Managing Fatigue or Weakness

Feeling weakness or fatigue is common in people with cancer, but it's different for each person. Feeling weak is often one part of having fatigue. It's important to remember that fatigue might get better after treatment ends for some, but last many months to years after treatment for others.

Describing and managing weakness

Weakness is decreased strength. If this is caused by surgery in a certain part of the body or loss of a body part, the weakness might be helped by physical therapy or occupational therapy. If weakness is caused by having an infection or having changes in blood levels, such as low blood counts, low electrolytes, or changes in hormones, treatment to help with the specific problem can help decrease weakness.

Describing fatigue

Fatigue can have many causes. People with cancer describe fatigue 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.

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. You can describe your level of fatigue as none, mild, moderate, or severe. Or you can use a scale of 0 to 10, where 0 means no fatigue at all, and 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?
  • 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?

Is it fatigue or depression? 

Some signs of fatigue or weakness often look a lot like those of depression, and it’s easy to confuse the two. Depression involves an inability to feel pleasure – people who are depressed feel sad or unworthy. They may give up hope. You can have fatigue and not be depressed, although some people have both fatigue and depression.

Sometimes it may be hard to find a label for what you’re feeling. Your doctor might want you to see a mental health professional to get another opinion on whether depression is part of the problem. If it is, treatment can help.

Managing fatigue

Because the symptoms of fatigue in people with cancer are usually caused by more than one problem, doctors, nurses, social workers, physical therapists, pharmacists, dietitians and nutritionists, and a number of others might be involved in treating your fatigue or weakness. These symptoms often are caused by more than one problem.

Treating different specific cancer-related problems, like anemia or pain, 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 or work with a palliative care team to address multiple symptoms.

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.

Different activities and therapies

Exercise, yoga, massage therapy, counseling, and dietary or nutritional counseling are all used to help treat fatigue and weakness.

If you’re having problems sleeping or sleeping too much, your doctor or nurse may suggest sleep therapy. This therapy can help you minimize sleep disturbances and learn improved sleep hygiene.

More research is needed and is being done in this area, but there are stimulant drugs your health care team may prescribe you if your fatigue doesn't improve. These stimulants are only prescribed for a short period. It's important you talk to your doctor about the benefits of taking these drugs, as well as the different side effects that may occur such as daytime sleepiness, withdrawal symptoms, insomnia, memory problems, or allergic reactions.

Exercise and yoga

Research studies have shown that physical activity during and after cancer treatment can decrease fatigue. Your health care team can refer you to exercise specialists (physical therapist, physical medicine, rehabilitation specialist) to help you with a safe exercise plan that can be modified to your condition. Yoga has helped improve sleep for some people with different types of cancer who are going through treatment.

Talk to your doctor first and always be careful about exercising if you have any of these conditions because they can lead to injury, pain, bleeding, or other problems if they aren’t taken into account before you start to exercise:

Massage therapy

Massage therapy has helped some patients during cancer treatment by possibly reducing stress levels and improving sleep. Talk to your doctor first before starting massage therapy.

Counseling

Behavioral therapy or mindfulness-based stress reduction has helped cancer survivors reduce fatigue. 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 health 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.

Studies have shown some breast cancer survivors reported lower distress and fatigue with counseling and behavioral therapy.

Nutritional counseling

Nutritional deficits can add to the problems of fatigue and weakness. Your health care team may refer you to a dietitian to check your calorie and nutritional intake. You may be prescribed vitamins or supplemental electrolytes (sodium, potassium, calcium, iron, or magnesium) to help reduce your symptoms. Cancer patients, who may be managing other side effects (nausea, vomiting, bowel problems, mouth sores ) or different medical conditions that affect eating, can benefit from this counseling.

What the patient can do

  • 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.
  • 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.
  • Talk to your health care team about any problems with your nutritional intake
  • Regular moderate exercise – especially walking – is a good way to ease fatigue. Talk to your doctor about the right exercise plan for you.
  • Ask your family or friends to help with the things you find tiring or too hard to do.
  • 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.
  • Each day, prioritize – decide which things are most important to you and focus on those tasks. Then plan ahead. Spread activities throughout the day and take breaks. Do things slowly, so that you won’t use too much energy at once
  • Avoid caffeine
  • Avoid exercising too late in the evening.

What caregivers can do

  • Help schedule friends and family members to prepare meals, clean the house, do yard work, or run errands for the patient. You can use websites that help organize these things, or ask a family member to look into this for you.
  • Try not to push the patient to do more than they are able to.
  • Help the patient set up a routine for activities during the day.

Call the cancer care team if

  • You feel too tired to get out of bed for a 24-hour period
  • You feel confused, dizzy, lose your balance or fall
  • You have problems waking up
  • You have problems catching your breath
  • The fatigue seems to be getting worse.

These may be signs of other problems that need to be treated.

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

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.

Brell JM,  Jones LW. Fatigue. In Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed. Philadelphia, PA: Elsevier; 2020:676- 681.

Mitchell SA. Fatigue. In Brown CG, ed. A Guide to Oncology Symptom Management. 2nd ed. Pittsburgh, PA: Oncology Nursing Society; 2015:385-419.

National Comprehensive Cancer Network. (NCCN).  Cancer-Related Fatigue. Version 1.2019. Accessed at www.nccn.org/professionals/physician_gls/f_guidelines.asp on September 18, 2019.

Oncology Nursing Society (ONS). Symptom interventions: Fatigue. Accessed at https://www.ons.org/pep/fatigue on January 2, 2020.

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]

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.

Brell JM,  Jones LW. Fatigue. In Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed. Philadelphia, PA: Elsevier; 2020:676- 681.

Mitchell SA. Fatigue. In Brown CG, ed. A Guide to Oncology Symptom Management. 2nd ed. Pittsburgh, PA: Oncology Nursing Society; 2015:385-419.

National Comprehensive Cancer Network. (NCCN).  Cancer-Related Fatigue. Version 1.2019. Accessed at www.nccn.org/professionals/physician_gls/f_guidelines.asp on September 18, 2019.

Oncology Nursing Society (ONS). Symptom interventions: Fatigue. Accessed at https://www.ons.org/pep/fatigue on January 2, 2020.

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: February 1, 2020 Last Revised: February 1, 2020

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