What is fatigue?
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
Fatigue is when you feel very tired, weak, drained and worn out. Cancer-related fatigue is different from tiredness because it is more severe, not the result of recent physical or mental activity, and generally doesn’t get better with rest or sleep. It can be ongoing and affect what you can do.
Who is affected?
Research shows that most people experience some level of fatigue, before, during and after treatment for cancer, and some people may feel fatigue for months or years after treatment ends.
People who are most at risk of developing cancer- related fatigue have fatigue before the cancer diagnosis; have depression or anxiety; sleep issues; other health conditions; and don’t do much exercise.
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.
Fatigue affects people with cancer in different ways. Symptoms of fatigue may be different before, during and after treatment, and can change over the day or week. Fatigue rarely occurs as just a single issue, it usually occurs with other issues such as pain, emotional distress, low red blood cell count (anaemia) and sleep issues.
People with cancer-related fatigue may report some or all of the following:
- having little or no energy
- feeling mentally or emotionally exhausted
- muscle aches and pains
- feeling weak all over
- trouble thinking clearly or concentrating
- difficulty doing daily tasks such as getting dressed, showering, cooking
- sleeping issues such as being unable to sleep or sleeping too much
- not enjoying their usual activities
- feelings of sadness or irritability.
Living with cancer-related fatigue can affect your daily life, including your work, relationships, sex life and social life.
Cancer-related fatigue usually has more than one cause, including:
- the cancer itself and cancer treatments such as chemotherapy, radiation therapy, immunotherapy and targeted therapy
- medicines, such as pain relief
- side effects of cancer or treatment, such as low red blood cells (anaemia), nausea, bowel issues or pain
- changes to blood and hormone levels
- not eating well or enough
- stress and mood changes, including depression and 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 health care team will ask you some questions. Several screening questionnaires have been developed to measure how cancer-related fatigue is affecting you, and your doctor or nurse may use one of these. These questionnaires ask about when the fatigue started, how long it has lasted, has it changed over time, and how fatigue is 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).
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 helpedSusan
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.
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.
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
Prof Michael Jefford, Medical Oncologist and Director, Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, VIC; 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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