Managing Cancer-Related Fatigue

This information will help you manage cancer-related fatigue during and after your cancer treatment.

Fatigue is the most common side effect of cancer and cancer treatment. Cancer-related fatigue is different from fatigue that people without cancer experience. Cancer-related fatigue usually lasts longer, can be intense, and may not get better with rest.

People describe cancer-related fatigue in many ways, such as:

  • Feeling tired or weak
  • Feeling like your arms and legs are heavy
  • Not wanting to do things
  • Not being able to concentrate
  • Feeling irritable
  • Feeling slowed down

The fatigue can range from mild to severe. It can develop gradually over time, or it can start suddenly, making everyday tasks difficult. It can last for months or years after you finish treatment.

 
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No one is sure what exactly causes cancer-related fatigue, but it may be caused by:

  • Cancer treatments, including chemotherapy, radiation therapy, surgery, and some biologic therapies
  • Medications to treat nausea (feeling like you’re going to throw up) and manage pain
  • The build-up of toxic substances that are left in your body after cells are killed by cancer
  • Injury to normal cells
  • Fever (a temperature above 100.4 °F or 38 °C)
  • Infection
  • Pain
  • Dehydration (too little water in your body)
  • Loss of appetite or not getting enough calories and nutrients
  • Trouble sleeping
  • Anemia (low level of red blood cells)
  • Shortness of breath
  • Being less active
  • Other medical conditions

Cancer-related fatigue may also be caused by emotional challenges, such as:

  • Anxiety
  • Depression
  • Grief
  • Family stress
  • Dealing with medical tests and treatments
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There are many things you can do to help manage your fatigue.

Talk with your healthcare provider

The first step is talking with your healthcare provider about what you’re feeling. When talking with your healthcare provider, it can be helpful to describe how your fatigue affects your daily activities and routines. For example, saying “I was so tired that I couldn’t work for 3 days” is more helpful than saying “I was really tired.”

Keep an activity log

When you’re first starting to notice and manage your fatigue, it’s helpful to keep an activity log. An activity log is a list of your activities, the time you do them, for how long you do them, and how you feel when you do them. You can use the log at the end of this resource, or you can create your own.

Keeping an activity log can help you notice a pattern to your fatigue. For example, are you more tired right after chemotherapy or just before another treatment? Are you more tired in the afternoon or the evening? Based on the answers to these and other questions, your healthcare provider will be able to suggest the best ways for you to manage your fatigue.

Other suggestions for managing fatigue

Do physical activity and exercise

  • Do your best to keep doing your current level of activity.
  • Walk daily, if your healthcare provider says it’s safe for you.
  • Think about starting an exercise program that’s appropriate for your treatment. Yoga may be helpful to include as part of an exercise program.

If you’re worried about doing physical activity or exercise, your healthcare provider can refer you to Memorial Sloan Kettering (MSK)’s Rehabilitation Service to meet with a physical therapist (PT) or occupational therapist (OT). Read the section “Meet with an OT or PT” or talk with your healthcare provider for more information.

Get enough sleep

Try to get continuous sleep at night instead of taking naps during the day. Limit naps to 15 to 20 minutes in late morning or early afternoon. This will help keep them from interfering with nighttime sleep.

Follow a regular pre-bedtime routine. Tips to improve your sleep routine include:

  • Avoid caffeine, alcohol, and tobacco after 6:00 pm. They may keep you awake.
  • Listen to music or read before bedtime. These things can help you relax.
  • Try to go to bed at the same time every night and wake at the same time every day.

If you notice changes in your sleep patterns, talk with your healthcare provider. They may be able to help.

Plan your activities

It may help to prioritize what you need to do each day. This will help you save your energy for things that are necessary and most important to you. Schedule important activities at those times when you have more energy.

Try to avoid activities that make you most fatigued. Look at your list of activities and think about how you felt when you did them. Ask for help. Don’t be afraid to rely on support from family, friends, or community organizations. Many organizations provide transportation to treatments and help with cooking and cleaning. Ask to speak with a social worker for more information.

Follow a healthy diet

Eat small, well-balanced meals and snacks throughout the day. Aim to drink 8 to 10 (8-ounce) glasses of liquids every day.

For more information about following a healthy diet, read the resource Eating Well During and After Your Cancer Treatment. Talking with a clinical dietitian nutritionist may also be helpful. Your healthcare provider can give you a referral to meet with a clinical dietitian nutritionist.

 

Keep socially active

Don’t cut yourself off from your family or friends. Spending time with them is important, but make sure to pace yourself. There are many ways you can keep in touch with your friends and family, including spending time with them in person, talking on the phone, or sending emails and text messages.

Get emotional support

Your family and friends can help you manage stress and fatigue. You may also want to join a support group for people with cancer. Many people also find that spirituality can help with concerns and worries. You can talk to a chaplain at Memorial Sloan Kettering (MSK) or ask to see a clergy person.

Get help with anxiety and depression

Tell your healthcare provider if you feel anxious or depressed. They can help you find a social worker or mental health provider who you can talk with.

Complementary therapies, such as relaxation techniques, may also help you manage anxiety. For more information about complementary therapies, call the MSK Integrative Medicine Service at 646-888-0800 or go to www.mskcc.org/cancer-care/integrative-medicine.

Meet with an OT or PT

OTs and PTs are healthcare professionals who can help you manage your fatigue.

  • OTs help improve the skills you need for important everyday activities such as getting dressed, taking a shower, or cooking a meal. An OT can help you plan your activities so you’re able to do as many physical activities as possible without getting too tired. They can also suggest ways that you can save energy and help you practice using special equipment or strategies like meditation or mindfulness.
  • PTs help improve your ability to move by helping you build your strength and balance. They can also help you come up with an exercise plan that works for you.

OTs and PTs can help you stay motivated and set goals. They can also help you keep track of your energy level and make changes to your exercise plan as needed. If you would like more information about how an OT or PT can help you manage your fatigue, ask your doctor or nurse for a referral.

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Tips for Saving Your Energy

Following the tips in this section can help you save energy when doing your daily activities. This may help with fatigue. If you have questions, talk with your nurse, OT, or PT.

General activities

  • Use a transport chair or wheelchair while travelling longer distances, if one is available.
  • Take your time with your activities and sit while you work. Remember to keep breathing normally (don’t hold your breath) and stop and rest often if you feel tired.
  • Sit on higher seats. They are easier to stand up from than low seats.
  • Organize and store your work items where you use them and can get them easily.
  • Maintain good posture. Sit up straight and try not to slouch.
  • If you need to bend over to reach for something, exhale (breathe out) when you bend over and inhale (breathe in) when you reach.

Showering

  • Install grab bars in your shower.
  • Use a shower bench to sit in the tub while you shower.
  • Use a sponge or brush with a long handle (such as a back brush) to scrub your feet and other areas that may be hard to reach.
  • Sit in front of a mirror or sink for activities that take more time, such as putting on makeup or shaving.
  • Keep your hair in a style that’s easy to care for.
 

Getting dressed

  • Sit on a chair or at the edge of your bed to get dressed.
  • Dress the lower part of your body first.
  • To put on your socks and shoes, sit and bring your foot to the opposite knee instead of bending over.
  • Choose shirts or blouses that button at the front and bottoms that fit loosely. These are easier to get on and off.

If you have any questions or concerns, talk with a member of your healthcare team. You can reach them Monday through Friday from 9:00 am to 5:00 pm at ____________________. After 5:00 pm, during the weekend, and on holidays, please call ____________________. If there’s no number listed, or you’re not sure, call 212-639-2000.

 
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Activity Log

Use this activity log to keep track of your activities and how you feel when you do them. Rate your intensity of fatigue on a scale of 1 to 10.

Date Time Activity Length
of Time
Intensity
of Fatigue
Comments
           
           
           
           
           
           
           
           
           
           
           
           
           
           

 

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