Cancer related fatigue

Overview

Cancer-related fatigue is a feeling of extreme tiredness that does not get better with rest. It is a very common side effect of cancer and its treatments. Unlike normal tiredness, this kind of exhaustion can make it hard to do everyday activities like dressing, eating, or even talking with friends. It can affect your body, your emotions, and your ability to think clearly.

Yes, cancer-related fatigue is very common. More than 8 out of 10 people with cancer will have fatigue during their treatment, and many continue to feel tired for some time after treatment is finished.

Cancer-related fatigue can affect anyone who has cancer, regardless of their age or the type of cancer. People receiving chemotherapy, radiation therapy, surgery, or other cancer treatments are especially likely to feel fatigue.

Symptoms

Common symptoms

• Constant feeling of exhaustion or lack of energy
• Feeling weak or heavy in the arms and legs
• Difficulty concentrating or remembering things
• Sleeping more than usual but still feeling tired
• Not feeling refreshed after rest or sleep
• Being less interested in activities you used to enjoy
• Shortness of breath with simple activities

Symptoms in children

• Being irritable or easily upset
• Not wanting to play or join in normal activities
• Complaining of being too tired to do things
• Losing interest in hobbies or schoolwork

Symptoms in older adults

• Feeling confused or unsteady on their feet
• Greater difficulty with daily self-care tasks
• Higher risk of falls due to weakness
• Withdrawal from social activities

Causes

Main causes

• The cancer itself – cancer cells can change the way your body uses energy
• Cancer treatments – chemotherapy, radiation, surgery, and immunotherapy can all cause fatigue
• Anemia – a low red blood cell count that reduces oxygen delivery to your tissues
• Hormonal changes – treatments can affect thyroid, adrenal, or other hormones
• Chronic pain – pain is exhausting to live with
• Stress and anxiety – worrying about cancer and treatment can drain your energy
• Poor nutrition – not eating enough or eating the wrong foods can lead to weakness

Risk factors

• Having a more advanced cancer at diagnosis
• Receiving intensive treatment, like chemotherapy combined with radiation
• Being older
• Having other health problems like heart disease or diabetes
• Already feeling tired before starting treatment

When to see a doctor

See a doctor urgently if:

• If fatigue is accompanied by chest pain, trouble breathing, sudden weakness, or fainting, call your local emergency number right away.
• If you have a fever or think you might have an infection, contact your cancer care team at once.

Book a routine appointment if:

• Tell your doctor or nurse if fatigue is not getting better, if it is preventing you from eating, drinking, or moving, or if it gets worse after treatment.
• Mention any new symptoms like dizziness, shortness of breath, or difficulty thinking clearly.

Diagnosis

There is no simple blood test for cancer-related fatigue. Your doctor will talk with you about your symptoms, ask how fatigue affects your daily life, and do a physical exam. They may also run tests to look for causes that can be treated, such as anemia or a thyroid problem.

Tests that may be done

• Blood tests to check red blood cell count (anemia), thyroid function, and organ health
• Review of your medications and any other health conditions
• A fatigue rating scale or questionnaire to understand how severe your fatigue is
• Discussion of your sleep, mood, and activity levels

What to expect at your appointment

Your doctor will work with you to find out which factors are most likely contributing to your fatigue. Be honest about your symptoms and how they affect you. The goal is to find ways to help you feel better and maintain your quality of life.

Treatment

Treatment for cancer-related fatigue focuses on managing any underlying causes, supporting your energy levels, and helping you cope with your daily life. It is not a 'one-size-fits-all' approach – your care team will tailor a plan to your needs.

Self-care at home

• Balance activity with rest – plan rest breaks during the day, but avoid long naps that can disrupt night sleep
• Use energy-saving tricks like sitting while preparing food or showering
• Set small, realistic goals each day and ask for help when you need it
• Stay hydrated by drinking plenty of fluids, unless your doctor says otherwise
• Keep a fatigue diary to share with your care team

Medical treatments

Your doctor may treat problems that make fatigue worse, such as anemia, infection, or pain. They may suggest strategies to improve sleep or relaxation techniques. In some cases, a referral to a physical therapist or occupational therapist can help you stay active safely. Some people benefit from counseling or support groups. Medications may be used for specific causes, such as depression or anxiety, but your doctor will always discuss the options and any risks with you. Never take any medication, supplement, or herbal product without checking with your oncology team first.

When is surgery considered?

Surgery is not a treatment for fatigue itself, but if surgery is part of your cancer treatment, recovery can add to fatigue. Your surgical team will give you guidance on gradually returning to normal activities and what to expect during healing.

Living with this condition

Living with cancer-related fatigue means learning to pace yourself and listen to your body. Plan your most important activities for times when you feel best. Break tasks into smaller steps and accept help from others. It is okay to say no to things that drain your energy.

Lifestyle tips

• Keep a regular sleep schedule – go to bed and wake up at the same times
• Take short gentle walks or do mild stretching if you are able
• Prioritize what matters most to you and let go of less important tasks
• Try relaxation techniques like deep breathing, meditation, or calming music
• Avoid alcohol and smoking, as they can make fatigue worse

Diet and exercise

Aim for a balanced diet with enough protein, fruits, vegetables, and whole grains. Eat small, frequent meals if you do not feel hungry. Stay hydrated. Gentle exercise, such as walking or yoga, may actually improve energy levels, but be sure to talk to your doctor before starting any new activity.

Mental health and emotional wellbeing

Feeling exhausted all the time can lead to frustration, sadness, or worry. It can feel like cancer has taken away your energy and your identity. These feelings are normal. Your mental health is just as important as your physical health, and it is okay to ask for emotional support.

Prevention

Cancer-related fatigue cannot always be prevented, but you can lower its impact. Staying gently active before and during treatment, eating well, getting enough sleep, and managing stress may help reduce how severe the fatigue becomes. It also helps to talk to your care team early about any tiredness you feel, so they can address it before it grows.

Complications

If left untreated

• If fatigue is not addressed, it can lead to missed or delayed cancer treatments
• It can cause depression and anxiety
• It can lead to social isolation and loss of close relationships
• It can make it hard to continue working or caring for your family

Long-term outlook

Most people find that fatigue slowly improves after treatment ends, although it can take time. In the meantime, there are many ways to manage it and keep your quality of life. With the right support and plan, you can live well even while dealing with fatigue.

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