Managing Cancer-Related Fatigue for Survivors

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

Fatigue is the most common side effect of cancer and cancer treatment. It can last for months or years after cancer treatment is completed. Fatigue related to cancer is different from fatigue that people without cancer experience. It usually lasts longer, can be intense, and may not improve with rest.

People describe cancer-related fatigue as feeling tired or weak, having a sense of limb-heaviness, not wanting to do things, not being able to concentrate, feeling irritable, or a sensation of moving slowly. The fatigue can range from mild to severe. It can develop gradually over time or can begin suddenly.

Causes of Cancer-Related Fatigue

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
• The build-up of toxic substances that are left in the body after cells are killed by cancer
• Injury to normal cells
• Infection
• Fever
• Pain
• Loss of appetite or not getting enough calories and nutrients
• Trouble sleeping
• Anemia (low level of red blood cells)
• Shortness of breath
• Dehydration
• Extra energy your body needs to repair normal cells

Other factors that may cause cancer-related fatigue include:

• Anxiety
• Depression
• Grief
• Not having enough restful sleep at night
• Being less active
• Family stress
• Dealing with medical tests
• Other medical conditions

How to Manage Cancer-Related Fatigue

The first step in managing cancer-related fatigue is to tell your healthcare provider (HCP) what you’re experiencing. Tell them the level of your fatigue. It’s helpful if you can be specific. For example, say “I was so tired that I couldn’t work for 3 days,” rather than “I was really tired.”

For 1 week, try keeping a list of your activities and how you feel when you do them. This is called an activity log. You may notice a pattern to your fatigue. For example, are you more tired in the afternoon or the evening? Based on the answers to this and other questions, your HCP will be able to suggest the best ways for you to manage your fatigue.

Here are some suggestions to help manage your fatigue.

Exercise daily. Moderate exercise can help increase your energy level and relieve symptoms of fatigue. Aim for 30 minutes of moderate exercise 5 days per week. Moderate exercise is activity that feels somewhat hard. You’re exercising at a moderate pace if your breathing quickens but you aren’t out of breath, you develop a light sweat after 10 minutes, and you can hold a conversation but you can’t sing. If you’re anxious about starting an exercise program, your HCP can refer you to Memorial Sloan Kettering’s (MSK) Rehabilitation Service. You will be evaluated by a specially trained doctor or a physical therapist to develop a plan to help strengthen and build muscles.

Improve your sleep quality and sleep routine. Try to get continuous sleep at night instead of taking naps during the day. Avoid long or late-day napping. Naps will almost always cause problems sleeping at night. Try to schedule a mild activity, such as reading or listening to music, instead of taking a nap. Follow a regular pre-bedtime routine. Although everyone is different, it’s best to avoid caffeine, alcohol, tobacco, and physical exercise several hours before going to bed. These things may keep you awake. You can try to relax by listening to music or reading before bedtime. For more information, read Managing Insomnia (www.mskcc.org/pe/insomnia)

Develop a routine for your daily activities. Know when you need to rest and when you have energy for activity. This can help you plan your days.

Plan your activities. It’s important to conserve your energy. You can do this by looking ahead at your daily schedule. This will help you save your energy for things that are necessary and important to you and allow you to space out activities throughout your day. Schedule important activities at those times when you have more energy.

Ask for help with activities that make you most fatigued. Ask for help. Don’t be afraid to rely on support from family, friends, or community organizations. Many organizations provide help with cooking and cleaning. Ask to speak with a social worker for more information about organizations that can help.

Ask your HCP for help with things that add to your fatigue. Tell your HCP if you’re feeling other symptoms (such as pain, anxiety, depression or insomnia) that can increase your fatigue. Your HCP may be able to give you medication that can relieve some of these symptoms or arrange an appropriate referral.

Follow a healthy diet. Eat a well-balanced diet that’s made up of fruits, vegetables, whole grains, and foods rich in protein such as lean meat, chicken, or fish. Eating smaller, more frequent meals may help with fatigue because you need less energy to digest smaller meals. Speaking with a clinical dietitian nutritionist may also be helpful. Your HCP can arrange this for you. Stay well hydrated.

Keep socially active. Don’t cut yourself off from your friends. Spending time with them is important, but make sure to pace yourself.

Get emotional support. Your family and friends can help you deal with stress and fatigue. You may also want to join a support group for cancer survivors. MSK’s Resources for Life after Cancer (RLAC) program has various support groups for people who have finished treatment. Ask your HCP for more information about this program or call 646-888-8106. Many people also find that spirituality can help with concerns and worries. You can talk to a chaplain at MSK or ask to see a member of the clergy.

Get help with anxiety and depression. Tell your HCP if you feel worried or down. They may have you talk with a social worker. Or, they may arrange for a counseling session with a psychotherapist from the MSK Counseling Center. In addition, learning relaxation techniques may help you manage anxiety. For more information about complementary therapies, call the MSK Integrative Medicine Service at 646-449-1010 or go to www.mskcc.org/cancer-care/integrative-medicine.

Meet with an occupational therapist (OT). An OT is a healthcare professional who can help you make a plan to participate in as many physical activities as possible without overtiring. Ask your HCP about scheduling a meeting with an OT at MSK.

Tips for Saving Your Energy

• Take your time with your activities and sit while you work. Remember to maintain normal breathing. Stop and rest as needed if you feel tired.
• Sit on higher seats, which are easier to stand up from than low seats.
• Work at a table or counter top that’s waist-high. This allows for better circulation and normal breathing.
• Organize and store your work items where you use them and can get them easily.
• Maintain good posture.
• If you must reach for something lower than an arm’s length, squat or bend from your knees and not from your back.
• 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.
• Shower with warm, not hot, water.
• Put a caddy over your shower head so that you don’t have to reach and bend to grab your soap and shampoo.
• Install grab bars in your shower. Use a shower bench to sit in the tub while you shower.
• Use a sponge or brush, such as a back brush with a long handle, to scrub your feet and other areas that may be hard to reach.
• Dry off with a towel while sitting or put on a terry cloth robe.
• Choose your clothing and lay them out before you get dressed. Sit on a chair or at the edge of your bed to get dressed.
• Select shirts or blouses that button at the front and bottoms that fit loosely. These are easier to get on and off.
• If you need to bend over to reach for something, exhale when you bend over and inhale when you reach.
• Wear slip-on shoes with low heels and shock-absorbent soles or insoles.

Additional Resources

OnCancer: News and Insights from Memorial Sloan Kettering (MSK)
www.mskcc.org/blog/recognizing-and-managing-related-fatigue

MSK video explaining how to manage fatigue after cancer treatment
www.mskcc.org/videos/playlist/diet-exercise-and-therapies-managing-fati…

CancerNet
www.cancer.net/navigating-cancer-care/side-effects/fatigue