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Combating Cancer-Related Fatigue

by Ann M. Berger, PhD, APRN, AOCNS, FAAN

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Regular physical activity, such as walking, has shown to be the most effective strategy for reducing physical fatigue.

Do you often feel a sense of physi­cal, emotional, or mental tiredness that limits your ability to do usual activities? Do you think that cancer or cancer treat­ment makes you feel exhausted? If you answered yes, you may be experiencing what your healthcare team refers to as cancer-related fatigue.

Most cancer survivors report fatigue before, during, and after cancer treat­ment. Fatigue often occurs with other symptoms, such as pain and poor sleep. Some survivors have said it is more distressing than all other symptoms they have experienced. Although the major­ity of survivors feel less fatigue after completing treatments, some report fatigue that interferes with usual func­tioning for years afterward.

Recognizing Fatigue
The first step in combating fatigue is to recognize that you feel fatigued. Next, you need to notify your doctor or nurse. This starts a process of screening and assessing your fatigue. You will be asked to rate your fatigue over the past seven days on a scale of 0 to 10. Your doctor or nurse will use your answer to develop a fatigue-management plan. Managing fatigue is important to your well-being and not a trivial issue. Your healthcare team’s goal is to reduce the distress fatigue causes so you can enjoy life. It is very important to discuss any concerns about fatigue with your healthcare provider.

Knowing your pattern of fatigue makes it easier to plan daily activities at home and at work.

Author of Article photo

Dr. Ann Berger

If you rate your fatigue as 4 or higher on a 10-point scale, further evaluation is recommended. Important areas to assess and possibly treat include pain, emotional distress, anemia, sleep dis­turbances, and nutritional deficits or imbalances. If you have been diagnosed with other chronic diseases, such as hypertension, diabetes, or arthritis, they need to be in good control so side effects from those treatments don’t escalate your cancer-related fatigue.

Conserving Your Energy
An im­portant general strategy for managing fatigue is conserving energy. You can do this by setting priorities, pacing your­self, and delegating energy-draining tasks.

Start by keeping track of your daily patterns using a journal, computer pro­gram, or Smartphone app. This will help you identify when your fatigue is better or worse. Knowing your pattern of fatigue makes it easier to plan daily activities at home and at work. Plan­ning the active part of your day around times of less fatigue allows you to fit in activities such as shopping, exercise, and naps. (Speaking of naps, you should limit naps to less than one hour to avoid interfering with nighttime sleep.) An­other effective way to conserve energy is to figure out which activities worsen your fatigue and delegate them to others.

In addition, physical activity, psycho­social interventions, massage, and fatigue education have all been found to allevi­ate cancer-related fatigue. With the help of your doctor or nurse, you can decide what will work best for you.

Reducing Physical Fatigue
Re­search has shown that regular physical activity is the most effective strategy for reducing physical fatigue. Beginning or continuing an exercise program, espe­cially a program with both resistance training (light weightlifting) and en­durance activities (walking, jogging, swimming), may help you feel less fatigued. Remember to discuss any ex­ercise program that you are considering with your doctor or nurse. He or she may refer you to a rehabilitation specialist to help you develop a plan to increase activity safely and without increasing your fatigue. Massage therapy may also reduce fatigue during cancer therapy.

Relieving Emotional and Mental Fatigue
You can select from several strategies that help relieve emotional and mental fatigue, including cognitive therapy, relaxation techniques, counsel­ing, support groups, hypnosis, and biofeedback. Support groups, held both in person and online, can help you cope with your feelings of fatigue and learn how others are coping. Journaling can be helpful; so can professional counseling. These therapies allow you to express your emotions about your diagnosis, treatment, and persistent fa­tigue. They can also provide you with support and encourage­ment from others experiencing fatigue.

Although there is less evi­dence in support of these therapies, both nutritional coun­seling and cognitive behavioral therapy for insomnia may be helpful. Your doc­tor or nurse may refer you to a dietitian who works with people with cancer or a sleep center that diagnoses and treats sleep disorders if these are identified as factors that may be contributing to your persistent fatigue.

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Dr. Ann Berger is a professor and Dorothy H. Olson Endowed Chair in Nursing at the University of Nebraska Med­ical Center in Omaha, NE.

Check out the National Comprehen­sive Cancer Network’s website,, for useful guidelines on managing fatigue.

This article was published in Coping® with Cancer magazine, March/April 2012.