Fatigue and cancer

Cancer and cancer treatments often make people very tired. This is called cancer-related fatigue. This page explains more about this fatigue and how it can be managed.

What is cancer-related fatigue?

Fatigue is when you feel very tired, weak, drained and worn out. You may have low or no energy, or feel run down or exhausted.

Cancer-related fatigue is worse or more intense than normal tiredness. It isn’t caused by physical or mental activity and usually won’t go away with rest or sleep. This fatigue can go on for some time and affect what you can do.

Who gets cancer-related fatigue?

What are the symptoms?

Fatigue affects people with cancer in different ways. Symptoms of fatigue may vary as the cancer changes, or due to different stages of treatment. They can also change over a day or week.

Fatigue is rarely just a single issue – it often happens along with pain, emotional distress, low red blood cell count (anaemia) and sleep issues. People with cancer-related fatigue may notice some or all of the following symptoms:

• having little or no energy
• feeling mentally or emotionally exhausted 
• muscle aches and pains 
• finding it hard to move, or feeling heavy or slow
• feeling weak all over
• having trouble thinking clearly or concentrating
• difficulty doing daily tasks such as getting dressed, showering and cooking
• having trouble sleeping
• not enjoying their usual activities
• feelings of sadness or irritability.

Cancer-related fatigue can affect your daily life, work, relationships, sex life and social life. But there are ways to help manage it (see below).

How is fatigue diagnosed?

To work out if you have fatigue, your healthcare team will ask some questions. Your doctor or nurse may use a screening questionnaire (a list of questions) to find out how cancer-related fatigue is affecting you. These questionnaires ask:

• when the fatigue started
• how long it’s lasted
• whether it has changed over time, and
• how it’s affecting your daily life.

You may have several tests to find out what might be contributing to the fatigue. These may include blood tests to check your red blood cell count, hormone levels, and kidney and liver function; urine tests; and heart function tests.

If the results show that conditions like anaemia or low levels of some hormones are contributing to the fatigue, these can be treated. You may need a referral to a specialist or a fatigue clinic (if available).

Question checklist

Ways that cancer-related fatigue can affect you

Some people say that fatigue is the most difficult side effect of cancer and its treatment. Sometimes, people might look well but still have severe fatigue.

Fatigue can make it hard to do everyday things, which can make you feel frustrated, upset and isolated. If you have continued feelings of sadness, talk to your doctor. You may have low mood or depression, and treatment may help.

Your family and friends may not fully understand how cancer-related fatigue affects what you are able to do. They may expect you to do the same things you did before the cancer diagnosis, and not know that some side effects continue for a long time.

It’s natural for them to want the distress and disruption of cancer to go away. If you find their reactions difficult to handle, explaining how fatigue is affecting you might help them to understand.

You can also give them this fact sheet – knowing more about cancer-related fatigue may help them understand what you’re experiencing. If you took time off work for treatment, talk to your employer about returning to work.

Australian laws require an employer to take reasonable steps to accommodate the effects of an employee’s illness. This may mean, for example, that your employer:

• allows you to return to work in stages
• is flexible with your start and finish times, and
• gives you time to rest during the day.

How long does fatigue last?

“I had to accept that I was dealing with fatigue and celebrate small improvements. I had to be careful not to overdo it and whatever help people offered, I took. That was very challenging for me but it helped.” Susan

Managing fatigue

The first step in managing fatigue is working out how it affects you. Use a scale to rate your fatigue from 1–10; the higher the number, the worse the fatigue.

Keep a record of your fatigue level at different times of the day, as well as anything you try and whether it helped. This can help you to understand how you feel day to day.

Talk to your general practitioner (GP); oncologist, haematologist or nurse; or an allied health professional like an occupational therapist, physiotherapist or exercise physiologist. Tell them how you feel, and how long you’ve had fatigue.

Your doctor will manage any health conditions, medicines or symptoms that may be causing or contributing to the fatigue. For example, if your red blood cell count is low (anaemia), you may be prescribed medicines or have a blood transfusion.

If pain is making fatigue worse, your pain medicine may need to be changed or adjusted.

Your doctor may also suggest trying medicines that are being studied to help people with cancer-related fatigue, including certain steroids for people with advanced cancer.

See below for practical suggestions that may help you manage fatigue when you have cancer. The costs for seeing an exercise physiologist, physiotherapist, dietitian or occupational therapist vary.

If your doctor refers you as part of a GP chronic condition management plan, you may be eligible for a Medicare rebate for up to five visits per calendar year. If you have private health insurance, your insurer may cover some of the costs.