+ -Text Size

Managing Cancer-related Fatigue

Fatigue is common in people with cancer, but it’s different for each person. While one person may feel too tired to even get out of bed, another may be able continue working and do most of the things they’ve always done. Fatigue might get better after treatment ends for some, but last many months after treatment for others.

Doctors, nurses, social workers, physical therapists, nutritionists, and a number of others might be involved in treating your fatigue. Fatigue is often caused by more than one problem. Treating a certain problem, like anemia, might make you feel better, but other things may need to be done, too. For this reason your cancer care team might have you try many different things to help manage your fatigue.

There’s no way to know if you’ll have fatigue, how bad it will be, or how long it will last. In some cases, it can be hard for the doctor to figure out exactly what’s causing your fatigue. Still, there are things you can do to help manage it. Here are some tips to help manage cancer-related fatigue:

Rest, but not too much.

Plan your day so you have time to rest. Take short naps or rest breaks (30 minutes or less), rather than one long nap during the day. Too much rest can lower your energy level and make it harder to sleep at night.

Sleep problems are common during cancer treatment. You may have trouble falling asleep or sleep too much. Certain drugs used to treat pain, nausea, or depression can make a person feel tired and sleepy. Talk with your cancer care team about this. Sometimes adjusting the doses or changing to a different drug can help.

Try to sleep 7 to 8 hours each night. Sleep experts tell us that having regular times to go to bed and get up helps us keep a healthy sleep routine. Avoiding caffeine in fluids (like coffee, tea, energy drinks, or soda), medicines (like headache remedies), or even in foods (like chocolate) for at least 8 hours before bed can help, too. Exercising too late in the evening might cause sleep problems.

If you’re having trouble sleeping, talk to your cancer care team about it. It can help to see a mental health professional who can work with you on causes and how to address sleep problems.

Stay active.

Try to stay as active as you can. Regular moderate exercise – especially walking – is a good way to ease fatigue. And not only can exercise help fatigue, it can help you sleep better, too.

Aerobic and strength-building exercise programs – started only with your doctor’s OK – can lead to better body function, as well as feeling better about your life and well-being. You may need to see a physical therapist to learn the best exercise routines for you at this time.

Talk to your doctor first and always be careful about exercising if you have any of these:

  • Cancer that has spread to your bones (bone metastasis)
  • A low white blood cell count
  • A low platelet count
  • A fever or active infection
  • Anemia (low red blood cell counts)
  • Unsteadiness, frailty, or other problem that might make exercise unsafe for you

These factors can lead to injury, pain, bleeding, or other problems if they aren’t taken into account before you start to exercise. If you have any of these factors, your exercise program will need to be set up by a professional who knows about exercise and cancer.

Save your energy.

Conserving (or saving) energy is one way to make sure you have enough energy to do what needs to be done each day. You may need to accept the fact that you can’t do everything you want to do.

Each day, prioritize – decide which things are most important to you and focus on those tasks. Then plan ahead. Spread activities throughout the day. Do things slowly, so that you won’t use too much energy at once. And don’t forget to give yourself time to take short rest breaks between activities.

Don’t push yourself by standing too long or by doing activities in extreme temperatures. Even long, hot showers or baths can drain your energy. Sit when you can – a shower chair may help. And a chair in the bathroom lets you brush your teeth or comb your hair without wasting energy by standing at the sink. Another easy tip is to store items that you use often within easy reach. This way you won’t have to strain or walk to get them.

Get help.

Ask your family or friends to help with the things you find tiring or too hard to do. This could include mowing the lawn, preparing meals, doing housework, or running errands. Don’t force yourself to do more than you can manage. Let others help you. This can help them feel useful and get your tasks done, too.

Many people may ask if there’s anything they can do for you. People who offer to help really want to, but they may not know what to do. Asking them to do something specific can give them something to do that really helps you and makes them feel good, too.

You may even want to pick a “job coordinator” who can organize people to sign up for routine chores. Your coordinator can also help others understand if there are times when you’re so tired that you don’t have the energy to talk or visit with people.

Eat well.

Drink plenty of water and juices. Eat as well as you can. Try to eat at least 2½ cups of fruits and vegetables each day. Get enough protein and calories to help your body heal.

Many people with cancer have changes in the way they eat, swallow, and taste things during treatment. Talking with a registered dietitian may help you learn ways to manage problems like loss of appetite, diarrhea, nausea, or vomiting. The dietitian also can make sure you are getting enough fluids and nutrients to help keep your blood chemistry balanced.

Reduce stress.

Having cancer is stressful and cancer treatment can cause even more stress. Talk with a social worker or nurse on your cancer care team about your level of stress. This can help you know if it’s “normal” stress or more worrisome anxiety or depression. Feeling tired might be linked to feeling depressed and anxious.

You may want to think about joining a support group. Sharing your feelings with others can help ease the burden of fatigue. You can also learn coping hints from others by talking about your situation. Ask your cancer care team to put you in touch with a support group. Or contact us to find a group near you.

Mental health counseling, stress management training, and relaxation exercises are some ways you can learn to improve the feelings related to fatigue and help overcome the tiredness you feel.

Distraction

Sometimes feeling tired can become so discouraging and frustrating that it’s easy to let it become all you think about. Try to distract yourself with other things, like listening to music, having relaxing visits with friends or family, or reading a book. These things can give you an escape from your fatigue without using up too much energy.

Use attention-restoring activities

Certain activities can help you relax, and focus better. These activities include things like walking in a park, sitting in a peaceful setting, gardening, doing volunteer work not related to your illness, or bird watching. Some people use meditation or guided imagery to clear their minds without leaving home.

Talk to your cancer care team.

Treating fatigue is an important part of care for you and your family. It’s often possible to lessen fatigue so that life can be more normal. But before anything can be done to help you, your cancer care team must know about your level of fatigue, or how bad your fatigue is.

Describing fatigue

No lab tests or x-rays can diagnose or show your level of fatigue. The best measure of fatigue comes from the way you describe your fatigue level to your cancer care team. But fatigue can be hard to describe.

People with fatigue describe it in many ways. They may say they feel tired, weak, exhausted, weary, worn-out, or slow. They may say they have no energy and can’t concentrate. They also talk about having heavy arms and legs, little drive to do anything, being unable to sleep or sleeping too much. They may feel moody, sad, irritable, or frustrated. Patients rarely describe what they’re feeling as “fatigue” unless their cancer care team suggests it.

How bad is your fatigue?

You can describe your level of fatigue as none, mild, moderate, or severe. Or you can use a scale of 0 to 10, where a 0 means no fatigue at all, and a 10 means the worst fatigue you can imagine. Ask your doctor or nurse how to describe your fatigue so they can understand how it affects your everyday life.

If you have moderate (4 to 6 on the 0 to 10 scale) to severe (7 to 10 on the 0 to 10 scale) fatigue, your doctor could ask you for more information. You might be asked questions like:

  • When did the fatigue first start?
  • When did you first notice that this fatigue is different?
  • How long has it lasted?
  • Has it changed over time? In what way?
  • Does anything make it better? Worse?
  • Are there times of day that you notice it more?
  • How has the fatigue affected the things you do every day or the activities that give meaning and enjoyment to your life?
  • Do you have any other problems or concerns?

In planning how to treat your fatigue, your doctor might take into account things like your type of cancer, the type and length of treatment, how likely the treatment is to cause fatigue, and your response to treatment.

Ask about medicines

There’s no magic pill that can make you less tired and give you more energy, but some medicines might help with fatigue. In some cases, fatigue can be bad enough that your doctor or nurse recommends a stimulant medicine for a short time.

If you’re having problems sleeping, your doctor or nurse may suggest a medicine to help you sleep.

More research is needed and is being done in this area, but there are drugs available that may give you relief if your fatigue gets bad.

Call your doctor.

Call your doctor if you feel too tired to get out of bed for a 24-hour period, if you feel confused, dizzy, lose your balance or fall, have problems waking up, have problems catching your breath, or if the fatigue seems to be getting worse. These may be signs of other problems that need to be treated.

Managing your fatigue

Here’s a recap of things you can do to help manage and reduce your fatigue:

  • Balance rest and activity. Too much time in bed can make you weak.
  • Talk to your doctor about physical exercise and what’s best for you.
  • List your activities in order of how important they are to you, so you can do the more important ones when you have the most energy.
  • Ask for help and have other people do things for you when possible.
  • Unless you’re given other instructions, eat a balanced diet that includes protein (meat, milk, eggs, and beans) and drink about 8 to 10 glasses of water a day.
  • Learn ways to deal with your stress. Try to reduce it using things like deep breathing, imagery, meditation, prayer, talking with others, reading, listening to music, painting, or any other things you like to do.
  • Tell your cancer care team about your fatigue. Keep a record of how you feel each day. Take it with you when you see your doctor.

Remember: There’s no one way to diagnose or treat fatigue. Talk to your doctor or nurse about it. Let them know how bad it is so you can get the help you need to deal with it.

References

Bower JE, Bak K, Berger A, et al. Screening, assessment, and management of fatigue in adult survivors of cancer: an American Society of Clinical oncology clinical practice guideline adaptation. J Clin Oncol. 2014;32(17):1840-1850.

Escalante CP, Kallen MA, Valdres RU, et al. Outcomes of a cancer-related fatigue clinic in a comprehensive cancer center. J Pain Symptom Manage. 2010;39(4):691-701.

Minton O, Richardson A, Sharpe M, et al. Drug therapy for the management of cancer-related fatigue. Cochrane Database Syst Rev. 2010;7:CD006704.

National Cancer Institute. Fatigue PDQ (Health Professional Version). 8/28/14. Accessed at www.cancer.gov/about-cancer/treatment/side-effects/fatigue/fatigue-hp-pdq on May 9, 2016.

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology. Cancer-Related Fatigue – V.1.2016. Accessed at www.nccn.org/professionals/physician_gls/f_guidelines.asp on May 9, 2016

Neefjes ECW, van der Vorst MJDL, Blauwhoff-Buskermolen s, Verheul HMW. Aiming for a Better Understanding and Management of Cancer-Related Fatigue. Oncologist. 2013;18(10):1135-1143.

Qu D, Zhang Z, Yu X, et al. Psychotropic drugs for the management of cancer-related fatigue: a systematic review and meta-analysis. Eur J Cancer Care (Engl). 2015 Oct 21. doi: 10.1111/ecc.12397. [Epub ahead of print]


Last Medical Review: 05/18/2016
Last Revised: 05/24/2016