Tiredness (fatigue)
Fatigue is feeling very tired most, or all, of the time. It is a very common problem for people with cancer.
What is fatigue?
Fatigue is a feeling of tiredness or exhaustion. It can be caused by the cancer itself, or the side effects of treatments. As many as 9 out of 10 people with cancer (90%) get cancer-related fatigue (CRF).
It is possible to manage fatigue. Your healthcare team may be able to help prevent or relieve fatigue and improve your quality of life.
Cancer-related fatigue usually gets better after treatment finishes. But it may continue for months or even years. Everyone is different and there is no way to know how long fatigue may last for each person.
You may find it helpful to keep a fatigue diary.
Causes of fatigue
The cause of cancer-related fatigue (CRF) is not fully understood. There may be many reasons for it:
- The cancer itself
The cancer may cause swelling in certain parts of the body, making your limbs heavier and harder to move. You may also have a reduced number of red blood cells or changes in hormone levels, which can cause tiredness. - Cancer treatments
We do not know exactly why cancer treatments cause fatigue. Cancer affects the body’s immune system. It could be that, after treatment, your body needs extra energy to heal and repair. Or fatigue could be caused by chemicals that build up when cancer cells are destroyed. We have more information on individual treatments and their effects. - Anaemia
Anaemia is caused by having a low level of red blood cells. This can be caused by the cancer itself or its treatment. You may be able to have treatment to help. The main treatment is a blood transfusions. If you are having chemotherapy, you may be offered a drug called erythropoietin, to help increase the number of red blood cells in the body. - Eating problems
Our bodies get energy from the food we eat. Fatigue can happen if the body does not get enough food, or there are changes to how the body uses the food. Cancer can sometimes cause these changes. - Pain
Many people with cancer do not have pain. But pain can cause fatigue. The best way to deal with fatigue caused by pain is to manage the pain. - Other health problems
Other health conditions like diabetes, heart problems or low thyroid function can also cause fatigue. Cancer-related fatigue may also make tiredness caused by other conditions worse. - Psychological effects of cancer
Conditions such as anxiety, depression and stress can make fatigue worse. You may find it helpful to discuss how you feel with someone close to you or your healthcare team. Macmillan’s Online Community is a place you can talk to others who understand what you are going through.
You may feel tired before treatment starts because of the tests and scans you have had to diagnose the cancer. If you are older you are more likely to be affected by cancer-related fatigue.
Effects of fatigue
Some common effects of fatigue include:
- difficulty doing simple things, such as brushing your hair or getting dressed
- feeling you have no energy or strength
- difficulty concentrating and remembering things
- difficulty thinking, speaking or making decisions
- feeling breathless after light activity
- feeling dizzy or lightheaded
- difficulty sleeping (insomnia)
- losing interest in sex
- feeling low in mood and more emotional than usual.
These may have an impact on your work, relationships and social life, but there are things that can help.
Managing fatigue
You should always get advice from your cancer doctor, specialist nurse or GP before making changes to manage fatigue. You should tell them about any other medical conditions you have, such as high blood pressure, diabetes or lung problems.
Here are some things you can do to manage fatigue:
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Keep active
Keeping active can boost your appetite, give you more energy and improve sleep. It is best to start slowly and balance with rest. You could set some simple goals, even just trying to walk from the front door to the back door. Being too inactive may make your muscles become weaker (deconditioning) and make fatigue worse. Your GP or cancer doctor may be able to refer you to a specialist cancer physiotherapist to help you.
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Eat well and keep to a healthy weight
Eating well can help you keep or regain your strength and give you more energy. You can find out your ideal healthy weight from your GP. It may help to keep a diary of what you eat, to see if you have more energy after certain meals. You should drink plenty of fluids and try different foods if you have taste changes. Your doctor may be able to refer you to a dietitian if you need more help and support.
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Keep to a normal sleep routine
Good-quality sleep may help with fatigue, as well as reduce your need to sleep during the day. It is important that any rest during the day does not stop you from sleeping at night.
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Try complementary therapies
Complementary therapies include relaxation, massage therapy and yoga. Before you use a complementary therapy, talk to your specialist doctor or nurse. Some therapies may affect your cancer treatment. Some of these therapies may be available on the NHS.
Booklets and resources
Living with fatigue
If you have fatigue, planning ahead can help. Try to plan your day so you have energy to do the things you want to do most. Short naps and rests can help, but try to balance them with some activity or exercise.
It is also important to plan around your treatment. Try to avoid anything energetic or stressful for 24 hours before and after your treatments. If you feel less well one day, it is okay to be less active and to rest more.
There are ways to manage your everyday activities when coping with fatigue:
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Spread housekeeping tasks over the week and ask for help if you can
Try to sit down when doing some tasks and use long-handled cleaning equipment to avoid stretching and bending. If possible, you may want to employ a cleaner. Depending on your situation, social services may be able to help.
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Do grocery shopping online or ask someone to help you
If you are unable to organise delivery, you should try to use a shopping trolley rather than carrying a basket. You could also try shopping at less busy times and asking shop staff for help.
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Try simple or ready-made meals when you are most tired
Prepare extra meals or double portions when you are feeling less tired and freeze them for when you need them. Try not to lift heavy pans when serving and avoid taking heavy items to the table.
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If you can, have a bath or sit in the shower
Resting while you wash will help you keep up your energy levels.
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Take care looking after children
If you have children, explain you are feeling tired and plan activities where you can sit down if possible. Try to avoid carrying small children. Use a pram or pushchair instead.
Your cancer doctor, specialist nurse or GP can refer you to an occupational therapist. They can look at practical ways of making a home safe, comfortable and easy to live in.
Getting support
It is important to talk about fatigue with your healthcare team. They will check for any causes that can be treated and look at any medicines you are taking. For example, they may reduce the dose of a tablet that makes you sleepy. You may also have an examination and some blood tests.
Dealing with fatigue all the time can be very difficult. You may be struggling with your emotions. It can help to talk to someone close to you or your healthcare team.
If you feel anxious or depressed, you may find counselling helpful. Or you may prefer to talk to other people with fatigue. You can also share your experience on our Online Community or use it to get advice from others.
Online support tool for people with fatigue
Macmillan and the University of Southampton have developed a new online resource for people with fatigue called RESTORE. RESTORE provides information about things you can do to help you cope with fatigue and feel more confident to manage it. Register to use the tool.
Common questions about fatigue
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Is fatigue the same as normal tiredness?
Cancer-related fatigue is different from the tiredness that someone without cancer may get. People with cancer may get tired more quickly after less activity. Their fatigue may not be helped by rest or sleep.
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Will fatigue affect my ability to work?
Talking to your employer about reasonable adjustments could help you return to work at a pace that suits you. Reasonable adjustments are things you can do for yourself to manage tiredness at work, but also ways that your employer can help. If you are self-employed, it can help to talk to the Department for Work and Pensions about benefits that you may be entitled to claim.
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Will I be able to drive?
If you are feeling too tired, ask family or friends to drive. Or if you must drive, take regular breaks. If you have to drive, plan your trip for when you know you usually feel more alert. It may also help to avoid driving at times when the roads are busiest.
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Are there any drug treatments for fatigue?
There are not any licensed drug treatments to help prevent or improve fatigue yet. Steroid drugs, such as dexamethasone, can sometimes be helpful. But they can have side effects, so you should talk to your doctor about the possible benefits and disadvantages. Research into other drug treatments is ongoing. Your doctor or specialist nurse can give you information about any drug trials that may be suitable for you.
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What is a fatigue diary and how should I use it?
Keeping a daily diary of your energy levels and when you have treatment can help you work out how treatment affects you. The fatigue diary has enough space to record your energy levels for 1 month.
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