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 and complementary therapies
Strong, good, or modest evidence of benefit
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) indicates confidence that the practice or therapy has an effect as noted.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) indicates that the practice or therapy is linked to the outcomes described with reasonable certainty. 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) means the practice or therapy may be linked to the outcomes described, but with a lower degree of certainty.
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.
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))
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
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 ›
Preliminary or weak evidence of benefit for fatigue
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) means the practice or therapy may be linked to the outcomes described, although substantial uncertainty remains. 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) may mean that the effects are small or that a high degree of uncertainty remains about the links between the practice or therapy and the outcomes described.
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*
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.