Tiredness
Topics covered on this page:
What is cancer-related tiredness?
Everyone experiences tiredness (also called fatigue) in the course of regular life. Cancer-related tiredness, however, goes beyond what you would normally feel at the end of a long, busy day. When you have cancer, you may feel a heavier kind of tiredness that doesn’t go away even after you relax, rest or sleep. Tiredness is the most common symptom people with cancer have.
Keep in mind that feeling tired is not the same thing as poor sleep patterns, although the two may happen together. Dealing with poor sleep may require some different strategies, which you can find on the Sleep page.
- How does it affect me? Cancer-related tiredness tends to be chronic, meaning it stays with you most of the time even if you relax and rest as much as you can. Sleep alone will not help your feelings of exhaustion, lack of motivation, and lethargy. It can get in the way of all areas of your life, including physical, social and work activities.
- Does it get better? Tiredness tends to come and go and is usually worse during treatment. It can improve after you’ve finished treatment but this may take several months after treatment ends. The strategies described here can help a lot. Be patient: small changes can help you feel less tired over time.
What causes tiredness?
Several aspects of cancer and its treatment can lead you to feel tired.
- The cancer itself
- Treatments: surgery, chemotherapy, radiation therapy
- Some medications, such as those for pain, depression, allergies or nausea
- Dehydration – not drinking enough fluids
- Poor eating habits
- Lack of physical activity
- Pain or discomfort
- Not getting enough sleep or having insomnia
- Anxiety and stress
- Hormonal imbalance
- Anemia (lack of iron in the blood)
- Infection
- Fever – higher than 38.0 C or 100.4 F
- Nausea – feel sick to your stomach
What are the signs of tiredness?
Typical signs of tiredness resulting from cancer or its treatment include:
- Your tiredness doesn’t get better, keeps coming back, or gets worse
- You are more tired than usual during or after an activity
- You feel tired even though you haven’t been physically active
- Your arms and legs feel heavy and hard to move
- You feel weak
- Your tiredness does not improve with rest or sleep
- You cannot concentrate or think clearly
- You feel sad, depressed or irritable
- You have difficulty doing daily activities
When should I get help for my tiredness?
It is natural to feel more tired than usual when you are going through cancer treatment. However, you should talk to your oncologist, your radiation oncologist, your nurse, or your pivot nurse at your next appointment if fatigue is a problem (for more information see Talking to your healthcare team). Let them know if you have any of the following:
- Fever (more than 38ºC or 100.4ºF)
- Anxiety (stress or worry)
- Depression
- Loss of appetite
- Dizziness
- Sleep changes
Talk to someone in your healthcare team immediately if:
- You are so tired, you have trouble with daily activities such as dressing, bathing or feeding yourself.
- You feel like your tiredness is suddenly much worse.
What can I do to help manage my tiredness?
There are a lot of options for managing your cancer-related tiredness and improving your energy level. Start by exploring the strategies below. If you need extra help, don’t hesitate to talk to the healthcare professionals on your team.
Keeping track of your cancer-related tiredness can help you understand your body and find patterns. Are you most tired when you get up too late? Too early? Review your diary every few days and look for patterns. Perhaps you’ll find out you feel more tired on the days you skipped your noontime walk or in the hours after a heavy meal. Here is some information you can record in your diary:
- What time did you start feeling tired
- What were you doing before you started feeling tired?
- How did the tiredness feel
- Did you do anything to try to feel less tired
- How well did it work?
- What are you eating? How many meals a day do you eat?
- How much and what are you drinking?
- To evaluate your tiredness more accurately, you can record it as a number from 0 to 10, with 0 = not tired at all and 10 = as tired as you can imagine.
- For more information see Symptom diary.
The best way to manage fatigue is to get moving. While it is hard to be physically active when you feel tired all the time, a bit of movement will actually give you more energy, along with improving your mood. And it doesn’t have to be painful—any physical activity that makes you breathe a little harder, such as brisk walking, can help.
- It is generally fine to be physically active during treatment, but check with your healthcare team before starting any exercise.
- Notice when you feel the least tired (for example, in the morning) and aim to exercise at those times.
- Aim for regular, gentle movement, rather than intense and infrequent workouts.
- Start slow and increase gradually. For example, you could start with a 10-minute walk a couple of times a week and gradually build up to half an hour, four times a week.
- Talk to a trainer or an exercise specialist about some gentle stretching and muscle-strengthening exercises you can work into your daily routine.
- Respect your body and its limits. If you move and start feeling unwell, take a break and don’t start again until you feel better.
- For more information see Get Moving.
Your psychological wellbeing is an important factor that can help manage fatigue. When you feel better in general, you will likely feel less tired. These simple tips can help:
- Make time for enjoyable activities that don’t require too much energy, like visiting a park or museum. Inviting friends along can help distract you and lift your mood.
- To feel calmer, explore relaxation or guided imagery. Relaxation techniques include meditation or breathing exercises. These focus on slow deep breathing and attention on breathing in and out. Guided imagery helps by imagining or visualizing a calm place or setting. For more information see Relaxation strategies.
- Limit thoughts and activities that increase your stress, as worrying can interfere with healthy sleep.
- Talk to friends and/or healthcare professionals about feelings that stress you out.
- Focus on the things you can do.
Good sleep hygiene means behaviours that help you sleep. Poor sleep can make you feel tired, and feeling tired can lead to poor sleep. The best way out of this cycle is to develop healthy sleep habits. Here are some helpful suggestions:
- Wake up at more or less the same time every day: regular sleep hours promotes good sleep.
- Have only short naps during the day and avoid naps within four hours of bedtime.
- Aside from nap or sleep time, avoid lying in bed so you don’t accidentally fall asleep.
- Try to wind down before bedtime. Do something you find relaxing, like drinking a cup of herb tea, having a warm bath, or listening to a meditation tape.
- Stay away from strenuous or stimulating activities in the evening—that includes television, computer and other screens. Screen time before bed could make it harder to fall asleep.
- Eat only light snacks in the evening and nothing right before bed.
- If you don’t fall asleep within 20 to 30 minutes, get out of bed. Then engage in a calming activity for a while, and return to bed when you feel sleepier.
- Make sure your bedroom is dark and at a comfortable temperature.
Poor nutrition can make you more tired, while a healthy diet can boost your energy. Eating smart also means keeping it simple, so food preparation doesn’t tire you out. Some approaches to try:
- Speak to a dietitian if you are losing weight, have a low appetite or have a medical condition that limits what you can eat.
- Build your diet around whole grains, vegetables, fruits, and healthy proteins such as eggs, cheese, and lean meat. Limit processed foods and foods high in sugar, salt and fat.
- Drink water and other healthy beverages you enjoy—a lack of liquids can make you more tired.
- If you find it hard to get food down, try high-calorie drinks such as protein shakes or smoothies.
- If you cannot eat 3 full-sized meals, eat smaller meals more often.
- Keep healthy “grab-and-eat” foods within easy reach. For example: whole-grain bread, cheese slices, dried fruits, and nuts.
- On days when you have more energy, do some advance cooking and freeze meal-sized portions.
- Avoid caffeine (including cola drinks) in the afternoon and evening in order to not disturb your sleep at night.
Even though it is recommended to stay active and exercise, it is also important to manage your energy. In other words, use your energy wisely throughout the day. It does not mean to do as little as possible at all times. Here’s how you can conserve energy:
- Listen to your body to know when you are getting more tired.
- Keep your activity level fairly even during the day, rather than pushing yourself hard for short periods of time.
- Choose the most important things to do and leave the rest aside, so you don’t wear yourself out.
- Do one activity at a time, without rushing, and rest between activities.
- As far as possible, schedule your activities for times of day when you have more energy.
- Sit down instead of standing for some activities (drying dishes, for example).
- Let the dishes soak before you wash them, and leave to air-dry.
- Eat prepared meals (meals on wheels, catering services, frozen foods).
- Have your groceries delivered.
- Ask for help doing tasks that tire you out.
⚠ 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 tiredness. 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.
Resources
For more information on cancer-related tiredness, self-management strategies and support organizations, check out the resources below.
BC Cancer – Managing Fatigue (Tiredness)
BC Cancer – Exercise: Maximizing Energy and Reducing Fatigue
Canadian Cancer Society – Managing Fatigue (video)
Cancer Care Manitoba – Living Well with Cancer-Related Fatigue
Cancer Care Ontario – How to Manage Your Fatigue
CHUM – Coping with fatigue related to cancer and treatments
Acknowledgement of sources
The content of this document has been adapted from the following sources:
- BC Cancer. Symptom Management Guidelines: Fatigue. 2018.
- BC Cancer. Symptom Management: Fatigue/Tiredness. 2017.
- BC Cancer. Exercise: Maximizing Energy and Reducing Fatigue.
- Canadian Cancer Society. Managing Fatigue (video).
- Coping with fatigue related to cancer and treatments. 2019.
- CPAC/CAPO A Pan Canadian Practice Guideline for Screening, Assessment, and Management of Cancer-Related Fatigue in Adults Version 2-2015,
- Cancer Care Ontario. How to Manage Your Fatigue. 2016.
- Coping Together: Getting on Top of Symptoms. How can we manage fatigue (tiredness)?
- Remote Symptom Practice Guides for Adults on Cancer Treatments. Fatigue/Tiredness. 2020.
- Cyr C et al. Cannabis in palliative care: current challenges and practical recommendations. Ann Palliat Med 2018;7:463-477.
- My Cancer Fatigue. Decision aid. 2019.
- My Cancer Fatigue. Management guide. 2019.
- Prostate Cancer Canada. TEMPO: Fatigue (tiredness).
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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