and seizures can contribute to cancer fatigue.
- Pain. Research shows that chronic, severe pain increases fatigue.
- Daily routine. Many people try to maintain their normal daily routine and activities during treatments. You may need to modify your routine to conserve energy.
- Stress can worsen feelings of fatigue. This can include any type of stress, from dealing with the disease and the unknowns to worrying about daily accomplishments or worrying about not meeting the expectations of others.
- Depression and fatigue often go hand in hand. It may not be clear which started first. One way to help sort this out is to try to understand how your feelings of depression. Are you depressed all the time? Were you depressed before your cancer diagnosis? Are you preoccupied with feeling worthless and useless? If the answers to these questions are yes, you may need treatment for depression.
- Insomnia. Inability to sleep eight hours a night will cause both mental and physical fatigue.
Diagnosis and Tests
How can I tell if I have cancer fatigue?
- Think of your personal energy stores as a "bank." Deposits and withdrawals have to be made over the course of the day or the week to ensure a balance between energy conservation, restoration and expenditure.
- Keep a diary for one week to identify the time of day when you are either most fatigued or have the most energy. Note what you think may be contributing factors.
- Be alert to the warning signs of impending cancer fatigue — tired eyes, tired legs, whole-body tiredness, stiff shoulders, decreased energy or a lack of energy, inability to concentrate, weakness or malaise, boredom or lack of motivation, sleepiness, increased irritability, nervousness, anxiety or impatience.
How is cancer fatigue diagnosed?
Your healthcare provider will assess your symptoms. You may be asked to complete a questionnaire or rate your fatigue level. Your provider may ask you to keep a journal to track your level of fatigue and factors that might contribute to fatigue.
Blood tests can check for anemia, signs of infection or other problems that cause fatigue.
Management and Treatment
How can I combat cancer fatigue?
The best way to combat fatigue is to treat the underlying cause. Unfortunately, the exact cause may be unknown, or there may be multiple causes. There are treatments to reduce certain causes of cancer fatigue, such as anemia or hypothyroidism. Other causes must be managed on an individual basis.
The following are tips you can use to combat cancer fatigue:
What are the complications of cancer fatigue?
Persistent fatigue can interfere with your ability to participate 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.
As many as 1 in 4 people with cancer develop depression. Sometimes, it’s hard to determine if fatigue leads to depression or vice versa.
How is cancer fatigue managed or treated?
The first step in treating fatigue is knowing the problem exists. Many people don't bother to mention fatigue to their doctors because they believe it is normal. It's vital that you discuss this and all symptoms or side effects with your healthcare provider. Then, efforts can be directed at determining the cause of the problem and prescribing appropriate treatment. Your particular cancer treatment regimen, with its known side effects, may provide clues for your doctor or health care professional. A simple blood test, for example, can determine if you are anemic.
There is no single medication available to treat fatigue. However, there are medications available that can treat some of the underlying causes.
When you’re struggling, you may want to see a palliative care specialist. These experts help people with cancer manage symptoms like pain, nausea and depression.
Your provider or palliative care team may recommend these actions to ease fatigue:
- 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. In-person and online support groups can also provide help.
- Talk to a dietitian: A nutrition specialist can recommend dietary changes, vitamins and electrolyte supplements to raise your energy. You can also find foods that won’t aggravate cancer treatment-related side effects like nausea, mouth sores and diarrhea.
- 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.
Outlook / Prognosis
How long does cancer fatigue last?
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.
- 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. These treatments include chemotherapy, immunotherapy and targeted therapy. You may be exhausted while taking the medications and feel better during the recovery phase (no medication). When treatment resumes, you feel exhausted again. You should have more energy when you finish the treatment.
When should I call the doctor?
You should call your healthcare 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.
What questions should I ask my doctor?
You may want to ask your healthcare provider:
- What is causing my fatigue?
- What are the best ways to manage cancer fatigue?
- How long will cancer fatigue last?
- Should I look out for signs of complications?
How can I conserve energy when I have cancer fatigue?
Plan and organize your work
- Change storage of items to reduce trips or reaching.
- Delegate when needed.
- Combine motions and activities and simplify details.
- Balance periods of rest and work.
- Rest before you feel tired.
- Frequent, short rests are beneficial.
- A moderate pace is better than rushing through activities.
- Reduce sudden or prolonged strains.
- Alternate sitting and standing.
Practice proper body mechanics to combat cancer fatigue
- When sitting, use a chair with good support.
- Adjust work heights − work without bending over.
- Bend at your knees and hips, not at your back.
- Carry several smaller loads or use a cart.
Limit overhead work
- Use long-handled tools.
- Store items lower.
Limit isometric work
- Do not hold your breath.
- Wear comfortable clothes to allow for free and easy breathing.
Identify anything in your environment that may contribute to cancer fatigue
- Avoid extreme temperature.
- Eliminate smoke or noxious fumes.
- Avoid long, hot showers or baths.
- Decide what activities are important to you, and what could be delegated.
- Use your energy on important tasks.
Should I change the way I eat to combat cancer fatigue?
Cancer fatigue may be worse if you're not eating enough or if you are not eating the right foods. Maintaining good nutrition can help you feel better and have more energy. The following strategies can help you improve your nutritional intake.
- Basic calorie needs. A person with cancer whose weight has been stable needs about 15 calories per pound of weight each day. For example, a person who weighs 150 pounds needs about 2,250 calories per day to maintain weight. You should add 500 calories per day if you have lost weight.
- Protein rebuilds and repairs damaged (and normally aging) body tissue. You need about 0.5-0.6 grams of protein per pound of body weight to rebuild and repair body tissue. For example, a 150-pound person needs 75 to 90 grams of protein per day. The best sources of protein include foods from the dairy group (8 ounces of milk = 8 grams protein) and meats (meat, fish, or poultry = 7 grams of protein per ounce).
- Fluid needs. Unless your healthcare provider tells you otherwise, you should aim for about 64 ounces per day to prevent dehydration. Fluids include juice, milk, broth, milkshakes, Jello® and other beverages. Of course, water is fine, too. It’s important to note that beverages containing caffeine do NOT count. And if you are losing fluid from excessive vomiting or diarrhea, you will need extra fluids.
- Supplemental vitamins. Talk with your healthcare provider to find out if vitamin supplements are a good idea for you. Vitamin supplements don't provide calories, which are essential for energy production. So vitamins cannot substitute for adequate food intake.
Can a dietitian help me fight cancer fatigue?
Dietitians can provide suggestions to work around any symptoms that may be interfering with caloric intake. They can help you find ways to take in calories despite an early feeling of fullness, swallowing difficulty or taste changes. Dietitians can also suggest ways of maximizing calories and proteins in smaller amounts of food. They may suggest powdered milk, instant breakfast drinks and other commercial supplements or food additives.
How can exercise help reduce cancer fatigue?
You may feel ill from your cancer or treatment, which may lead to less physical activity. Decreased levels of physical activity can lead to tiredness and lack of energy. Scientists have found that even healthy athletes forced to spend extended periods in bed or sitting in chairs develop feelings of anxiety, depression, weakness, fatigue and nausea. Regular, moderate exercise can decrease the feeling of fatigue and help you feel energetic. Even during cancer therapy, it's often possible to continue to exercise. Be sure to check with your healthcare provider before starting an exercise program.
Exercise has many health benefits. Regular exercise can:
- Lower blood pressure.
- Improve your heart's pumping ability.
- Give you more energy.
- Increase your endurance.
- Strengthen your tendons, ligaments, joints and bones.
- Ease the pain and stiffness of arthritic joints.
- Lead to a more positive outlook.
- Improve your sleep patterns.
- Increase your appetite.
What is the right kind of exercise for cancer fatigue?
It's important for you to exercise your whole body every day, or at least every other day. A good exercise plan starts slowly, allowing your body time to adjust. Any kind of exercise is acceptable, including walking, riding a stationary bike, yoga or swimming (if the immune system is OK), and strength training. Whatever kind of exercise you do should be at a moderate intensity so you can say to yourself "I am working somewhat hard." Avoid exercise that makes you feel sore, stiff or exhausted.
What is the wrong kind of exercise for cancer fatigue?
Exercising only occasionally or doing too much too fast can be dangerous. If you experience soreness, stiffness, exhaustion or feel out of breath as a result of your exercise, you are overdoing it.
Can stress management help with cancer fatigue?
Managing stress can play an important role in combating fatigue. Here are some ways you can manage stress:
- Adjust your expectations. For example, if you have a list of 10 things you want to accomplish today, pare it down to two and leave the rest for other days. A sense of accomplishment goes a long way to reducing stress.
- Help others to understand and support you. Family and friends can be helpful if they can "put themselves in your shoes" and understand what cancer fatigue means for you. Cancer support groups can be a source of support as well. Other people with cancer truly understand what you are going through.
- Relaxation techniques including guided meditation, deep breathing or visualization can help reduce stress and minimize cancer fatigue.
- Divert your attention. Activities that divert your attention away from fatigue can also be helpful. Activities that require little physical energy but demand attention include knitting, reading or listening to music.
If your stress feels overwhelming, talk to your healthcare provider. They are there to help.
Can sleep be improved to reduce cancer fatigue?
Sleep is an important part of wellness. Good sleep can improve your mental and physical health. Several factors contribute to how well you sleep, and there are things you can do to improve your sleep, including:
- Doing relaxation exercises, meditation or relaxation yoga before going to sleep.
- Avoiding long afternoon naps.
- Going to bed only when sleepy. Use your bedroom only for sleep and sexual activities.
- Setting a consistent time to lie down and get up.
- Avoiding caffeine and stimulating activities in the evening.
- Establishing a relaxing pre-sleep routine.
How can I prevent cancer fatigue?
You can’t do much to prevent cancer-related fatigue. But these strategies may help minimize the problem:
- Adopt healthy sleep habits: To build better sleep habits, keep phones and TVs out of the bedroom, go to bed at the same time every night and sleep in a dark, quiet room.
- Ask for help: Let family and friends run errands, fix meals or help with housework or child care.
- Cut back on caffeine: Caffeine provides a temporary pick-me-up. But it can also keep you up at night.
- Drink plenty of fluids: It’s important to stay hydrated and eat nutritious foods.
- Set priorities: Be realistic about what you can do. Save your energy for the things that matter most.
- Stay physically active: Go for a walk or try yoga or tai chi. Don’t exercise too late in the evening. The activity may make it harder to fall asleep.
- Take 30-minute rest breaks: During the day, don’t sleep longer than 30 minutes or you could have trouble falling asleep at night. Rest breaks can help if you have an upcoming event that requires a lot of energy.
A note from Cleveland Clinic
A chronic illness like cancer can bring many unwanted challenges. Cancer fatigue is one of them. It makes sense that fighting off cancer can tire out your body. Cancer treatments can also be physically and mentally exhausting. Still, you shouldn’t hesitate to let your healthcare provider know how cancer fatigue is affecting your life. You can take steps to bring more energy back into your days.
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