What approaches can help you manage fatigue?

We present many approaches to reducing fatigue and summarize the evidence regarding their effectiveness.

Fatigue may be a symptom of stress. If stress is contributing to your fatigue, managing your stress will be important in reducing it.

Top practices and therapies for managing fatigue

Therapies and practices we have reviewed

The specific effects of these therapies on fatigue are summarized below on this page.

Further therapies

Therapies recommended in clinical practice guidelines; see guidelines ›

Energy therapies including external qigong and electromagnetics

Ginseng

Hypnotherapy

Light therapy

Massage therapy

Mindfulness-based approaches

Psychosocial therapies:

  • Behavioral therapy
  • Cognitive behavioral therapy (CBT)
  • Cognitive behavioral therapy for insomnia (CBT-I)
  • Information and counseling
  • Mind-body stress reduction (MBSR)
  • Psychoeducational therapies/educational therapies
  • Stimulus control/sleep restriction/sleep hygiene

Approaches for caregiver fatigue

Some practices and approaches are recommended specifically for caregivers. Within our Caregiver Handbook, see the section Finding support for yourself ›

Self-care practices

The evidence supporting the effects for each practice is listed in the full handbooks available through the image links.

Eating Well: preliminary evidence

Substantially less fatigue among people eating a diet rich in fruits, vegetables, whole grains, and foods high in omega-3 fatty acids (preliminary evidencesignificant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect (this is the CancerChoices definition; other researchers and studies may define this differently))

Recommended in practice guidelines for managing fatigue; see guidelines ›

Moving More: mixed evidence

Less cancer-related fatigue among people participating in exercise without regard to treatment phase
(good evidencesignificant 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))

Less cancer-related fatigue during treatment among people participating in exercise (strong evidenceconsistent, 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))

Less cancer-related fatigue among people participating in exercise after treatment (strong evidence)

Insufficient (conflicting) evidencepreclinical evidence only OR clinical studies with such poor or unclear methodology that no conclusion can be drawn OR conflicting findings across clinical studies with no preponderance of evidence in one direction; conflicting evidence occurs when studies find conflicting effects (positive effect vs no effect or negative effect) with the same treatment and the same general study population (same cancer type, for example) (this is the CancerChoices definition; other researchers and studies may define this differently) of an impact on fatigue among people with advanced cancer participating in exercise

Recommended in practice guidelines for managing fatigue; see guidelines ›

Combining Eating Well and Moving More: preliminary evidence

  • Less fatigue among women with early breast cancer participating in an intervention of both diet and exercise (preliminary evidence)

Sleeping Well: modest evidence

More fatigue among people with metastatic colorectal cancer, lung cancer, or lymphoma with poorer sleep quality (modest evidencesignificant 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))

Creating a Healing Environment: preliminary evidence

Exposure to bright light, including blue-spectrum light, is helpful at times when you want to be alert but may interfere with sleep if it’s shortly before bedtime.

Better subjective alertness among healthy volunteers exposed to blue-enriched light (preliminary evidence)

Less fatigue or sleepiness among people exposed to bright or blue-enriched light during waking hours and not during sleep hours (preliminary evidence)

More fatigue among young adults exposed to blue light at night (using a mobile phone after going to bed) (preliminary evidence); avoiding bright or blue light as you approach bedtime is advised

Sharing Love and Support: preliminary evidence

Higher levels of a symptom cluster including fatigue among people with cancer experiencing loneliness (preliminary evidence); addressing loneliness may help relieve fatigue

Complementary approaches

We present complementary therapies supported by evidence for managing fatigue. Those with the best evidence are presented first.

A therapy may show a stronger effect or have more evidence in some situations than in others. The evidence supporting the effects for each therapy is listed in the full reviews available through the image links.

Strong, good, or modest evidence of benefit

Acupuncture: mixed evidence

Less fatigue during or after cancer treatment among people treated with acupuncture (good evidencesignificant 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))

Less cancer-related fatigue without regard to treatment phase among people treated with acupuncture (modest evidencesignificant 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))

No evidence of additional benefit to massage therapy for fatigue during autologous tissue breast reconstruction among people treated with acupuncture in a preliminary study

Recommended in practice guidelines for managing fatigue; see guidelines ›

Astragalus: modest and weak evidence

Substantially less fatigue during chemotherapy among people treated with an herbal mixture containing astragalus (modest evidence)

Less fatigue among people with advanced metastatic cancers treated with astragalus polysaccharides (weak evidenceone or more case studies, supported by animal evidence OR small treatment effects of limited clinical significance OR studies with no controls OR weak trends of effects (this is the CancerChoices definition; other researchers and studies may define this differently))

Melatonin: good evidence except among people with advanced cancer

Less fatigue during radio/chemotherapy among people with cancer treated with melatonin (good evidence)

Less weakness or lack of energy (asthenia) among people with advanced metastatic cancer (good evidence)

No evidence of an effectoverall, one or more studies did not demonstrate that a treatment or intervention led to an expected outcome; this does not always mean that there is no effect in clinical practice, but that the studies may have been underpowered (too few participants) or poorly designed. Larger, well-designed studies provide more confidence in making assessments. on fatigue among people with advanced cancer treated with melatonin in a preliminary study

Mistletoe: modest evidence

Less fatigue among people with cancer treated with mistletoe (modest evidence)

Moxibustion: modest evidence

Less cancer-related fatigue among people treated with moxibustion (modest evidence)

Relaxation techniques: mixed evidence

Less fatigue during chemotherapy among people treated with progressive muscle relaxation (modest evidence)

Less fatigue after surgery or stem cell transplant among people with cancer treated with relaxation techniques (modest evidence)

No evidence of an effect on reported fatigue after conventional resection of colorectal carcinoma among elderly people treated with relaxation techniques in a small trial

Tai chi or qigong: good to preliminary evidence

Less fatigue without regard to treatment phase among people with cancer practicing qigong or tai chi 
(strong evidenceconsistent, 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))

Less fatigue during cancer treatment among people with breast cancer practicing tai chi (modest evidence)

Less fatigue during chemotherapy among people with colorectal cancer practicing Baduanjin qigong, a common form a qigong (preliminary evidence)

Less cancer-related fatigue after cancer treatment among people practicing tai chi (good evidence)

Recommended in practice guidelines for managing fatigue; see guidelines ›

Vitamin C: intravenous use: modest and preliminary evidence

Less fatigue during conventional cancer treatment among people with cancer treated with intravenous vitamin C (modest evidence)

Not specific to cancer:

  • Less fatigue among office workers treated with intravenous vitamin C (not specific to cancer) (preliminary evidence)
Yoga: good evidence

Less cancer-related fatigue among people practicing yoga (good evidence)

Recommended in practice guidelines for managing fatigue; see guidelines ›

Therapies with preliminary or weak evidence of benefit for fatigue

Acupressure Learn moreSee Less
Antioxidant supplements with a special diet and pharmaceuticals Learn moreSee Less
Electroacupuncture Learn moreSee Less
Fasting or calorie restriction Learn moreSee Less
Fermented wheat germ extract Learn moreSee Less
Guided imagery Learn moreSee Less
Healing touch Learn moreSee Less
Mediterranean diet Learn moreSee Less
Modified citrus pectin Learn moreSee Less
Polarity therapy Learn moreSee Less
Probiotics and prebiotics Learn moreSee Less
Reiki Learn moreSee Less
Reishi mushroom Learn moreSee Less
Relaxation techniques combined with guided imagery Learn moreSee Less
Relaxation techniques combined with education Learn moreSee Less
Progressive muscle relaxation with breathing, meditation, guided imagery, and self-hypnosis, plus acupressure antinausea wristbands Learn moreSee Less
Support groups and interventions Learn moreSee Less
Therapeutic Touch Learn moreSee Less
Turmeric and curcumin Learn moreSee Less
Vitamin D Learn moreSee Less
Isoquercetin, ascorbic acid, and nicotinic acid Learn moreSee Less

Therapies with no evidence of benefit for fatigue

Non-aspirin non-steroidal anti-inflammatory drugs (NSAIDs) ›

  • No evidence of an effectoverall, one or more studies did not demonstrate that a treatment or intervention led to an expected outcome; this does not always mean that there is no effect in clinical practice, but that the studies may have been underpowered (too few participants) or poorly designed. Larger, well-designed studies provide more confidence in making assessments. on fatigue during chemotherapy among people with stomach cancer treated with celecoxib in a preliminary study

Further therapies used to manage fatigue

These therapies are used to manage fatigue. Many are recommended in at least one clinical practice guideline; see guidelines ›

Ashwagandha (Withania somniferra)

Calcium*

Electromagnetics

Folate*

Ginseng (both American and Asian)

Iron*

Hypnotherapy

Light therapy

Magnesium*

Massage therapy ›

Mindfulness-based approaches

Selenium*

Vitamin B12*

Psychosocial therapies:

  • Behavioral therapy
  • Cognitive behavioral therapy
  • Cognitive behavioral therapy for insomnia
  • Information and counseling
  • Mind-body stress reduction
  • Psychoeducational therapies/educational therapies
  • Stimulus control/sleep restriction/sleep hygiene

*for people with a deficiency

Personal stories

CancerChoices Senior Clinical Consultant Laura Pole, RN, MSN, OCNS, October 18, 2018: CancerChoices advisor Janie Brown, RN, MSN, MA, is an oncology nurse and co-founder of a cancer retreat program and center in Vancouver, British Columbia. Her CancerChoices story is a treasure trove of helpful information.

Janie describes how her partner with breast cancer and her team made decisions about chemotherapy, wove in useful 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 psychosocial therapy, and acupuncture therapies to prevent and minimize treatment side effects and created a caring community. The integrative plan staved off usual chemotherapy side effects including fatigue.

Read Janie’s full post on our blog

CancerChoices Senior Clinical Consultant Laura Pole, RN, MSN, OCNS: My colleague, a medical advocate, and I navigated a 50-year-old woman with breast cancer and type 2 diabetes. She takes metformin for her diabetes. She had completed chemotherapy and radiation therapy over a year before working with us, yet still experienced marked fatigue affecting her work and personal life. My colleague ordered a test of her vitamin B12 level, and it came back low. He prescribed B12 injections for her, and within a week her energy came back to pre-chemo levels. For over a year and half her fatigue was blamed on the chemo, when its persistence was likely due to metformin’s effect on her B12 levels.

Helpful links for managing fatigue

Authors

Nancy Hepp, MS

Lead Researcher and Program Manager
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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, program manager, and writer for CancerChoices. 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 and Program Manager

Laura Pole, RN, MSN, 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, RN, MSN, OCNS Senior Clinical Consultant

Last update: January 8, 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.