Feeling Fatigued?

Feeling Fatigued?

Here are some strategies to help you cope.

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

Does cancer or cancer treatment leave you feeling exhausted? Do you feel physically, emotionally, or mentally tired? Do those feelings reduce your ability to participate in your usual activities? If you answered yes to these questions, you may be experiencing what your healthcare team refers to as cancer-related fatigue

Many cancer survivors say they experience fatigue at diagnosis, during treatment, and even after treatment ends. A large number of survivors say that fatigue is more distressing than all the other cancer symptoms and treatment side effects they experience. Although most survivors report lower fatigue after the end of active treatment, some continue to experience fatigue that interferes with usual functioning for years. 

The first step to combatting fatigue is to be aware of it. The next step is to tell your doctor or nurse that you are experiencing fatigue. Your healthcare provider will then assess your fatigue and help you come up with a fatigue-management plan. For most people, managing fatigue is a balancing act between conserving energy and participating in physical activity and exercise. 

Conserving Energy – It’s important to set priorities for what you want to spend your energy doing, and then pace yourself throughout the day so you’ll have enough energy to do those activities. Knowing your usual patterns of fatigue will make it easier to plan your daily activities in order to best conserve energy. You can keep track of the times of day when you feel the most fatigued, as well as the activities you find most draining, by recording them in a journal, computer program, or smartphone app. 

This will allow you to easily see when your fatigue is better or worse and plan accordingly. Try to schedule high-energy tasks, such as shopping or exercise, during times of the day when your fatigue is usually lower. 

Another aspect of managing fatigue is learning which activities worsen your fatigue and reducing the time you spend doing them, or simply delegating those tasks to others. It’s especially important to delegate energy-draining tasks when your fatigue is moderate to severe. The goal is to remain as active as possible by learning to balance activity with rest in order to avoid overexertion and, therefore, more severe fatigue. 

A Note on Napping

It’s OK to take short naps during the day. However, keep in mind that daytime naps should last no longer than one hour and should be taken at least four hours before bedtime so as not to interfere with nighttime sleep.

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Exercise – Research has confirmed that regular physical activity is the most effective strategy for reducing physical fatigue in cancer survivors. All survivors are encouraged to begin, or continue with, an exercise program that includes both resistance training (such as light weightlifting) and endurance activities (like walking, jogging, or swimming). 

Managing fatigue is a balancing act between conserving energy and participating in physical activity and exercise.

Many communities offer exercise and yoga classes for adult cancer survivors. However, since exercise programs are not one-size-fits-all, talk with your doctor or nurse before starting any exercise program, even one that is geared toward cancer survivors. Your doctor may suggest you meet with a rehabilitation specialist to help you develop an individualized exercise plan that allows you to increase your physical activity safely without worsening your fatigue. 

Exacerbating Factors – If your fatigue is moderate to severe, your doctor may want to address other factors that could be exacerbating your fatigue. These may include

  • pain
  • emotional distress
  • anemia
  • sleep disturbances
  • other chronic diseases or conditions
  • deconditioning (from a lack of physical activity)
  • nutritional deficits or imbalances

If you have other chronic diseases, such as hypertension, diabetes, or arthritis, it’s important that your symptoms be well-controlled so they don’t worsen your cancer-related fatigue. 

Cancer-related fatigue is not a trivial issue. It is very important that you discuss your fatigue – and the problems it may be causing – with your healthcare provider, especially if your fatigue is severe or if you are so exhausted you can’t function in your usual activities. Managing fatigue is critical to your well-being. By working with your doctor to develop a fatigue-management plan, you can reduce the distress caused by cancer-related fatigue so you can get back to enjoying life. 


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

This article was published in Coping® with Cancer magazine, July/August 2016.

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