Fatigue

Fatigue at a glance

Fatigue goes beyond feeling tired from missing a night of sleep. Fatigue can keep you not only from recreational activities you enjoy but also from working or providing care for children, elders, pets, or others in your life. Fatigue can keep you from taking care of your own basic needs, such as preparing meals, overseeing your well-being, and paying bills. It can also interfere with your ability to socialize with the people you need for support, isolating you when you most need help and companionship. Cancer-related fatigue can impair your quality of life, but several therapies can provide relief.

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Fatigue: overview

What is fatigue? 

Fatigue as a symptom of cancer or side effect of treatment goes well beyond simply feeling temporarily tired or worn out, such as from a sleepless night. Some describe it as “unexplained, persistent, and relapsing exhaustion,”¹Fatigue and Exhaustion: Causes, Symptoms, and Treatment. Web MD. October 4, 2023. Viewed June 13, 2024. and it “lasts longer, is more profound and isn’t relieved by rest.”²Mayo Clinic staff. Fatigue. Mayo Clinic. December 2, 2020. Viewed May 11, 2022. 

Fatigue and cancer

Cancer-related fatigue (CRF) is one of the most common side effects of having cancer and receiving cancer treatment. Physical, mental, and emotional challenges all feed into CRF. CRF can affect all facets of a person’s quality of life.³Bower JE, Lacchetti C et al. Management of fatigue in adult survivors of cancer: ASCO-Society for Integrative Oncology guideline update. Journal of Clinical Oncology. 2024 May 16:JCO2400541. 

Fatigue is linked to pain, which may work in both directions—each can trigger and enhance the other.⁴Theobald DE. Cancer pain, fatigue, distress, and insomnia in cancer patients. Clinical Cornerstone. 2004;6 Suppl 1D:S15-21. If you are experiencing pain in addition to fatigue, we recommend you visit our Pain › handbook to explore therapies and practices that may help with your pain, which may also help reduce your fatigue.

In extreme cases, fatigue may cause a person with cancer to stop treatment. Managing fatigue may allow you to complete treatment to achieve its full benefits as well as maintain a higher quality of life. 

Fatigue is linked to lower immune function,⁵Levy SR, Herberman ML et al. Correlation of stress factors with sustained depression of natural killer cell activity and predicted prognosis in patients with breast cancer. Journal of Clinical Oncology. 1987 Mar;5(3):348-53. a body terrainthe internal conditions of your body, including nutritional status, fitness, blood sugar balance, hormone balance, inflammation and more factor linked to worse cancer outcomes.

Caregiver fatigue

Caregivers can also experience fatigue. Caregiver fatigue occurs when the caregiver feels physically, emotionally, and psychologically exhausted, often leading to a change in attitude. Some practices and approaches are recommended specifically for caregivers. Within our Caregiver Handbook, see the section Finding support for yourself › 

What can cause fatigue?

Many factors may trigger or worsen fatigue among people with cancer.

Medical or emotional conditions

Lifestyle behaviors

Medications

Cancer treatments such as radiation therapy, surgery, and some drugs, hormone therapies, and immunotherapies

Aspirin › or other nonsteroidal anti-inflammatory drugs › such as ibuprofen (Advil) or naproxen (Aleve)

Metformin › can cause lower vitamin B₁₂ levels, which can contribute to fatigue; consider asking your doctor to test your levels if you are using metformin

Antihistamines

Cough medicines

Sedatives

Other therapies

What are signs or symptoms of fatigue?

Signs & symptoms of cancer-related fatigue:⁸Cancer Fatigue. Cleveland Clinic. September 8, 2021. Viewed May 24, 2022; Cancer-Related Fatigue. Moffitt Cancer Center. July 15, 2015. Viewed May 24, 2022.

Top evidence-based practices and therapies for managing fatigue 

Clinical practice guidelines

These recommendations are based on a rigorous review of a high level of evidence. Therapies are recommended in the guidelines for different phases of cancer treatment. Each of these therapies is also recommended in at least one other clinical practice guidelines.⁹Survivorship Care for Cancer-Related Late and Long-Term Effects. National Comprehensive Cancer Network Guidelines for Patients. 2024. Viewed June 4, 2024; Gowin K, Muminovic M et al, Mehta A. Integrative therapies in cancer care: an update on the guidelines. American Society of Clinical Oncology Educational Book. 2024 Jun;44(3):e431554; Campbell KL, Winters-Stone KM et al. Exercise guidelines for cancer survivors: consensus statement from International Multidisciplinary Roundtable. Medicine and Science in Sports and Exercise. 2019 Nov;51(11):2375-2390; Fabi A, Bhargava R et alI; ESMO Guidelines Committee. Cancer-related fatigue: ESMO clinical practice guidelines for diagnosis and treatment. Annals of Oncology. 2020 Jun;31(6):713-723; Greenlee H, DuPont-Reyes MJ et al. Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment. CA: A Cancer Journal for Clinicians. 2017 May 6;67(3):194-232—this set of guidelines has been endorsed by the American Society of Clinical Oncology (ASCO): Lyman GH, Greenlee H et al. Integrative therapies during and after breast cancer treatment: ASCO endorsement of the SIO clinical practice guideline. Journal of Clinical Oncology. 2018 Sep 1;36(25):2647-2655; Bower JE, Bak K et al; American Society of Clinical Oncology. Screening, assessment, and management of fatigue in adult survivors of cancer: an American Society of Clinical Oncology clinical practice guideline adaptation. Journal of Clinical Oncology. 2014 Jun 10;32(17):1840-50;

Both during and after treatment

• Exercise (aerobic, resistance, or combination) should be tailored according to the individual patient’s abilities and may be either supervised or unsupervised. Finding a way to move your body, even gentle stretching, can help to lessen fatigue. See Moving More: what to do (and what to avoid) › 
• Cognitive behavioral therapy (CBT), either with or without hypnosis, is a therapy method designed to change negative thought patterns and behaviors to improve emotional and physical well-being.¹⁰Mayo Clinic Staff. Cognitive behavioral therapy. Mayo Clinic. Viewed June 4, 2024. Learn more about CBT and find a practitioner › or learn more about hypnotherapy for cancer ›
• Mindfulness-based programs, including mindfulness-based stress reduction (MBSR) promote relaxation and stress reduction through practices like meditation and deep breathing. See Relaxation Techniques and Mindfulness Practices: Coping With Cancer › from CancerCare. Find mindfulness practices for people with cancer ›

During treatment 

• Tai chi or qigong are forms of mind-body exercise and meditation, practiced at a low to moderate intensity. See Tai Chi or Qigong › 
• Psychoeducation about side effects, such as fatigue, may be offered in an oncology clinic to individuals before beginning treatment.¹¹Marschall A. How psychoeducation is used in therapy. VeryWell Mind. May 22, 2023. Viewed June 4, 2024.
• American ginseng, Panax quinquefolius, an herbal supplement used in traditional medicine and by naturopathic oncologists is recommended at 2,000 mg daily. See Ginseng (American) › from About Herbs. 

After treatment

• Yoga is a mind-body practice that includes breath control, meditation, and physical postures. See Yoga: affordability and access ›
• Acupressure is the application of pressure to specific places on your body. See Acupressure: affordability and access ›
• Moxibustion is the practice of burning a special herb to apply heat close to the skin at specific points. See Moxibustion: affordability and access ›

Recommendation against use; should be avoided

The guidelines recommend against use of these therapies due to a lack of effect in clinical trials.

Other practices and therapies

We present approaches to reducing fatigue backed by modestsignificant effects in at least three small but well-designed randomized controlled trials (RCTs), or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observational studies), or several small studies aggregated into a meta-analysis (this is the CancerChoices definition; other researchers and studies may define this differently), goodsignificant effects in one large or several mid-sized and well-designed clinical studies (randomized controlled trials (RCTs) with an appropriate placebo or other strong comparison control or observational studies that control for confounds) (this is the CancerChoices definition; other researchers and studies may define this differently), or strongconsistent, significant effects in several large (or at least one very large) well designed clinical studies or at least two meta-analyses of clinical studies of moderate or better quality (or one large meta-analysis) finding similar results (this is the CancerChoices definition; other researchers and studies may define this differently) evidence of effectiveness.

If your fatigue is a symptom of other medical conditions, you may need to seek treatment to address the cause of your fatigue to find relief.

Conventional treatment

Your doctor may be able to determine if any of the medical conditions or medications listed above (or others) may be causing your fatigue and recommend treatments, such as for insomnia or infection.

Lifestyle practices 

• Eating Well: A diet, such as a Mediterranean diet, rich in fruits, vegetables, whole grains, and omega-3 fatty acids may lead to less fatigue. Including a colorful array of fruits and vegetables makes for a diet rich in polyphenols and antioxidants, which can contribute to less fatigue. Fasting or restricting calories before and/or after chemotherapy treatments may possibly lead to less fatigue.¹²Pole L, Hepp N. How can Eating Well help you? What the research says. CancerChoices. April 14, 2024. Eating well is recommended in one practice guideline for managing fatigue.¹³Survivorship Care for Cancer-Related Late and Long-Term Effects. National Comprehensive Cancer Network Guidelines for Patients. 2024. Viewed June 4, 2024. See Which foods to eat (and what to avoid) ›

Complementary therapies 

Supplements and natural products

• Astragalus-based Chinese botanicals: People treated with astragalus-based Chinese botanical formulas showed substantially less fatigue during chemotherapy.¹⁴Williams M, Hepp N, Pole L. How can astragalus help you? What the research says. CancerChoices. May 10, 2024. See Traditional medicine and professionals ›
• Melatonin is a hormone and supplement that regulates sleep cycles. People treated with melatonin during radio/chemotherapy have shown less fatigue. People with advanced metastatic cancer have also shown less weakness or lack of energy when treated with melatonin.¹⁵Hepp N. How can melatonin help you? What the research says. CancerChoices. May 29, 2024. See Melatonin: affordability and access ›
• Mistletoe is a plant extract formulated for injections or infusions. People with cancer treated with mistletoe have shown less fatigue.¹⁶Hepp N. How can mistletoe help you? What the research says. CancerChoices. May 28, 2024. See Mistletoe: affordability and access ›
• Vitamin C: intravenous use: People with cancer treated with intravenous vitamin C have shown less fatigue during conventional cancer treatment.¹⁷Hepp N, Pole L. How can intravenous vitamin C help you? What the research says. CancerChoices. April 12, 2024. See Vitamin C: Intravenous Use: affordability and access ›

Other complementary therapies

• Acupuncture is a practice of inserting fine needles into the body at specific points. People treated with acupuncture have shown less fatigue, including during cancer treatment.¹⁸Hepp N. How can acupuncture help you? What the research says. CancerChoices. May 29, 2024. Acupuncture is recommended for managing fatigue in several practice guidelines.¹⁹Bower JE, Bak K et al; American Society of Clinical Oncology. Screening, assessment, and management of fatigue in adult survivors of cancer: an American Society of Clinical oncology clinical practice guideline adaptation. Journal of Clinical Oncology. 2014 Jun 10;32(17):1840-50; Survivorship Care for Cancer-Related Late and Long-Term Effects. National Comprehensive Cancer Network Guidelines for Patients. 2024. Viewed June 4, 2024; Greenlee H, DuPont-Reyes MJ et al. Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment. CA: A Cancer Journal for Clinicians. 2017 May 6;67(3):194-232; Deng GE, Frenkel M et al; Society for Integrative Oncology. Evidence-based clinical practice guidelines for integrative oncology: complementary therapies and botanicals. Journal of the Society for Integrative Oncology. 2009 Summer;7(3):85-120. See Acupuncture: affordability and access › 
• Energy therapies effective for managing fatigue include biofield energy therapies or subtle energy therapies using touch, stimulation, or non-touch energy from a therapist. Such energy therapies are recommended in one practice guideline for managing fatigue.²⁰Deng GE, Frenkel M et al; Society for Integrative Oncology. Evidence-based clinical practice guidelines for integrative oncology: complementary therapies and botanicals. Journal of the Society for Integrative Oncology. 2009 Summer;7(3):85-120. See pages on affordability and access for these therapies: Therapeutic Touch® ›, healing touch ›, Reiki ›, or polarity therapy ›
• Relaxation techniques include several techniques that often bring your attention to your breathing, muscles, or other body functions to relax and calm them. People treated with progressive muscle relaxation have shown less fatigue during chemotherapy, and people treated with relaxation techniques have shown less fatigue after surgery or stem cell transplant.²¹Hepp N. How can relaxation techniques help you? What the research says. CancerChoices. May 29, 2024. See Relaxation techniques: affordability and access ›

Recommendation against use; should be avoided

Two natural products have recommendations against use for fatigue during cancer treatment in a practice guideline due to a lack of effect in clinical trials.²²Greenlee H, DuPont-Reyes MJ et al. Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment. CA: A Cancer Journal for Clinicians. 2017 May 6;67(3):194-232.

Healing stories

Additional helpful links

Resources to explore practices and therapies to manage fatigue

Exercise

Cognitive behavioral therapy

Free meditation videos

Mindfulness courses

Links for health professionals

Ng JY, Zhang CJ, Ahmed S. Dietary and herbal supplements for fatigue: a quality assessment of online consumer health information. Integrative Medicine Research. 2021 Dec;10(4):100749.

Henson LA, Maddocks M et al. Palliative care and the management of common distressing symptoms in advanced cancer: pain, breathlessness, nausea and vomiting, and fatigue. Journal of Clinical Oncology. 2020 Mar 20;38(9):905-914.

Authors

Christine Mineart, MPH

CancerChoices Team

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Christine has a dynamic background in the life sciences, public health, and program operations. Her career began at the lab bench with a Gates Foundation-funded HIV Vaccine research group, which led her to graduate studies in public health epidemiology at UC Berkeley. Her research experience spans clinical epidemiology research to evaluating the impacts of community nutrition programs in Los Angeles, the Central Valley, and Oakland. Most recently she has worked in executive operations for a seed-stage venture capital firm based in San Francisco. Personally, Christine is passionate about holistic health and wellness. She is a clinical herbalist and Reiki master, and she has been practicing yoga for 15+ years. She brings a breadth of experiences to her work leading the CancerChoices program.

Christine Mineart, MPH CancerChoices Team

Nancy Hepp, MS

Lead Researcher

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Ms. Hepp is a researcher and communicator who has been writing and editing educational content on varied health topics for more than 20 years. She serves as lead researcher and writer for CancerChoices and also served as the first program manager. Her graduate work in research and cognitive psychology, her master’s degree in instructional design, and her certificate in web design have all guided her in writing and presenting information for a wide variety of audiences and uses. Nancy’s service as faculty development coordinator in the Department of Family Medicine at Wright State University also provided experience in medical research, plus insights into medical education and medical care from the professional’s perspective.

Nancy Hepp, MS Lead Researcher

Laura Pole, MSN, RN, OCNS

Senior Clinical Consultant

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Laura Pole is senior clinical consultant for CancerChoices. Laura is an oncology clinical nurse specialist who has been providing integrative oncology clinical care, navigation, consultation, and education services for over 40 years. She is the co-creator and co-coordinator of the Integrative Oncology Navigation Training at Smith Center for Healing and the Arts in Washington, DC. Laura also manages the “Media Watch Cancer News That You Can Use” listserv for Smith Center/Commonweal. In her role as a palliative care educator and consultant, Laura has served as statewide Respecting Choices Faculty for the Virginia POST (Physician Orders for Scope of Treatment) Collaborative as well as provided statewide professional education on palliative and end-of-life care for the Virginia Association for Hospices and Palliative Care.

For CancerChoices, Laura curates content and research, networks with clinical and organizational partners, brings awareness and education of integrative oncology at professional and patient conferences and programs, and translates research into information relevant to the patient experience as well as clinical practice.

Laura sees her work with CancerChoices as a perfect alignment of all her passions, knowledge and skills in integrative oncology care. She is honored to serve you.

Laura Pole, MSN, RN, OCNS Senior Clinical Consultant

Miki Scheidel

Co-Founder and Creative Director

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Miki Scheidel is Co-founder and creative director of CancerChoices. She led the effort to transform Beyond Conventional Cancer Therapies, the prior version of CancerChoices, to its current form. Miki and her family were deeply affected by her father’s transformative experience with integrative approaches to metastatic kidney cancer. That experience inspires her work as president of the Scheidel Foundation and as volunteer staff at CancerChoices. She previously worked with the US Agency for International Development and Family Health International among other roles. She received her graduate degree in international development from Georgetown University, a graduate certificate in nonprofit management from George Mason University, and a Bachelor of Arts from Gettysburg College.

Miki Scheidel Co-Founder and Creative Director

Last update: July 10, 2024

Last full literature review: April 2022

CancerChoices provides information about integrativein cancer care, a patient-centered approach combining the best of conventional care, self care, and evidence-informed complementary care in an integrated plan cancer care. We review complementaryin cancer care, complementary care involves the use of therapies intended to enhance or add to standard conventional treatments; examples include supplements, mind-body approaches such as yoga or psychosocialtherapy, and acupuncture therapies and self carelifestyle actions and behaviors that may impact cancer outcomes; examples include eating health-promoting foods, limiting alcohol, increasing physical activity, and managing stress practices to help patients and professionals explore and integrate the best combination of conventionalthe cancer care offered by conventionally trained physicians and most hospitals; examples are chemotherapy, surgery, and radiotherapy and complementary therapies and practices for each person.

Our staff have no financial conflicts of interest to declare. We receive no funds from any manufacturers or retailers gaining financial profit by promoting or discouraging therapies mentioned on this site.