Fatigue

What is fatigue? 

Fatigue means feeling extremely tired most or all of the time. Often it is not relieved by rest. Fatigue is a very common symptom of cancer and can build up over the course of your treatment. The tiredness usually eases off gradually once you’ve finished treatment.

Some people can feel tired for months and even years afterwards or find that fatigue develops some time after treatment. 

Tell your doctor or nurse if fatigue is affecting you, so they can find the cause and give you advice and treatment to help.

What are the symptoms?

Fatigue can be mild or severe. Different people experience fatigue in different ways.   

If you have fatigue you may find:

• Simple chores such as showering or preparing food seem overwhelming.
• You feel as if you have no energy and could spend whole days in bed.
• You have trouble thinking, speaking or making decisions. 
• You feel breathless after only light activity. 
• You have trouble getting to sleep (insomnia).
• You lose your sex drive.
• You feel sad, frustrated or upset.
• Your tiredness disrupts your work, social life, or daily routine.    

What causes fatigue?

• The cancer itself
• Cancer drugs like chemotherapy or targeted therapies
• Surgery – You may feel very tired when you’re recovering from surgery
• Radiotherapy. Fatigue can build up during a course of radiotherapy, so you might find you feel more tired towards the end of your treatment or even for some time afterwards. Travelling to and from the hospital can also add to your tiredness
• Not eating well. Fatigue can be caused by poor nutrition. Your body needs protein, carbohydrates, fats, vitamins, minerals, and water to do its work. We have a booklet Diet and Cancer, which has tips on eating well during and after cancer treatment
• Low levels of red blood cells (anaemia), due to the cancer or its treatment
• Not sleeping well. This can be linked to side-effects of cancer treatment, or can also be caused by worries about your illness, or your finances, for example
• Dealing with difficult emotions and feeling stressed, anxious or depressed
• Lack of exercise – physical activity can help build your stamina and reduce your fatigue so you can go about your daily activities

How is fatigue treated?

Some treatments can help with fatigue, depending on what’s causing it. 

• Blood transfusion. If you’re fatigued because you have a low red blood cell count (anaemia), having an infusion of blood can make you feel better.
• Nutritional advice. If you’re not eating well, a dietitian may be able to give you some advice to help you get the nutrients and calories you need from your diet to keep your energy and strength up. They can also give you any supplements you might need. For example, iron or vitamin B12. 
• Hormone or steroid treatment. Some types of surgery and certain immunotherapy and hormone therapy drugs can affect your hormone levels, which can leave you feeling tired. You may need hormone supplements or steroids to improve your fatigue. 
• Counselling. Feeling anxious or depressed can sap your energy. Talking to a counsellor can help you to feel better. Find out more about counselling and how to get free counselling. 
• Complementary therapies. Some complementary therapies may help relieve fatigue, depending on what’s causing it. For example, gentle massage, yoga or mindfulness. Check with your medical team first, to make sure the therapy you’re thinking about is safe for you. Read more about complementary therapies.

What should I do if I have fatigue?

• Ask your doctor about exercising. Being active can help with fatigue. Your doctor may also be able to recommend an exercise programme for you.
• Note when your energy levels are best. You may have to decide which tasks are important to finish and do them over the course of the day or when you have most energy.
• Ask for help at work or at home with any jobs that you find tiring.
• Try to eat a well-balanced diet. Eat little and often if your appetite is poor. Our booklet Diet and Cancer has tips to help.
• Try to avoid stress. Talk to friends and family about any worries you have and take time to enjoy yourself. Counselling  may help too.
• If you are not sleeping well, have a good bedtime routine and try relaxation techniques. Avoid stimulants like caffeine and alcohol in the evening and try not to use electronic devices for an hour before bedtime.
• Short naps (less than an hour) and rest periods can be helpful, as long as they don’t stop you from sleeping at night.
• Try complementary therapies such as meditation, acupuncture or massage, if your doctor says they’re safe for you.

• Keep a diary of your energy levels: Use the diary pages below to take note of the times when you feel most and least tired. This can help you to plan your activities. Your doctor may also find your fatigue diary useful.

See our Coping with fatigue booklet for more information on fatigue.