Skip to content

Cancer – Fatigue – Positive/Negative Cycles

Fatigue affects many patients during and after cancer diagnosis and is frequently related to treatment. Patterns of fatigue are often specific to the type of treatment (e.g. chemotherapy) and may be cumulative (e.g. in radiotherapy). Whilst exact mechanisms are not fully understood, cancer related fatigue is multifactorial, implicating hormonal health (including hypothalamic-pituitary axis disruption and serotonin dysregulation), inflammatory mediators (cytokines), the autonomic nervous system and haematological health. Other causes directly related to disease including anaemia, de-conditioning.

Fatigue can be debilitating and is frequently cited by patients as a factor impacting upon quality of life during and after cancer.

Current evidence supports physical activity for improving fatigue, however it can be difficult for some patients to begin if they feel exhausted. Health professionals can help by explaining the reasons for becoming more active, how to integrate short periods of activity and how to pace activity.


Andersen C, Rørth M, Ejlertsen B, Adamsen L, The effects of a six-week supervised multimodal exercise intervention during chemotherapy on cancer-related fatigue.Eur J Oncol Nurs. 2013 Jun;17(3):331-9. doi: 10.1016/j.ejon.2012.09.003. Epub 2012 Oct 16

Arnold M, Taylor NF, Does exercise reduce cancer-related fatigue in hospitalised oncology patients? A systematic review, Onkologie. 2010;33(11):625-30.

Baumann FT, Zopf E M, Bloch W, Clinical exercise interventions in prostate cancer patients–a systematic review of randomized controlled trials, Support Care Cancer. 2012;20(2):221-33.

Bourke L, Smith D, Steed L, Hooper R, Rosario DJ, Exercise for Men with Prostate Cancer: A Systematic Review and Meta-analysis, Eur Urol. 2016 Apr;69(4):693-703.

Carayol M, Bernard P, Boiché J, Ninot G, Psychological effect of exercise in women with breast cancer receiving adjuvant therapy: what is the optimal dose needed?, Ann Oncol. 2013 Feb;24(2):291-300.

Cramp F, Daniel J, Exercise for the management of cancer-related fatigue in adults, Cochrane Database Syst Rev. 2008 Apr 16;(2):CD006145.

Mustian, KM, Comparison of pharmaceutical, psychological, and Exercise Treatments for cancer-related fatigute: a meta-analysis, JAMA Oncol. 2017 Jul 1;3(7):961-968.

Sweegers, MJ, Altenburg TM, Chinapaw MJ, et al., Which exercise prescriptions improve quality of life and physical function in patients with cancer during and following treatment? A systematic review and meta-analysis of randomised controlled trials, Br J Sports Med 2018; 52: 505-13