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Fatigue is a common side effect that is experienced by individuals with cancer and may persists for months after completing treatment. Fatigue may be caused by the disease itself and may also be a side effect of therapy. Insomnia, depression, poor nutrition and anemia, or low levels of red blood cells can all contribute to fatigue.

Cancer-treatment fatigue is more than just being tired. It is an overwhelming sense of tiredness that is not always relieved by rest. It can be mild, causing a person to have less energy to do the things he or she wants to do; or it can be severe, affecting many areas of a person’s life and resulting in the inability to do basic activities.

Fatigue is one of the most common side effects of cancer treatment. It can affect many areas of normal living, including one’s desire to eat and drink. Left unchecked, it can lead to severe consequences such as malnutrition and dehydration, which contribute to additional fatigue, thus creating a dangerous cycle.

Fatigue is Common Among Long-Term Survivors of Cancer

According to an article published in the journal Cancer, a significant portion of survivors of breast cancer experience fatigue five to 10 years following treatment.

Researchers from California recently conducted a clinical study to assess fatigue in women who were long-term survivors of breast cancer. This study included 763 women who had survived breast cancer. They completed questionnaires at 1-5 years after diagnosis and at 5-10 years following diagnosis.

A significant portion of women reported fatigue for extended periods following diagnosis.

  • Approximately 34% of patients reported significant fatigue at 1-5 years following diagnosis.
  • Approximately 21% of patients reported significant fatigue at both 1-5 years and 5-10 years following diagnosis.
  • Fatigue was significantly associated with the presence of depression.
  • Women who were treated with both radiation and chemotherapy had increased incidence of fatigue compared to those treated with either treatment alone.

The researchers concluded that fatigue for extended periods following diagnoses occurs in a significant portion of cancer survivors and is an issue that needs to be addressed. The researchers suggested that treatment for depression may help alleviate fatigue in some of these women.

How Fatigue Affects Nutrition

Fatigue can significantly affect one’s desire to eat as well as one’s energy to prepare basic meals and snacks. Even walking to the kitchen can feel like running a marathon. This lack of energy is often overwhelming, causing patients to go many hours or even full days with only a few bites of food. This pattern leads to malnutrition and dehydration, both of which lead to more fatigue.

Eating for Energy

Many patients are in search of foods that will give them energy to overcome the fatigue. Unfortunately, there are no such foods. Even caffeine can reduce long-term energy levels and impair sleep, leading to additional fatigue. Foods that are purported to be a good source of energy simply provide calories (energy for the metabolism) but don’t provide a cancer patient with the type of energy he or she seeks.

Some cancer patients turn to herbal supplements such as guarana, ma huang, or ginseng for an energy boost. These are known stimulants, but the stimulation provided by these supplements has not been proven safe or effective in cancer-treatment fatigue. In addition, because they have known side effects and may interact with medications, they are not recommended during cancer treatment.

Eating Despite Fatigue

The best advice for people with cancer treatment fatigue is to eat a balanced diet that includes protein foods such as meat, eggs, cheese, peas, and beans and to drink eight to 10 glasses of fluids per day. Preventing malnutrition and dehydration can help keep baseline energy levels up and provide the body with the fuel it needs to maintain basic activities, although this is easier said than done.

Here are some tips to make meeting your nutritional needs easier during this difficult time:

  • Ask for help. Friends and family members are usually happy to prepare meals or go to the grocery store.
  • Set a timer for 60-minute intervals. Eat a few bites and drink some fluids every time the timer goes off.
  • Eat a few bites every time a commercial comes on TV.
  • Keep a cooler or mini-refrigerator in the room where you rest or next to your chair or bed. Keep it stocked with yogurt, pudding, cheese, milk, juice, or nutritional supplement drinks.
  • Keep nonperishable food items such as nuts, dried fruit, juice boxes, crackers, and peanut butter next to your chair or bed and nibble often.
  • Eat high-calorie, high-protein foods to maximize your nutritional intake.

Exercise reduces fatigue and improves strength, physical functioning, and emotional well-being in men and women undergoing chemotherapy, according to the results of a study published in the British Medical Journal.

While exercise has long been associated with the prevention of cancer and other diseases, new studies are focusing on the role of exercise in improving well-being in patients undergoing cancer treatment. A randomized, controlled trial in Denmark involved 269 cancer patients (73 men, 196 women) ranging in age from 20-65 years. (Patients with bone or brain metastases were excluded.)

The patients were randomized to receive conventional care only or conventional care plus a supervised exercise program that included high-intensity cardiovascular and resistance training, relaxation and body awareness training, and massage for a total of nine hours per week for six weeks.

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Using several different measures, including questionnaires, strength testing, and aerobic testing, the researchers assessed the patients’ fatigue levels as well as vitality, physical functioning, emotional well-being, and a number of other factors.

The results indicated that patients in the exercise group experienced a significant reduction in fatigue. In addition, they had improved vitality, aerobic capacity, muscular strength, emotional wellbeing, and physical and functional activity. However, there was not a significant effect on quality of life..

A review of 56 studies published in The Cochrane Library found that moderate exercise could help combat fatigue. 

The results of the analysis indicated that individuals with solid tumors benefited from aerobic exercise, such as walking or biking, both during and after cancer treatment. In contrast, resistance training did not appear to significantly reduce fatigue. The benefits of exercise for coping with fatigue were observed specifically for people with breast cancer and prostate cancer.

The researchers concluded that aerobic exercise during and after cancer treatment could help reduce cancer-related fatigue in individuals with solid tumors. 

What About Ginseng?

Cancer patients and survivors who took ginseng supplements for two months felt noticeable relief from fatigue, according to the results of a study published in the Journal of the National Cancer Institute.

Ginseng has shown promise in earlier studies. To evaluate its benefit, researchers conducted a randomized, double-blind study that included 364 people with cancer-related fatigue. Participants were randomly assigned to receive 2,000 milligrams of ginseng or placebo for eight weeks.

Throughout the study, participants reported their fatigue on a special questionnaire and researchers noted scores at baseline, four weeks, and eight weeks. After eight weeks, participants in the ginseng group reported a 20-point score increase, on average, compared with a 10-point improvement in the placebo group. Patients who were receiving active cancer treatment appeared to reap greater benefits from the ginseng than those who had completed treatment. Side effects (such as nausea, vomiting, and anxiety) did not differ significantly between the two groups.

The researchers concluded that 2,000 mg daily of American ginseng appears to relieve cancer-related fatigue. Although the results are promising, patients and survivors should use caution with any type of supplement—and always consult their physician first. Ginseng appears to be beneficial, but research will be ongoing to determine its safety and efficacy. In the meantime, exercise has been shown to be one of the safest and most effective ways to relieve cancer-related fatigue.4


The results of a Phase III study indicate that overall, long-acting methylphenidate is ineffective in the management of cancer-related fatigue. Methylphenidate may provide some benefit, however, to certain subgroups of patients, such as those with advanced cancer or severe fatigue. These findings were recently published in the Journal of Clinical Oncology.6

Some research has also indicated that stimulants of the central nervous system (CNS), such as methylphenidate, may alleviate cancer-related fatigue. Methylphenidate is a drug used to treat attention deficit hyperactivity disorder (ADHD) and narcolepsy.

In the current Phase III double-blind study, 148 patients with cancer-related fatigue were randomized to receive either long-acting methylphenidate or placebo for four weeks. Several standardized methods were utilized to measure fatigue. Comparing cancer-related fatigue in the patients who had the placebo versus methylphenidate indicated that overall, methylphenidate did not improve cancer-related fatigue. Patients with Stage III or IV cancer and/or severe fatigue, however, were reported to experience some improvement in this side effect with the use of methylphenidate. Appetite loss and nervousness were more prevalent in the methylphenidate group versus the placebo group.

The researchers concluded that the use of long-acting methylphenidate was not effective in the management of cancer-related fatigue for most cancer patients. Long-acting methylphenidate may provide some reduction in fatigue among patients with advanced disease or severe fatigue. These results indicate that cancer-related fatigue remains a significant problem among patients with cancer and further study is required to identify effective management strategies.


  1. Bower J, Ganz P, Desmond K, et al. Fatigue in Long-Term Breast Carcinoma Survivors. *Cancer.*2006;106:751 – 758.
  2. Adamsen L, Quist M, Andersen C, et al. Effect of a multimodal high intensity exercise intervention in cancer patients undergoing chemotherapy: Randomized controlled trial. British Medical Journal. 2009; 339: b3410.
  4. Barton DL, Liu H, Dakhil SR, et al. Wisconsin Ginseng (Panax quinquefolius) to improve cancer-related fatigue: A randomized, double-blind trial, N07C2. Journal of the National Cancer Institute. Published early online July 13, 2013. doi: 10.1093/jnci/djt181
  5. Cramp F, Byron-Daniel J. Exercise for the management of cancer-related fatigue in adults. The Cochrane Library. Published online November 14, 2012. DOI: 10.1002/14651858.CD006145.pub3
  6. Moraska AR, Sood A, Dakhil SR, et al. Phase III, Randomized, double-blind, placebo-controlled study of long-acting methylphenidate for cancer-related fatigue: North Central Cancer Treatment Group NCCTG-N05C7 trial. Journal of Clinical Oncology. 2010;28:673-3679.