The month of October is breast cancer awareness month so I wanted to write about an issue that is so common in cancer …fatigue. Fatigue is often poorly understood by both those who experience it as well as by the greater community. It is defined as

“Feeling extremely tired, weak and lacking energy” – Cancer Council Australia

Unlike tiredness, fatigue is not always improved by sleep and rest and can encompass not only the physical tiredness but mental exhaustion as well. Research has found that fatigue is one of the most common complaints expressed by individual’s with cancer. Let’s take a closer look at what causes it…

Causes of fatigue



Cancer itself can cause fatigue by using the bodies energy to grow. Cancer cells are hungry cells so they do literally drain the energy out of you.

Cancer treatments

Surgery, radiation and chemotherapy can all cause significant fatigue as a side effect. During these treatments the usual body processes are disrupted which causes strain on the body (and mind). After cancer treatments the body also needs to put more energy into the healing processes which can mean there is less energy readily available for everyday life.

Reduced physical activity

This often occurs due to the time constraints of attending appointments and cancer treatments as well as the fatigue that occurs as the side effects of the cancer treatments. Unfortunately when we stop exercising it can become a downward spiral from a fatigue point of view. As we lose fitness, our body gets more exhausted as the muscles are not working efficiently which in turns leads to us doing less exercise as we have less energy and so on…

Dietary changes

Nutrition plays an extraordinary role in our energy levels. Unfortunately due to some of the common side effects of cancer treatments such as changes in taste, nausea and loss of appetite, many individuals become fatigued from poor nutritional intake as the fuel that our body needs is not available.

Psychological stress

Ongoing stress from dealing with cancer treatments and the concern of the unknown also play a significant role in exhaustion and fatigue. Ongoing stress causes inflammation in our body by consistently increasing our fight or flight hormones. This inflammation adds to the ongoing mental and physical fatigue.


How can fatigue be managed?


Even though fatigue cannot be cured it can be effectively managed with simple strategies. The following are examples of beneficial strategies to consider in managing your fatigue.


This refers to reducing the pace of your activities to spread your energy further. You will find it hard to keep up your pre cancer pace of life. Be kind to yourself and try to do little bits regularly as your fatigue allows you to. You will know if you have done too much as you will be exhausted for a day or so afterwards. It’s okay to delay less important tasks to other days and consider delegating tasks to others where possible. You may find that you need to break tasks into smaller portions rather than completing them in one go eg. Vacuuming, laundry, gardening. For personalised strategies for managing fatigue, we recommend booking in for a consultation so that you get the best information for your particular circumstances.

Sleep hygiene

Sleep hygiene refers to the process of readying the body for sleep. Try to create a bed time routine that you follow every night – this helps your body recognise that it is getting ready for sleep. It is really important to prepare your body for sleep in order to get good quality restorative sleep. It is also important to try to have a regular wake up time each day for this same reason. Try to also limit the length of naps during the day to avoid your body not being tired at bed time.

For more information on sleep hygeine, check out this information sheet created by WA health.


A well-balanced diet is essential in optimising energy levels. Dietitians are the best clinicians to check your nutritional intake and what your body’s needs are. Dietitians can also advise on options such as nutritional supplements where lack of appetite or changes in taste are making it difficult to meet your needs. Dieticians are located within most cancer centres or you can find an accredited dietician via Find a Dietitian (


Exercise is essential in improving the bodies energy levels (surprise, surprise – of course a physio would say that!). When we exercise, we improve the efficiency with which our bodies work by improving our muscle, heart and lung fitness. This means that we use less energy in our general day to day life. Exercise also assists in getting better quality sleep by reducing stress and anxiety and it helps you to spend more time in deep sleep which is where most of our tissue repair happens. It is important that you continue to exercise during your treatments as well as afterwards as research has shown not only that it is beneficial for fatigue but also that it improves quality of life, function and can reduce your risks of developing lymphoedema. When adding exercise to your routine make sure you monitor your fatigue levels as it can be very easy to overdo it. Start slowly with short periods of exercise and build up as your endurance improves. If you are unsure about what exercise is safe for you or how to pace your exercise, please get in contact with us at Calm and Connection Physiotherapy.


Mindfulness and meditation are useful tools to reduce stress and anxiety and to also assist in managing mental fatigue. Mindfulness of breathing can be a great starting point and remember to start small and slowly build as your focus improves. Even short periods of mindfulness can be very beneficial. Thanks to covid, there are now lots of apps and websites that can guide you with mindfulness including calm and headspace to name a few.


Prioritisation refers to thinking about what needs to happen in your day and sorting tasks from the most important to the least important. By doing this, you can ensure you get to the most pressing tasks when you have more energy and if you run out of energy and need to rest it will most likely be the less important tasks that go by the wayside if you are having a bad day. Remember, priorities do not just need to be practical – if you really want to go for coffee with a friend, make that your priority for the day!


When fatigue is having a big impact on your life, spending a small amount of time planning out your week can be vital for success. By planning out your high priority tasks, you can estimate when you may need rest periods to allow you to keep your energy levels up. Even with fatigue, it is important that you do things that bring you joy – be it getting to a concert, going out with friends or going on that holiday you have been planning all year. Planning allows you to determine where you can save some energy so that you can do the things that are meaningful to you.


How long does fatigue usually last?


Fatigue after cancer treatment can last anywhere between 6 and 12 months. The most important thing to do is focusing on being kind to yourself and managing it. Trying to fight against fatigue can make the symptoms worse and far more distressing. By creating strategies and options that allow you to do what is important to you within your fatigue limits, it can make the process of recovery less onerous and can give you back your sense of control over your life.


If you would like to book a consultation to discuss your fatigue and strategies to assist you, please reach out to us via or phone 0437194826.

Until next time, be kind to yourself.


Jenny Romanczukiewicz


ALA accredited lymphoedema practitioner