Fatigue: Detailed Information

Fatigue is a feeling of tiredness or not having enough energy. There are two main types of fatigue. Acute fatigue is when you feel tired for a short time. Chronic fatigue is a feeling of tiredness that is always with you or a feeling of tiredness that comes and goes but never goes away completely.

Many cancer survivors experience chronic fatigue after their active treatment has ended. Survivors can experience chronic fatigue because of the treatment they received for their cancer or because of the different emotions they are feeling in their life after cancer. Chronic fatigue can also be a sign of a recurrence or another illness.

Currently, you may be working with your health care team to manage your fatigue symptoms. You may notice that you are tired all the time and feel like you shouldn’t complain or that no one will listen. Feeling tired all the time isn’t something you should ignore just because your treatment is over and your cancer is in remission. You and your health care team can take steps to help you with your fatigue.

Do all survivors experience fatigue?

Studies show that 30 percent of cancer survivors experience fatigue that can last for years. Survivors who received certain types of treatments for their cancer are more at risk for fatigue.

You may be more at risk for fatigue if:

• You were treated with chemotherapy
• You received high doses of chemotherapy followed by a bone marrow transplant or a stem cell transplant
• You are still taking certain medications that can cause fatigue
• You were treated with chemotherapy, radiation or surgery that affected your hormones

What are the symptoms of fatigue?

Some symptoms of fatigue that survivors might experience include:

• Feeling tired even though you had a good night’s sleep
• Feeling sleepy throughout the day
• Feeling sudden, extreme tiredness
• Feeling too weak to stand
• Finding it difficult to start routine activities
• Needing to stop in the middle of activities to rest or not being able to do activities for very long
• Difficulty concentrating
• Irritability

In most cases, a survivor’s energy level will return to normal within the first six months after active treatment ends. However, during that time, you can still get help with your fatigue and work with your health care team to minimize your symptoms.

If you have been feeling good but suddenly start to become extremely tired again, you may be experiencing a new, severe fatigue. This can be a sign of infection or a late effect of cancer treatment. Make an appointment to discuss your fatigue with your health care team.

What are some of the physical causes of fatigue?

Some of the physical causes of fatigue are:

• Low red blood cell counts (anemia)
• Difficulty breathing
• Changes in how well your heart pumps blood
• Changes in muscle or bone due to surgery or treatment
• Changes in the hormone levels in your body
• Changes in your immune function or the way your body responds when your immune system is challenged
• Changes in kidney function so your body is not as good at clearing out waste products
• Trouble sleeping
• Symptoms such as pain or numbness in your feet that make it harder to move
• Side effects of medications
• Chronic pain

Sometimes the exact cause of your fatigue may be unknown, but that does not mean that you and your health care team can’t work together to help manage your fatigue.

What are some of the emotional causes of fatigue?

Some emotional causes of fatigue are:

• Anxiety
• Frustration
• Boredom
• Depression

Depression is a common emotional cause of fatigue. When thinking about the causes of your fatigue, you should also discuss with your health care team any feelings of sadness or depression you may be experiencing.

Fatigue and depression can both happen during your survivorship, and both are real problems that you should discuss with your health care team. But being tired does not necessarily mean a survivor is depressed. Sometimes survivors hear things like, “You’re not tired – you’re just depressed.” While depression may be one cause of fatigue, it’s important that you discuss all possible physical and emotional causes with your health care team.

When is a cancer survivor likely to experience fatigue?

Many people think that fatigue is something that survivors will only experience during treatment. This is not true. Some survivors experience fatigue months or years after completing active treatment.

A type of fatigue called post-cancer fatigue affects some survivors after their active treatment has ended. If you have experienced symptoms of fatigue and have worked with your health care team to rule out any other causes, you might be experiencing post-cancer fatigue.

Post-cancer fatigue is different than chronic fatigue. With post-cancer fatigue, the cause – treatment for cancer – is known. Not enough research has been done to know a lot about the exact causes of post-cancer fatigue. But it exists, and you can discuss it with your health care team.

Can fatigue be cured?

Right now, the medical community does not know enough about why people experience persistent fatigue to cure it. However, fatigue is a treatable condition, and you can work with your health care team to manage the symptoms.

What can survivors do to minimize the risk of fatigue?

Below is a brief list. For more information, see Suggestions.

• Maintain a comfortable balance between activity and rest.
• Try to find balance with a healthy lifestyle.
• Pay attention to your sleep habits.

This document was produced in collaboration with:
Lillian M. Nail, PhD, RN, CNS, FAAN
Rawlinson Distinguished Professor of Nursing & Senior Scientist
Oregon Health & Science University

Fatigue: Suggestions

Maintain a comfortable balance between activity and rest:

• Keep a list of your activities and how much rest you get.
• Keep track of situations that seem to make you feel more tired such as traveling across time zones, sitting down for too long, being in a room that is too warm or having to concentrate for a long period of time. Planning ahead may help you avoid these activities.
• Find ways to break up your activities into shorter time periods, or allow yourself time to rest between activities.

Try to find balance with a healthy lifestyle:

• Do not use tobacco products.
• Work with your health care team to develop an exercise plan.
• Maintain a healthy body weight.
• Work with your health care team to develop a diet that includes the right amounts of fruits, vegetables, protein, carbohydrates and fat.

A well-balanced diet is important. A normal, healthy diet consists of protein, carbohydrates, some fat, fiber, vitamins and minerals. If you unintentionally gain or lose weight, ask your health care provider to refer you to a dietitian or nutritionist to evaluate your nutrition.

Pay attention to your sleep habits:

Keep a sleep diary to track your sleep habits.

Some items to write down in a sleep diary are:

• The time you turn out the light to go to sleep
• When you wake up and why you awakened (noise, pain, to take medication, etc.)
• The time you get out of bed in the morning
• Naps you take during the day

This information can help you and your health care team decide if sleep problems play a role in your fatigue.

Other suggestions to improve sleep quality include:

• Sleep in a comfortable bed.
• Avoid sleeping on the sofa or in a chair.
• Sleep with the lights out in a quiet room.
• Wear comfortable sleep garments.
• Avoid heavy meals, food or drinks containing caffeine, and intense exercise prior to bedtime.

If fatigue and/or sleep problems begin when you start a new medication, ask your health care provider if it might be a side effect of the medication. If the answer is yes, ask about changing the medication or changing the times when you take the medication.