Fatigue
Understanding Cancer Fatigue: Causes, Symptoms, and Management
What is Cancer Fatigue?
Many people with cancer experience fatigue—a profound sense of tiredness, low energy, and exhaustion. This can occur before, during, and after treatment, with some individuals reporting that their fatigue persists for weeks, months, or even years after completing cancer therapy. Cancer-related fatigue (CRF) is a combination of physical, emotional, and mental exhaustion that does not improve with rest or sleep.
CRF is typically more severe and difficult to manage than the fatigue experienced by those without cancer and can affect individuals regardless of whether they are undergoing cancer treatment.
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Did you know?
Cancer-related fatigue (CRF) is one of the most common cancer symptoms, affecting more than half of cancer patients.
Key Causes of Cancer - Related Fatigue
Cancer Treatments:
Chemotherapy
Radiation Therapy
Immunotherapy
Surgery
Anemia
Fatigue usually begins a few days after a chemotherapy session and generally improves before the next treatment
Fatigue often starts a few weeks into radiation therapy, peaking near the end of treatment, and then gradually improves over the following weeks and months.
Fatigue typically begins within the first few weeks to months of immunotherapy but can occur at any time during treatment, depending on the type of immunotherapy used
Fatigue commonly starts immediately after surgery and improves as the body heals.
Treatments like chemotherapy, radiation therapy, and surgery can reduce the number of red blood cells in the body, leading to anemia, which can cause fatigue
Struggling with fatigue?
Speak with our oncology care team for solutions.
​"As a Family Nurse Practitioner, I've seen firsthand the impact that stress can have on our health. In today's fast-paced world, stress has become almost unavoidable, but its effects on our bodies can be profound, potentially increasing our risk for diseases like cancer. That's why it's crucial to prioritize stress management as part of our overall wellness routine."
Gracienne Jean Pierre
Biofeedback & HeartMath Provider
Cancer consequences
Pain​
Living with pain can be exhausting, and many pain medications can also contribute to drowsiness and fatigue.
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Distress, Anxiety, and Depression​
Emotional distress, anxiety, and depression can either cause or exacerbate fatigue. Conversely, fatigue can intensify these emotional states.​​
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Sleep Problems
Many cancer patients suffer from insomnia—difficulty falling or staying asleep. Poor sleep quality or insufficient sleep can increase daytime fatigue. Other sleep issues, such as sleep apnea and restless leg syndrome, can also interfere with restful sleep​
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Problems Eating and Drinking
Maintaining a balanced diet and adequate hydration can help reduce fatigue. However, cancer patients often struggle with eating and drinking due to other symptoms such as pain, sickness or breathlessness.
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Lack of Physical Activity
Too much rest or inactivity can lead to fatigue, decreased physical function, and muscle weakness.
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Other Health Conditions
Other health issues, particularly in older adults, can exacerbate cancer-related fatigue. Conditions like arthritis, heart or respiratory problems, and hormonal imbalances can all contribute to increased fatigue.
“Sleep is usually disrupted during treatments and can continue to be affected even after cancer. When you are sleep deprived inflammation and cortisol levels rise, which can lead to insulin resistance and weight gain which can be huge factors for cancer. According to a 2004 study, up to 80% of people affected by cancer are affected by fatigue and/or insomnia, which can impact the cells of the immune system.”
Taffie Lynn Butters
Board-certified health coach​
How Does Cancer Fatigue Affect you?
Physical Symptoms​
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Persistent Tiredness: Feeling exhausted all the time, even after resting or sleeping.
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Weakness: A noticeable decrease in strength, making it difficult to perform everyday activities.
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Shortness of Breath: Feeling winded or out of breath with minimal exertion.
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Sleep Disturbances: Difficulty falling asleep, staying asleep, or experiencing restful sleep, leading to further fatigue.
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Reduced Physical Activity: A noticeable decline in physical activity due to lack of energy or stamina.
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General Discomfort: Experiencing aches, pains, or a sense of physical unease that contributes to the feeling of fatigue.
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Emotional and Cognitive Symptoms
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Difficulty Concentrating: Struggling to focus on tasks or maintain attention for extended periods.
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Memory Problems: Experiencing issues with short-term memory, such as forgetting appointments or losing track of conversations.
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Irritability: Becoming easily frustrated, angry, or upset, often due to the overwhelming sense of exhaustion.
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Depression and Anxiety: Feelings of sadness, hopelessness, or anxiety that may be exacerbated by the physical toll of fatigue.
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Lack of Motivation: A decrease in the desire or willingness to engage in activities or pursue goals.
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Emotional Numbness: Feeling detached or indifferent, possibly as a coping mechanism for chronic fatigue.
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Overwhelm: Becoming easily overwhelmed by routine tasks or daily responsibilities due to the constant sense of fatigue.
Effective Ways to Manage Fatigue During Cancer Treatment
Medical Treatments
There is currently no approved drug specifically for the management of Cancer-Related Fatigue (CRF). Numerous randomized, double-blind, placebo-controlled phase II-III clinical trials have evaluated various drugs and nutraceutical interventions for CRF in oncological patients across all stages of the disease. However, none of these drugs have gained sufficient scientific consensus to warrant a formal recommendation. Your cancer care team may prescribe medications to help you feel more alert and awake. Always consult your care team before taking any new medicines or supplements, as some may interact with your cancer treatment.
Lifestyle Changes
Emotional distress and mental health issues can worsen fatigue. Counseling, stress management techniques, and relaxation exercises can help you cope with and reduce the fatigue you feel.
Sleep Therapy
If you're experiencing sleep disturbances, such as difficulty falling asleep, frequent awakenings during the night, or sleeping excessively due to cancer-related fatigue, your cancer care team may recommend sleep therapy. Sleep therapy is a structured approach designed to address these issues by improving the quality and consistency of your sleep. This therapy can involve various techniques, such as cognitive-behavioral therapy for insomnia (CBT-I), which focuses on changing negative thoughts and behaviors around sleep. Additionally, it may include sleep hygiene practices, like maintaining a regular sleep schedule, creating a restful sleep environment, and limiting naps during the day. In some cases, sleep therapy may also involve relaxation techniques, such as mindfulness or progressive muscle relaxation, which can help reduce stress and anxiety that may be contributing to sleep problems. By incorporating these strategies, sleep therapy aims to not only improve your sleep but also enhance your overall energy levels and mood, making it easier to manage the daily challenges of cancer treatment. Improved sleep can lead to better physical and emotional resilience, supporting your recovery and quality of life throughout your cancer journey.
Physical Activity
Physical exercise is the most effective intervention for managing Cancer-Related Fatigue (CRF). There is robust evidence that physical exercise can attenuate systemic inflammation and improve CRF, thereby enabling patients to better perform activities of daily living and enhancing their functional quality of life. For cancer patients, both during and after treatment, prolonged inactivity and lack of exercise can result in a loss of skeletal muscle mass and strength, which gradually impairs their ability to carry out basic activities of daily living (e.g., climbing stairs or maintaining balance). This state of physical deconditioning can lead to various physical ailments, reduced muscle strength and cardiovascular fitness, lower self-esteem, and an increased risk of anxiety and depression.
Nutrition
Cancer patients frequently face challenges in maintaining a diet that provides adequate nutrients, which can significantly impact their overall health and contribute to cancer-related fatigue. To address this, your cancer care team may monitor your vitamin and mineral levels to ensure your body receives the essential nutrients needed to support energy levels and reduce fatigue. If you're struggling with eating, consulting a nutrition specialist can offer personalized guidance and support, helping you manage your diet more effectively during treatment and potentially alleviating some of the exhaustion associated with cancer.
Relaxation
Incorporating practices such as yoga, Qigong, meditation, and mindfulness into daily routines can significantly reduce stress levels, which is particularly beneficial for those experiencing cancer-related fatigue. These activities not only promote relaxation and mental clarity but also help manage the physical and emotional exhaustion that comes with cancer fatigue. By calming the mind, soothing the body, and reducing stress, they can alleviate some of the overwhelming fatigue associated with cancer, leading to improved energy levels and a greater sense of well-being.
Explore our cancer rehabilitation services here.
Vitamins and Supplements for Cancer-Related Fatigue
Common Supplements
American Ginseng Root Powde
Some research suggests that American ginseng might help alleviate cancer-related fatigue, though more studies are needed to confirm its effectiveness. A systematic review of clinical trials found ginseng to be safe and potentially beneficial, but the quality of the studies was not sufficient to recommend it as a standard treatment option
L-carnitine, Coenzyme Q10, Astragalus, Guarana
Other nutraceuticals like L-carnitine, coenzyme Q10, astragalus, and guarana have also been studied for CRF, but none have demonstrated sufficient evidence of clinical benefit. Consequently, both ASCO and ESMO guidelines recommend against the use of these products for managing CRF.
Dietary Considerations
Probiotics
Probiotics may support digestive health and strengthen the immune system, potentially reducing the severity and frequency of diarrhea caused by antibiotics or chemotherapy. Emerging research also suggests that gut bacteria could influence fatigue and cognitive issues, commonly known as "chemo-brain," which are side effects of chemotherapy. Since it can be challenging to get enough probiotics solely through diet, patients might consider adding probiotic-rich foods like kefir, Greek yogurt, kimchi, miso, and other fermented foods to their meals. Additionally, a high-fiber diet, rich in fruits, vegetables, legumes, and whole grains, may improve the diversity of gut bacteria. Patients should consult with their healthcare team and seek nutritional guidance before starting probiotic supplements.​
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Learn more about supplements for cancer patients here​