After treatment: Tiredness

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I thought when I finished treatment, I would also be finished with feeling exhausted all the time. I thought that I would be able to play soccer with my kids and go back to work right away. But even a month later, I feel almost as tired as I did when I was going in for chemotherapy.
Richard
Recovering from colon cancer
Topics covered on this page:

I’ve finished treatment—why am I still so tired?

It is completely normal to experience fatigue after you have finished your cancer treatment. Fatigue affects up to 90% of patients after treatment. It is the most common complaint during the first year of recovery.  

Cancer-related fatigue is different from normal tiredness. It is a more intense exhaustion and lack of energy. Also, it does not get better with rest or sleep. Sometimes this fatigue may be manageable, and at other times it may feel much worse.  

Fatigue after treatment has been described in the following ways: 

  • Feeling tired even after resting or sleeping.  
  • A feeling of weakness throughout the body.  
  • Heavy arms and legs.  
  • Feeling very tired mentally, emotionally and physically. 
  • Difficulty thinking, remembering and concentrating.  
  • Trouble doing everyday tasks like getting dressed or doing the dishes.  
  • Shortness of breath after light activity, such as making the bed.  

Will it get better? For most people, fatigue gradually improves once treatment is over. However, it is not unusual for some amount of fatigue to continue for months after treatment ends, and sometimes for years. It depends on a number of things, including the type of cancer, the type of treatment and each person’s unique response to treatment. See the section What can I do to help manage my fatigue for strategies to help improve this side effect. 

How does it affect me? If you are experiencing fatigue after your treatment ends, it can affect all areas of your life including:

  • The activities you are able to do as you recover.
  • When you can return to work.
  • Your sexual life.
  • Your relationships with family and friends.

For more information about returning to work, see Back to Work.

For more information about sexual difficulties, see Sexual Matters.

For more information about relationships with friends and family, see Communication.

It is easy to get discouraged by a lack of energy. Many also worry about having to explain to family and friends that they are still tired. Another common concern is that fatigue is a sign that the treatment did not work or that the cancer has come back, which has been found to be unrelated.

Many people find fatigue more frustrating and distressing in recovery. They had been looking forward to getting back to their “normal” life and activities. In most cases, it is difficult to jump in right where you left off when you were diagnosed with cancer. Since it may take time for your energy to come back, it is important not to get discouraged.

In general, fatigue affects you in three ways:

  • Mild fatigue: You have some symptoms, but you are able to do your usual daily activities. For example, taking care of yourself, cooking or going to work.
  • Moderate fatigue: Your symptoms are causing you some distress. You have difficulty carrying out your usual daily activities. You also have trouble doing activities that require more energy, such as walking or going up stairs.
  • Severe fatigue: You are very tired and have a lot of distress. You cannot do your usual daily activities. You may feel like resting or sleeping all day. When you are resting, sometimes you feel sudden fatigue, a fast heart rate and/or have a hard time breathing.

What causes fatigue after cancer treatment?

The exact reasons for fatigue after cancer treatment are not well understood. It may be related to the type of treatment you received, as well as your body’s reaction to the treatment. People who get the same treatment don’t always have the same side effects.   

Other factors that may cause fatigue after treatment—or make it worse—include:  

  • Pain. Depending on your cancer or treatment, you may have pain after treatment.  
  • Sleep problems. 
  • Poor nutrition or dehydration (not drinking enough liquids).  
  • Not enough physical activity. If you were unable to be active during treatment, you may have also lost muscle strength.  
  • Stress, anxiety or depression.  
  • Other medical conditions—such as anemia or hypothyroidism. 
  • Medications—such as for pain or anxiety.

For more information on pain, see Pain. 

For more information on sleep problems, see Sleep. 

For more information on dehydration, see Dehydration.

For more information on nutrition, see Looking after yourself.

For more information on stress, see Distress. 

For more information on anxiety, see Anxiety. 

For more information on depression, see Depression. 

When should I get help for my fatigue?

Even though you have finished treatment, your healthcare team is still there to help you with any problems or concerns you may have. Your appointments may not be as regular as they used to be; however, you don’t have to deal with things on your own.  

Regular post-treatment follow-up includes checking for symptoms or long-term effects, like fatigue. Don’t hesitate to bring this up if it is a problem for you. It is important for your healthcare team to know about your symptoms. They can also reassure you that your fatigue is normal. There may also be something that can be done to help, such as: 

  • If you are having trouble eating well, your doctor can refer you to a nutritionist. 
  • You may have another condition, like anemia for example, that needs to be treated. 
  • Adjustments may need to be made to a medication you are taking.  
  • If you are having severe anxiety or are feeling depressed, your doctor may prescribe a medication that could help.  

If you feel that your fatigue is severe and it is interfering with your daily activities, try to talk to someone in your healthcare team as soon as possible. Avoid waiting for your next appointment. For some examples of questions you can ask your healthcare team about your fatigue, go to Ask your healthcare team questions in the section What can I do to help manage my fatigue? 

For more information, see Talking to your healthcare team. 

Manage

What can I do to manage my fatigue?

There are many strategies that you can try in recovery to help improve your fatigue. Keep in mind that fatigue is a personal experience and can be felt very differently by each person. As well, certain self-management strategies will work better for some people than others. Don’t compare yourself to anyone else—just focus on your own body.  

The website My Cancer Fatigue can help you create an action plan to manage your fatigue. The site focuses on five topics: physical activity, sleep strategies, nutrition, psychological interventions and spiritual practices. You can choose all or some of the topics and tips to build your action plan. There are also videos, tools, such as workbooks and an “energy and progress tracker”, as well as tips for caregivers. 

It may take time for your fatigue to improve and for self-management strategies to work. Try not to be frustrated or distressed if it’s taking longer than you expected to see improvement. Anxiety can make your fatigue worse. Take it one day at a time and focus on what you can do, not what you can’t do. Every change, no matter how small, is a step towards a more complete recovery.

During treatment, you may have tracked your fatigue in a symptom diary. This is a useful practice after treatment as well. It will help you notice the patterns in your fatigue as you recover and where to make adjustments in your activities. The information will also help your healthcare team understand how you are progressing. Details to keep track of include:

  • How tired you feel on a scale of 1-10 (1=very little fatigue, 10=worst possible fatigue) at different times of the day.
  • What you were doing when you felt the most tired.
  • What makes it feel better or worse.

For more information, see Symptom diary.

Your healthcare team can help you understand your fatigue better and how to approach dealing with it. You could talk to your oncologist, a nurse in your cancer centre or your family doctor, depending on what is appropriate for where you are in your recovery. Questions that you can ask about your fatigue include:

  • Is my fatigue “normal” or an expected symptom?
  • What is the likely cause (e.g., treatment, the cancer itself)?
  • How long is it likely to last? If and when it goes away, is it possible it will return?
  • Will it change (e.g., get worse or get better)?
  • Will certain activities affect it more?
  • Is there an effective treatment for my fatigue?
  • What can I do to manage it (e.g., diet, exercise, rest)?
  • How might it affect my recovery?
  • What do I do if I notice new symptoms or if existing symptoms worsen?
  • When should I contact the doctor? Are there any side effects I should tell the doctor right away?
  • In emergency situations, who can I call after hours, on weekends, or on holidays?

For more information, see Talking to your healthcare team.

There are many energy-saving strategies that can help you manage your fatigue.

  • Set realistic goals. Listen to your body and don’t to overdo anything. Understanding your body’s limits will help you make the most of your energy and help you avoid getting discouraged. Keep in mind that you are still recovering. Your body is not ready to do everything it used to do. Start slowly with simple and achievable goals. Even small changes can make a big difference. For example, if you used to work out regularly and you want to get back into exercising, don’t push yourself to start with the same workout program you did before you were diagnosed. Instead, try something simple like a 10-minute walk around the block and see how you feel.
  • Plan your day. Planning your activities can help you make the most of your energy. You can use a symptom diary (see Symptom diary) to track your energy levels and what makes your fatigue better or worse. This will help with your scheduling.
    • Make a list each day and prioritize the most important items. Do these tasks when you know you will have the most energy.
    • Try and spread out your activities evenly throughout the day. This way you won’t overdo it for short periods. Plan to switch between easy and hard tasks.
    • Reduce or eliminate activities that are less important to you.
    • Include enjoyable activities that don’t require a lot of energy and help you feel alert. Examples include reading or taking a walk.
  • Save your energy. This is an important part of using your energy wisely. It will help you feel less tired in general and have more energy when you need it most. Below are a number of tips for saving energy in everyday life. For tips on saving energy when you go back to work, see Cancer and Work at cancerandwork.ca.
    • Schedule down time. Build time into your day to relax, rest or take a short nap (~20–30 minutes).
    • Pace yourself. Make sure you have enough time to do the items on your list without rushing. Focus on one activity at a time. Don’t try to do too much at once.
    • Take the time to recharge between activities. Stop and rest before you get tired. This might mean taking a break in the middle of a task.
    • If an activity is too tiring, break it down into steps and spread it over a longer period of time. This can be over days if necessary.
    • Sit when you can. For example, use a stool to prepare food or wash the dishes. If you have children, choose activities that you can do sitting down. For example, board games, reading, or drawing.
    • Shop online and/or have your groceries delivered.
    • Buy prepared, or easy to prepare, meals.
    • Plan to cook when you have more energy. You can also make extra food to freeze.
    • Just say no. Don’t feel pressure to do anything you don’t feel up to right now. It is OK to say no to volunteer responsibilities or social obligations.
  • Ask for help. You may find it hard to ask for help from family and friends once your treatment is over. You may feel that they won’t understand that you’re still tired and need their support. Take some time to explain to those closest to you about any problems that you are still dealing with after treatment. Tell them you might still need help with activities that tire you. Some examples might include getting to appointments or work, cooking, yard work and child care.

A lot of research has been done on the effects of physical activity on fatigue in cancer patients. Studies have shown that regular physical activity helps improve fatigue after cancer treatment. Exercise may be the last thing on your mind when you’re tired. However, moving your body regularly helps boost your energy. Even small amounts of activity every day can make a difference. Talk to your healthcare team before starting a new exercise program. Make sure that your plan for being physically active is appropriate for you, particularly if you have other health conditions. Always stop exercising if you feel unwell or have pain. Physical activity can also help improve sleep and anxiety, both of which may affect levels of fatigue.

Here are some strategies you can try to be physically active:

  • Choose activities you enjoy. It doesn’t matter what you choose to do. What matters is that you get started. You’re more likely to continue a physical activity that you enjoy. Swimming, biking, running, walking, hiking, aerobics, yoga and dancing are a few examples. The possibilities for physical movement are endless. Think about if you’d prefer exercising alone or if scheduling time with a friend would help you stay motivated.
  • Start small. If you have not been active for a long time, you could start by looking for any opportunity to move about during the day. This is a good place to begin, even for just a few minutes at a time. For example, you could walk around when you’re on the phone or fold laundry standing up.
  • Start slowly. Only do as much as you are able to do. Make sure you are going at a pace that is comfortable for you. It is important to start slowly and build up your strength. Balance activity and rest. For example, you could start with a stroll around the block every day. When you feel comfortable with that, try walking for 5–10 minutes, 2–3 times a week. You could add some simple stretches to this.
  • Step it up. As you get stronger, gradually increase the amount of time you walk. You can also try walking faster. Ideally, you should be aiming for about 30 minutes of moderate intensity activity (e.g., brisk walking) almost every day. As you feel ready, include strength training as well. Strength training builds up your muscles. For more details on how to put together an exercise program to help reduce your fatigue, see BC Cancer–Exercise: Maximizing Energy & Reducing Fatigue.
  • Try mind-body exercises. Activities like yoga and tai chi combine slow movement, stretching, controlled breathing and mediation. These practices help relax the mind and body as well as provide exercise.
  • Use regular activities as exercise. Another way you can get moving is to use chores, such as housework or yardwork, as exercise. Vacuuming, shovelling and raking leaves all count as exercise and help build muscle. If you do these activities fast enough, you can get your heart rate up for an effective workout.
  • Get a personal trainer. If this is an option for you, a personal trainer can help you develop an exercise program that is right for you. They can also provide you with the structure you may need to achieve your physical activity goals.

For more information, see Get Moving.

It is very common to have trouble sleeping well after treatment. However, it is important to get enough sleep at night to help manage fatigue. You should aim for around 8 hours of sleep each night. Practicing good sleeping habits can help you improve the quality of your sleep.

  • Limit naps during the day. Sleeping too much can make you more tired. Short naps (~20–30 minutes) can help with your energy and likely won’t interfere with sleeping at night. Try not to nap after 3:00 pm.
  • Go to bed and get up at the same time every day.
  • Use your bed only for sleeping or intimacy. Don’t watch TV or eat in bed.
  • Turn off all screens at least 30 minutes before bedtime. This includes computers, tablets, phones and TV. The light from these screens can trick your brain into thinking it’s daytime and make it hard to sleep.
  • Don’t have big meals close to bedtime. Choose light snacks for something to eat in the evening.
  • Avoid caffeine (coffee, tea, cola, chocolate) in the afternoon and evening.
  • Wind down before going to bed. Choose something enjoyable that relaxes you. Some examples include reading, listening to music, meditating or taking a warm bath. Avoid doing anything demanding, like intense exercise or problem solving.
  • If you can’t fall asleep after around 20 minutes, get up. Do something calm and relaxing, and go back to bed when you feel sleepy.

Stress and anxiety can make fatigue worse. When you feel better emotionally, you feel less tired. You can also cope better with any fatigue you are experiencing. Managing stress is always easier said than done. However, there are a number of methods that can be helpful. 

  • Practice relaxation strategies. Most relaxation techniques can be done almost anywhere.
    • Breathing exercises. This focuses on slow, deep breathing. Even a few minutes of deep breathing can help you relax.
    • Progressive muscle relaxation. This involves tensing and relaxing a muscle, or group of muscles, one at a time.
    • Guided imagery or visualization. Some people find that this technique relaxes them by helping them imagine being in a place that makes them feel calm in real life. Guided means someone talks you through the process in person or using a recording.
    • Meditation is a practice of quieting the mind, usually by focusing attention on the breath. You can meditate sitting, lying down and even walking.
  • Explore complementary therapies. Complementary therapies may help reduce stress and improve your emotional wellbeing. Some examples are massage therapy, music therapy, acupuncture, healing touch and reflexology.
  • Focus on what you can control. Try to stay in the present moment. Worrying about things you have no control over in the future can affect the amount of stress and anxiety you experience in your everyday life.
  • Make time for relaxing activities. Try to make some time to do something you enjoy every day. It could be as simple as listening to music or spending time with people who make you laugh. It is important to include activities in your day that make you feel good. Also try to limit situations that cause you stress.

For more information, see Relaxation Strategies.

It is important to follow a healthy, well-balanced diet. Include plenty of fruit, vegetables and whole grains to keep your energy levels up. Some eating tips to manage fatigue include:

  • Choose energy-boosting foods.
    • Fruit, vegetables and whole grains are foods called complex carbohydrates. These foods are digested slowly and keep you full longer, giving you energy throughout the day. They also contain vitamins, antioxidants (substances that help protect the cells from damage) and fibre that are important for your health. Beans, sweet potatoes, brown rice and whole-wheat bread are other examples of complex carbs.
    • Healthy fats are another good source of energy. Options include salmon, tuna, mackerel sardines, nuts, seeds, avocados and olive oil.
    • Add protein to every meal. High-protein foods include fish, chicken, eggs, beans, lentils, quinoa or tofu. Good snack proteins include nuts, cheese, peanut butter, hummus and Greek yogurt.
    • For more information on high-energy and protein-rich foods, see the CHUM health sheet Eating protein-rich and energy-dense foods.
  • Limit foods that are high in added sugar. For example, cake, chips and candy. These foods have little nutritional value. They can also make you feel tired after an initial “sugar rush”.
  • Drink plenty of fluids. Try to drink around 8 cups of fluids throughout the day, unless you’ve been told otherwise by your healthcare team. Not drinking enough fluids can make you feel more tired. You can drink water, but you can also get your fluids from other sources. For example, juice, milk, smoothies and soup.
  • Limit your intake of caffeine and alcohol.
  • Don’t skip meals. Eat regularly to maintain your energy.
  • Have healthy protein snacks on hand for when you get hungry between meals.
  • Keep it simple. For easy options for healthy meals and snacks, check out Staying well-nourished with cancer-related fatigue.

If you would like help planning healthy meals or if you have trouble eating because of your cancer or treatment, speak to your healthcare team. They can refer you to a nutritionist or a dietician. 

For tips on how to eat healthy, see information on page 4 to 7 in Looking After Yourself.

You don’t have to deal with your fatigue on your own. In addition to your healthcare team, there are a number of other options you can consider for support.

  • Connect with family and friends. Talking about your emotions and worries can help you reduce your stress.
  • Talk to a therapist. Talk to a professional if you are having trouble managing your emotions on your own. A therapist can help you think about your worries differently. They can also give you ideas on how to manage stress and anxiety. This can help with your fatigue, as stress can worsen fatigue. Most cancer centres have psychological support services. These services are often also available to patients after treatment, as they continue with their oncology follow-up appointments.
  • Join a support group. It often helps to talk to people who have had similar experiences. You may feel less alone and you can learn new ways to help you cope with fatigue. Many organizations also offer one-on-one support or peer counselling if you are not comfortable talking in a group.
  • See a specialist. Depending on your cancer or treatment a specialist might be able to help you with managing fatigue in your daily activities. Talk to your doctor to see if this is a good option for you and for a referral. For example, an occupational therapist, a physical therapist, or a rehabilitation program might be helpful.

For more information, see Getting Support.

⚠ Important information about cannabis

Some patients do use cannabis to reduce pain, help with relaxation or as a sleeping aid. However, the research is still unclear about the use of cannabis to manage cancer-related symptoms, including anxiety. It is important to talk to your doctor before trying cannabis. For more information on what cancer patients should know about cannabis, go to: www.bccancer.ca/health-info/coping-with-cancer/medical-cannabis. 

How can caregivers help?

A caregiver can support a recovering cancer patient dealing with fatigue by reviewing the action items in the What can I do to help manage my fatigue? section with them and providing encouragement. A caregiver can also use the patient list of self-management strategies to create their own action list. For example:

  • Help the patient prioritize and schedule activities. 
  • Try not to push the patient to do more than they feel ready to do.
  • Offer to accompany the patient on walks if they want to start exercising.
  • Help schedule family and friends to prepare meals or run errands.

Available services

For services available in Quebec to help you deal with cancer-related fatigue, check out the services below.

The Quebec Cancer Foundation supports people with cancer and their loved ones throughout Quebec, through services suited to their needs and daily concerns.  

Services offered for Tiredness/Fatigue

Several services and activities offered by the Quebec Cancer Foundation can be useful to help you manage your fatigue: kinesiology services, psychological support, complementary therapies, and others. The Quebec Cancer Foundation also has many documentary resources on the subject.  

Contact

1-800-561-0063

infocancer@fqc.ca

The mission of the Quebec Breast Cancer Foundation is to promote the well-being of cancer patients and their families through research, innovation, support and awareness.

It is committed to offering a range of services, including a hotline for information and resources adapted to the needs of people living with cancer.

Services offered for Fatigue

My Active Health: a service that helps by offering physical activities on a regular basis which contribute to relieving fatigue, such as:

  • My mobile application
  • My exercise videos
  • My oncologic yoga
  • Dragon Boat Teams

The Quebec Breast Cancer foundation offers psychosocial support. The social workers from the support service can also help form strategies with you to cope with fatigue and to master all worries and preoccupations that can intensify.

Free virtual clinic: a service of first aid offered to people affected by breast cancer. We aim to help manage the secondary effects that arise after treatment and those that persist long term. The clinic is:

  • Easy-to-use
  • Accessible 24/7

General information
They offer support for people with cancer and their family, friends and caregivers.

Their information specialists are there to answer your questions and offer up-to-date, reliable information on topics that include:
• cancer treatment and side effects
• clinical trials
• coping with cancer
• emotional support services
• prevention
• help in the community
• complementary therapies

Offered Services 

The Cancer Information helpline is available Monday to Friday in English and French from 8 h to 18 h HE. For other languages, they can access an interpreter service. 

Website and live-chat: 

Talk to an information specialist | Canadian Cancer Society 

(Toll free) number: 

1-888-939-3333 

Contact form: 

Cancer information and support | Canadian Cancer Society 

You can also access the CCS database below to find support services in your area.

Service locators

Below is a list of organizations that can help identify local support services for you and those that support you. The quality of the services has not been verified by e-IMPAQc. Before using these services, verify with your healthcare practitioner. 

The Canadian Cancer Society offers a service locator resource where you can find services and programs in your city or nearest your postal code.  

Contact

info@cancer.ca 

1-888-939-3333  (Monday-Friday)

The Regroupement des Organisations Communautaires en Oncologie (ROCO) offers a service locator resource specific to the province of Quebec. It lists support resources available by region.  

Contact 

info@rocoqc.ca

514-506-3503  

The Quebec Cancer Foundation offers a resources directory of community, association and public resources by region or postal code.   

The foundation also has a document lending service. Their materials (books, web resources, online articles, webcasts) cover a wide range of topics related to cancer. It is free to borrow and materials are sent by mail or email anywhere in Quebec.  

Contact

infocancer@fqc.qc.ca 

1-800-363-0063  (Monday to Friday, 9 AM to 5 PM EST) 

Acknowledgement of sources​

The content of this document has been adapted from the following sources: 

  • American Cancer Society. Get Active. 2021.  
  • American Society of Clinical Oncology. Answers: Cancer Survivorship. 2021. 
  • American Society of Clinical Oncology. 8 Ways to Cope with Cancer-Related Fatigue (Dr. Merry Jennifer Markham). 2017. 
  • BC Cancer. Exercise: Maximizing Energy & Reducing Fatigue. 2020. 
  • BC Cancer: Managing Fatigue (Tiredness). 2020. 
  • Cancer Care Ontario. How to Manage Your Fatigue. 2016. 
  • Cancer Council Australia. Living Well After Cancer. 2018. 
  • Cancer Support Community. Fatigue.  
  • Canadian Cancer Society. Fatigue.  
  • Canadian Cancer Society. Life After Cancer Treatment. Fatigue. 2018. 
  • Cancer and Work. Fatigue. 
  • CHUM. Coping with fatigue related to cancer and treatments. 2019. 
  • Coping Together: Getting on Top of Symptoms. How can we manage fatigue (tiredness)? 
  • Dana-Farber Cancer Institute. Your Body after Treatment.  
  • Handbook of Cancer Survivorship. Fatigue. 2018. 
  • Harvard Medical School. Life After Cancer: Preserving your health and well-being after treatment. 2017. 
  • Jones JM. Cancer-related fatigue and associated disability in post-treatment cancer survivors. 2015. 
  • Kessels E. The effect of exercise on cancer-related fatigue in cancer survivors: a systematic review and meta-analysis. 2018. 
  • Looking Forward. What to Expect After Treatment. Fatigue. 2016. 
  • Macmillan Cancer Support. Coping with Fatigue (Tiredness). 2018. 
  • Memorial Sloan Kettering Cancer Center. Managing Cancer-Related Fatigue. 2020. 
  • National Cancer Institute. Facing Forward: Life After Cancer Treatment. 2018. 
  • National Cancer Institute. Fatigue: Patient Version. 2021. 
  •  

Healthcare professional endorsement

The content of this document has been reviewed and approved by a team of healthcare professionals and clinical experts.

Disclaimer

Please note that this fact sheet is not intended as a substitute for consultation with a healthcare professional. Rather, it was designed to complement interventions by your treating team. If you have questions about your health, or any medical issue, you should contact a healthcare professional right away. You should not delay seeking medical advice, or disregard professional medical advice, because of information in this fact sheet. Before beginning any health treatment, always consult your doctor. All care has been taken to ensure that the information contained in this document is accurate at the time of publication. e-IMPAQc is not responsible for any injury or damage to persons or property arising out of, or related to, any use of the fact sheet, or because of any errors or omissions.

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