Fatigue is the most common side effect of cancer treatment. It can happen during or after treatment.
Learn more about:
- What is cancer-related fatigue?
- Who is affected?
- What are the symptoms?
- What causes fatigue?
- How is fatigue diagnosed?
- How long does fatigue last?
- How can cancer-related fatigue affect you?
- Podcast: Managing Cancer Fatigue
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 is affected?
Research shows that most people with cancer experience some fatigue. This can happen before, during and after cancer treatment. Some people may feel fatigue for months or years after treatment ends.
People at higher risk of cancer-related fatigue include those who have depression, anxiety, sleep issues or other health conditions; who don’t do much exercise; or who have had fatigue before they had cancer.
Cancer-related fatigue may be mild, moderate or severe. It can vary depending on cancer type, stage, how long you have treatment, and your age. It may be worse if you have more than one treatment or if cancer has advanced.
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
- trouble thinking clearly or concentrating
- difficulty doing daily tasks such as getting dressed, showering, 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.
What causes fatigue?
Cancer-related fatigue usually has more than one cause, including:
- the cancer itself or treatments (e.g. chemotherapy, radiation therapy, immunotherapy, targeted therapy)
- medicines, including for pain relief
- symptoms of cancer or side effects of cancer treatment, such as low red blood cells (anaemia), nausea, bowel issues or pain
- changes to blood and hormone levels
- not eating well, or your body not getting enough nourishment from the food you eat
- stress and mood changes (e.g. anxiety)
- not sleeping well
- a lack of physical activity
- other health problems, such as infection, diabetes, arthritis and heart conditions.
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 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).
How long does fatigue last?
Cancer-related fatigue can last throughout treatment and for some time after it is finished. Energy levels usually improve over time.
Most people find they feel better 6–12 months after treatment ends. For some people, cancer-related fatigue can continue for years.
If you have advanced cancer, see Living with advanced cancer for more information.
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
How can cancer-related fatigue affect you?
Some people say 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.
Helping family and friends understand
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 realise 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.
Returning to work after treatment
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 start and finish times, and gives you time to rest during the day.
Podcast: Managing Cancer Fatigue
Listen to more of our podcast for people affected by cancer
More resources
All updated content has been clinically reviewed by: Prof Michael Jefford, Medical Oncologist and Director, Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, VIC. This edition is based on the previous edition, which was reviewed by the following panel: Prof Michael Jefford; Kirsten Adlard, Exercise Physiologist, The University of Queensland, QLD; Anthea Carey, Consumer; Andrea Concannon, Consumer; Dr Briana Clifford, Exercise Physiologist, UNSW Fatigue Clinic and Research Program, NSW; Hazel Everett, Clinical Nurse Consultant – Cancer Services, St John of God Subiaco Hospital, WA; Dr Suzanne Grant, Senior Research Fellow, NICM Health Research Institute, Western Sydney University, and Chris O’Brien Lifehouse, NSW; Pippa Labuc, Senior Occupational Therapist, Peter MacCallum Cancer Centre, VIC; Prof Andrew Lloyd, Director, UNSW Fatigue Clinic and Research Program, NSW; Catherine Meredith, Consumer; Dr David Mizrahi, Exercise Physiologist and Research Fellow, The Daffodil Centre at Cancer Council NSW and The University of Sydney; Dr Elizabeth Pearson, Allied Health Researcher, Peter MacCallum Cancer Centre, VIC; Dr Astrid Przezdziecki, Clinical Psychologist, Mind My Health, NSW; Chris Sibthorpe, 13 11 20 Consultant, Cancer Council Queensland; Kate Woodhead, Physiotherapist, St Vincent’s Hospital Melbourne, VIC.
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