The most common and perhaps most debilitating of all the blood cancer treatment side-effects is cancer related fatigue (CRF).

This daily lack of energy and whole-body fatigue is not relieved with sleep, nor is it the result of over exertion. This fatigue makes it difficult to cope with the normal demands of daily living due to a total lack of energy. CRF is not to be confused with tiredness that is often felt at the end of a long day, where energy is restored after a good sleep.

CRF typically displays the following characteristics:

  • generalised weakness or feelings of heaviness;
  • reduced ability to concentrate and perceived lack of short-term memory;
  • reduced motivation or interest in engaging in usual activities;
  • difficultly sleeping;
  • fatigue that is not relieved by sleep; and
  • difficulty completing normal daily tasks due to fatigue.

This form of fatigue usually diminishes one year after treatment finishes, however, 20-30% of people with CRF experience persistent fatigue that lasts five years or longer1.


  • blood levels, e.g., anaemia;
  • various causes of anaemia, such as nutritional deficits;
  • hypothyroidism (an underactive thyroid) – a common post-radiation treatment to lymph nodes in the neck;
  • the cancer itself, especially if  it causes anaemia;
  • cancer treatments:
  • chemotherapy – experience varies, but fatigue can last a couple of days and can extend beyond completion of treatment
  • radiation – has a cumulative effect, usually lasting 3-4 weeks after treatment ends
  • hormone treatment – can cause fatigue while on treatment
  • bone marrow transplant – fatigue can last up to 12 months
  • medications, such as antihistamines, antidepressants, narcotics, and anti-nausea;
  • depression and feelings of helplessness – it is common to confuse fatigue and depression, and it can be difficult to distinguish these conditions;
  • pain;
  • anxiety/stress;
  • sleep disturbance;
  • deconditioning;
  • inflammation.

The good news is that deconditioning, depression, pain, inflammation, anxiety and sleep disturbance can all be helped by exercise.


You can use various tools to help manage CRF.

  • Relaxation/distress management. Join a support group. Practise daily relaxation/meditation.
  • Pacing/energy conservation. Schedule your day/week to work out how much energy you can ‘spend’. Ensure a balance between energy conservation, restoration and expenditure.
  • Plan a rest period during the day.
  • Keep a diary for a week recording fatigue levels, activity, rest and energy expenditure.
  • Eliminate any activities that are causing you to ‘crash’ the most.
  • Distraction. Listen to music, watch a funny movie, laugh.
  • Perform physical activity that is consistent and sustainable. A graded exercise program is the best management for fatigue disorders.
  • Nutrition. Eat a healthy, balanced diet that regulates blood sugar levels, so you are not experiencing extreme highs and lows.
  • Sleep hygiene. Go to bed and wake at the same times each day, reduce/limit daytime naps, consume caffeine only before 11am, no screens one hour before bed.
  • Adequate pain control.
  • Get out into nature. Go for a walk in the morning sun. Enjoy morning sun on your face for 20 minutes. This will improve your mood and regulate your circadian rhythm.


Too much rest causes your muscles to reduce in size and strength, which makes it harder for you to move. As a result, you become less active which causes more deconditioning, fatigue and weakness. The cycle of deconditioning can be reversed – by exercise, which is the best way to cope with fatigue. It is something you can control and there are no bad side-effects. Exercise will have positive effects on your physical and psychological self.


Exercise is now recommended as a part of every cancer treatment plan. Research has found it has no harmful effects on patients with cancer and has shown that those who exercise regularly experience less CRF.

Useful link

By Dale Ischia

ESSA accredited Exercise Physiologist and ACSM cancer exercise trainer