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Cancer Treatment Centers of America


What is fatigue?

Fatigued patients often describe feeling tired, exhausted, lethargic or weak, having heavy arms and legs, and little drive to participate in activities. Some experience either bouts of insomnia or may sleep too much. For those suffering from fatigue, even simple activities can seem grueling. The feeling typically doesn’t go away, even after a full night’s sleep. Factors, including the type and stage of cancer, treatment history, current medications, diet, sleep or rest patterns, psychological profile and certain conditions (such as anemia, breathing problems, decreased muscle strength, etc.), may be important considerations in determining how to approach symptom management. Fatigue is often worse in patients who:

  • Are undergoing a combination of treatments
  • Are in pain
  • Have advanced cancer
  • Are elderly
  • Are anemic
  • Experience psychological symptoms such as depression, anxiety or emotional distress

Cancer-related fatigue may be caused by many factors, and those that contribute to one person’s condition may differ completely from someone else’s experience. Cancer treatments such as chemotherapy and radiation therapy can cause fatigue.

With radiation therapy, for example, extra energy may be needed to repair damaged skin tissue. Radiation treatments may also cause cumulative fatigue, which increases over the course of treatment. The anti-cancer drugs used in chemotherapy may also harm healthy red blood cells and lower new red blood-cell production. Fatigue can also be a common symptom of some types of cancer.  Chemotherapy can disrupt eating and sleeping patterns, too, compounding fatigue’s effect.

How likely are cancer patients to experience fatigue?

Fatigue is a common side effect for cancer patients, especially during treatment. A 2011 review published in the Annals of Oncology estimated that 50 percent to 90 percent of cancer patients report feeling fatigued. The condition can profoundly affect all aspects of quality of life. Many patients report fatigue as one of the most important and distressing symptoms related to cancer and its treatment.

How can integrative care help?

A number of integrative oncology services may help alleviate fatigue. These therapies address some of the underlying causes of fatigue and may help prevent interruptions in treatment.

Chiropractic Care

Pain contributes to fatigue, and can lead to poor sleep, which compounds fatigue. Fatigue can also lead to sleeping in uncomfortable positions—like, for example, falling asleep in a chair, which can cause further discomfort. Chiropractic care providers may help reduce musculo-skeletal stress, which can alleviate pain and may help with quality of sleep.

Mind-Body Medicine

Based on the theory that thoughts directly influence what goes on in the body, mind-body medicine uses a variety of techniques to enhance the mind's impact on physical function, symptoms and health. At Cancer Treatment Centers of America® (CTCA), mind-body services are available to both patients and caregivers. Fatigue-related therapy options include:

  • Talk therapy or counseling, which encourages patients to ask for help and empowers them with tools such as self-care strategies and plans to help them figure out the way forward
  • Breathing and relaxation techniques that help calm the nerves, lower the heart rate and help offset the fatigue caused by stress or anxiety
  • Reiki therapy, which may help with fatigue.

Naturopathic Medicine

This integrative care service uses therapies to treat the whole person and encourage the self-healing process. The naturopathic oncology provider consults with the patient’s oncologist during cancer treatment to help manage side effects, including fatigue. Therapy options include dietary supplements, as well as panax ginseng, golden root, Acetyl L-carnitine and essential oils, which have also been known to help.

Nutrition Therapy

Patients experiencing fatigue typically move less and may sleep more, which can lead to a decrease in food intake and increase in muscle loss. Patients may become malnourished, deconditioned and weak. At CTCA®, dietitians monitor each patient’s nutritional status from the beginning to the end of cancer treatment, making modifications as needed to reduce side effects and help prevent treatment interruptions. The nutrition team may use various interventions to combat fatigue, including:

  • Liquid nutrition: Drinking calories requires less energy than chewing. Dietitians can recommend drink options that meet calorie, protein, vitamin and mineral needs.
  • Nutrient-dense recommendations: When patients miss meals because of low energy or longer sleep patterns, they have fewer opportunities to take in adequate nutrients throughout the day. Dietitians can help identify ways patients can get more calories, protein, vitamins and minerals from various foods, beverages and nutritional supplements. 
  • Quick and easy meal and snack ideas: When patients are too tired or weak to prepare meals, they may not eat. Dietitians can help to brainstorm ideas and identify resources for easy meal options.

Oncology Rehabilitation

This wide range of therapies is designed to help patients build strength and endurance and maintain the energy needed to perform daily tasks, roles and responsibilities. Options include:

  • Physical therapy and occupational therapy, to develop an individualized treatment program that provides education about the tools and strategies available to balance energy with exercise and daily tasks. A program may combine range-of-motion training and stretching with light or moderate resistance exercises and endurance training. These therapeutic exercises aim to reduce fatigue while therapists monitor results and progress, adapting to the patients’ abilities and personal goals. Therapists may also recommend certain adaptive equipment to reduce the amount of energy spent performing particular tasks while improving independence.
  • Auriculotherapy, a painless, non-invasive form of oncology rehabilitation that stimulates the auricle of the external ear may help alleviate fatigue and other side effects of treatment.
  • Manual therapy, which may include traditional massage, stone therapy, soft-tissue manipulation, aromatherapy, reflexology and other techniques, may also help.