Fatigue means feeling very tired, exhausted and lacking energy. It can be a symptom of the cancer itself or a side effect of treatment.
There are ways to manage fatigue and the symptoms you might have. Treating the cause of cancer related fatigue can sometimes help to reduce tiredness. Help is also available to treat the symptoms of fatigue.
Managing fatigue
Many things can cause fatigue in people with cancer. This includes the cancer itself and treatment you might have.
Your doctor will want to check for other medical conditions that may be causing your fatigue. There are several possible causes, these might include:
sleep apnoea - when your breathing stops and starts during your sleep
depression
long term lung problems
heart failure
liver failure
Treating the cause and the symptoms of fatigue can improve how you feel. Your doctor may refer you to a specialist to help manage your fatigue if your symptoms continue to get worse and treatment to improve them hasn’t helped.
There are some suggestions below that may help improve your symptoms. It might take time to learn how to manage your fatigue and to know what works best for you.
Research shows that daily physical activity helps people with cancer. It can:
make you feel better
give you more energy
improve your appetite
help with your mood
It's important to work at your level. When you start, build up safely and gradually. It's also important that you do something you enjoy.
To start with, you could go for a short walk each day. Walking is a good way to be more active and help maintain your weight. When you're ready, try to increase the distance you walk. You might prefer to walk alone. Some people find they are more likely to walk if they go with someone else.
A pedometer is a good way of keeping track of how active you are by counting the number of steps you take. Nowadays you can use your smartphone or smartwatch to do this. You may have a built in app or you could download one.
If you're having treatment or have advanced cancer you should try to keep as active as you can.
Talk to your doctor, nurse, or physiotherapist about what you can do so you can find a realistic goal and don't overdo things. They can help you plan an exercise programme that suits your needs
Remember to:
not overdo it
work at your level of comfort and pace
build up gradually
drink plenty of water whenever you exercise to prevent dehydration
is when you have a low number of red blood cells in your blood. One symptom of anaemia is feeling tired.
Some people with cancer will have anaemia at some point during their illness. Fatigue caused by anaemia can have a big effect on your daily life.
There are several reasons why you may have anaemia. One cause could be the cancer itself, affecting how you make red blood cells. Or it could be your treatment stopping your body from making red blood cells.
To increase the level of red blood cells it might be helpful to have a blood transfusion, but not everyone needs this. You usually have regular blood tests to check the levels of red blood cells.
Another treatment for anaemia is a drug called erythropoietin or EPO. EPO is a hormone made by your kidneys that encourages the body to make more red blood cells. Studies have shown that EPO can raise red blood cell levels in the body and improve people's quality of life. EPO can be helpful for some people who can’t have a blood transfusion for any reason.
Sleepless nights can make you feel tired, irritable, and a bit dazed. It might help to change a few things about when and where you sleep if you often have trouble sleeping at night.
Sometimes getting too much sleep is not helpful either. To help you sleep as well as possible try to:
Go to bed and get up at the same time each day.
Make sure the room you sleep in is comfortable, calm, quiet and not too hot or too cold.
Spend time relaxing before you go to bed, for example, have a warm bath, read or listen to music.
Stop caffeine (coffee, tea, chocolate and caffeine like drinks) and alcohol about 6 hours before you go to bed.
Limit daytime naps to 20 to 30 minutes or don't have them at all so they don’t stop you sleeping at night.
Have a light snack before you go to bed, this may help stop hunger waking you up.
Electronic screens give out blue light. Looking at these screens could affect your sleep. Avoiding these devices for an hour at least before you go to bed may improve your sleep.
When you really can't sleep, it might help get up, read or listen to music until you feel sleepy. Or try having a warm milky drink. Then go back to bed and try again.
Let your doctor or nurse know if you’re having trouble sleeping. It might be a good idea to keep a diary of your sleep pattern if it’s going on for some time. This allows your doctor or nurse to build up a picture.
Eating enough to keep up your energy levels can be hard. This can be due to side effects from your treatment making you feel unwell. Some of the symptoms that could prevent you from eating enough include:
feeling or being sick
constipation
diarrhoea
It's important to try and eat a healthy balanced diet when you can. Your diet is very important in maintaining a healthy weight and giving you energy.
Speak to a member of your healthcare team for more information. They might refer you to a dietician for further advice if they think you need it.
Resting and saving your energy levels are important to help you cope with fatigue. There are things you can do in your daily life that can help to save your energy.
Plan your day so you can rest a few times throughout the day. Try to stick to your plan and a routine if you're able to. Try not to lay in bed or stay in your nightwear if you have no plans to go out. You usually feel better if you get up, have a wash, get dressed, and go for a short walk if you can.
It’s important not to overdo it even though you think you can. You'll be more tired later in the day and less able to cope.
You don't have to sleep while you rest. Just sitting or lying down to rest will help. If you do sleep, keep it short so it doesn’t affect your nighttime sleep.
Here are some tips to help you rest and save energy:
Make a list of things that you want to do during the day and put them in order of importance. Does anything on the list need a lot of energy?
Could you do things another way? For example, you could try online shopping instead of going to the shops.
Do you have to do everything today or could you spread it out over the week?
You may find you benefit from resting at certain times of the day, for example, after eating.
Ask other people for help with tasks like shopping, housework or collecting children from school.
Plan ahead where possible and allow plenty of time for travelling so you're not rushing.
Put chairs around the house so that you can easily stop and rest if you need to.
Have handrails fitted to help you balance (your GP or hospital healthcare team can help to arrange this for you).
Wear loose fitting clothes and things with few buttons to do up.
Sit down to do household tasks or daily activities like washing, getting dressed, or chopping vegetables when you can.
Have plenty of nutritious snacks and drinks in, so you can have something quickly when you feel like eating.
Play games that you can do sitting or lying down if you enjoy doing these with family and friends. Some examples include reading, puzzles, board games or drawing.
Have ready meals available for those days you don’t want to cook.
Don't forget to do things that you enjoy.
Steroids may help reduce cancer fatigue in the short term for people with advanced cancer.
Researchers are looking at several types of drugs to help improve cancer fatigue. More research is needed to understand how well these drugs work.
Cognitive behavioural therapy (CBT) teaches you how to calm your body and mind. It helps you to control your feelings, think more clearly and generally have a more positive outlook.
Several studies have shown that CBT can reduce levels of fatigue.
A fatigue diary helps you keep a record of how you're feeling, how your energy levels change and can show patterns to your fatigue. This can help you plan your day. It can also highlight which activities make you feel better or worse.
There is evidence that people find their level of fatigue improves with:
yoga
mindfulness
Some doctors think acupuncture might help reduce cancer related fatigue. But more research is needed to understand how it helps.
As research develops, treatment and advice may change. Talk to your doctor, GP, or specialist nurse before using any complementary therapies, particularly if you are having any cancer treatment.
You may find you aren’t able to work if you have fatigue. Do speak to your employer to discuss possible adjustments that may help. For example, working from home, or flexible working hours.
Just about everyone needs support from someone else when they have cancer. You can get support from family, friends, doctors, nurses, and other members of your healthcare team.
You can also get support from other people who've been through a similar thing. Sharing your feelings with someone in a similar situation can make you feel less anxious. You can often get tips on how to cope better from talking about your situation.
Talk to your specialist nurse about support groups available to you in your area. Or you can look at cancer charity websites. Talking to other people in a support group can also show you that you are not alone.
Counselling may help you, your family, and your friends. It may help you understand why you have fatigue and what you can do to reduce and manage it.
Management of anaemia and iron deficiency in patients with cancer: ESMO Clinical Practice Guidelines
M Aapro and others
Annals of Oncology, 2018. Volume 29, Supplement 4.
Screening and Assessment of Cancer-Related Fatigue: A Clinical Practice Guideline for Health Care Providers
M Insana Fisher and others
Physical Therapy and Rehabilitation Journal, 2022 Volume 102, Issue 9.
Tiredness/Fatigue in adults
National Institute for Health and Care Excellence (NICE). Last updated October 2021
Comparison of Pharmaceutical, Psychological, and Exercise Treatments for Cancer-Related FatigueA Meta-analysis
Cancer-related fatigue: ESMO Clinical Practice Guidelines for diagnosis and treatment
A Fabi and others
Annals of Oncology, 2020
The information on this page is based on literature searches and specialist checking. We used many references and there are too many to list here. Please contact patientinformation@cancer.org.uk with details of the particular issue you are interested in if you need additional references for this information.
