What helps cancer-related fatigue?

What is cancer-related fatigue?

Cancer-related fatigue is a persistent sense of physical, emotional or mental tiredness related to cancer or its treatment that is not proportional to recent activity and is not relieved by rest or sleep. It is one of the most common and troublesome effects of cancer and its treatment.

It can continue for months or years after treatment ends and affect work, relationships, mood and quality of life.

What causes it?

Causes are often multiple: the cancer itself, chemotherapy, radiotherapy, surgery, hormonal and targeted treatments, anaemia, poor sleep, pain, low mood, reduced activity, deconditioning, poor nutrition, thyroid problems and some medicines.

Identifying and treating contributing factors, such as anaemia, thyroid problems, depression or sleep disorders, is an important first step.

Which treatments reduce cancer-related fatigue?

A meta-analysis of 113 randomised trials with 11,525 participants compared the four most commonly recommended treatments 1. Exercise (weighted effect size 0.30), psychological interventions (0.27) and combined exercise and psychological interventions (0.26) significantly improved cancer-related fatigue during and after primary treatment, while pharmaceutical interventions did not (0.09) 1.

The authors concluded that exercise and psychological interventions should be recommended as first-line treatments for cancer-related fatigue 1.

What kind of exercise helps?

An international exercise roundtable found enough evidence that aerobic training, combined aerobic and resistance training, or resistance training can improve fatigue in cancer survivors 2.

Starting with short, regular sessions of walking or cycling and light strength exercises, then gradually increasing duration and intensity, is a practical approach. Exercise is generally safe during and after treatment, although precautions may be needed 2.

Which psychological approaches help?

Cognitive behavioural therapy, mindfulness-based approaches and psychoeducation can help people manage fatigue, adjust activity patterns, improve sleep and address worry and low mood.

Support groups and counselling can reduce isolation and provide practical coping strategies.

How can daily life be adapted?

Pacing involves planning the day, prioritising important activities, spreading tasks out and taking short rests before becoming exhausted. Keeping a diary of energy levels helps identify patterns.

A regular sleep schedule, limiting long daytime naps, eating a balanced diet, staying hydrated and accepting help from others can all make fatigue more manageable.

How is cancer-related fatigue different from ordinary tiredness?

Ordinary tiredness usually follows effort and improves with a good night's sleep or a quiet weekend. Cancer-related fatigue often appears without a clear reason, can be overwhelming and may not lift even after long periods of rest. People describe feeling drained in body and mind, with heavy limbs, difficulty concentrating and low motivation.

Because it is different, advice that works for ordinary tiredness, such as simply resting more, can make cancer-related fatigue worse by reducing fitness further. Recognising the difference helps people and families understand why a planned increase in gentle activity is recommended.

How can families and employers help?

Families can help by sharing household tasks, protecting time for rest and exercise, and understanding that energy levels change from day to day. Planning important events for times of day when energy is usually better can make a real difference.

Employers can support a phased return, flexible hours, the option to work from home, and regular short breaks. Written plans agreed with occupational health or the care team make it easier to adjust work as fatigue improves or fluctuates.

When should fatigue be checked by a doctor?

Tell your care team about fatigue at any stage. Seek prompt advice for sudden severe fatigue, breathlessness, chest pain, dizziness, fever or bleeding, which may indicate anaemia, infection or other complications.

Fatigue together with persistent low mood, loss of interest or hopelessness may indicate depression, which is treatable.

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