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NCCN Survivorship Guidelines & Your Cancer Journey, Part 7: Fatigue

By Guest Blogger June 5, 2013Pearls of Wisdom Blog

I counted the days until treatment ended, literally marking them off on the refrigerator calendar with a big “X” as if I was a school girl waiting for summer vacation. Without realizing it, I equated the end of treatment with the end of undesirable side effects. I was very aware of the many long-term side effects cancer treatment can cause from the handful of consent forms and countless articles I read before and during this stage of medical vigilance. I did, however, really believe that as soon as treatment ended, so too would the side effects fatigue being one of the most debilitating and frustrating.In reality though, the fatigue stuck around for a long time after cancer treatments ended.

I don’t know if I was ever warned how tired cancer treatment would make me. For those of you who have not experienced it, it is complete and debilitating fatigue. Fatigue that does not seem to go away after a good night’s sleep, a cup of strong coffee, or a brisk walk around the neighborhood. I remember waking up tired, going through my daily tasks tired, and ending the day absolutely exhausted, regardless of what I did during the 16 hours in between.

People told me to be patient with myself and made statements like, “The cancer did not grow overnight so recovering from it will take just as long, if not longer.”I had been a patient patient for months and was ready to have my life (and my energy to tackle it) back. I was out of patience waiting to be well and ready to be a patient taking a proactive role in a road to wellness.

Fatigue is the most common symptom experienced by cancer patients. It is estimated that as many as 75% of patients develop cancer-related fatigue (CRF). That is why the National Comprehensive Cancer Network (NCCN) included fatigue in their new practice guidelines on cancer survivorship. Surgery, radiation, and chemotherapy all contribute to fatigue.For most patients, fatigue can be attributed to the physical and emotional stress that cancer treatments have placed on their body.

It may sound counterintuitive, but increasing your exercise will help.Patients who exercise report less overall fatigue throughout the day.Although it is recommended that we get 3-4 hours of exercise a week, every little bit can be beneficial.Patients who are not regular exercisers may want to start out small and gradually increase effort.For me, yoga was a lifesaver when my fatigue was at its worst.I was able to exercise while reducing stress and calming my racing thoughts.Other relaxation techniques such as massage, meditation, or a warm bath have also been shown to relax patients and possibly reduce overall fatigue.

Sleep disturbances definitely contributed to my fatigue. Towards the end of treatment, I came to rely on an afternoon nap. The problem was that as my fatigue worsened, my naps became longer and drifted into the early evening hours.After speaking to my doctor regarding my fatigue, she recommended I try to limit my naps to no longer than 20 minutes and not to nap past 3pm, as this could interfere with a good night’s rest. I also assessed my current nighttime sleep patterns, ensuring I got adequate amounts of rest at night. This included reducing my caffeine and alcohol intake; not watching TV or reading in bed; and maintaining a regular sleep schedule, even on weekends. Trying to be resourceful, I also bought room-darkening shades to adjust the light in my bedroom, and started sleeping with additional pillows under my arms to ameliorate lingering soreness from surgery.

The reality is that fatigue for almost all patients does get better. As your body heals, fatigue is often reduced. For me, I also had to adjust my expectations. Rather than dwelling on what I could not do in any given day, I had to make a conscious effort to focus on what I was able to accomplish. Celebrating small milestones became essential for me to stay positive and actively engage in my recovery. I’m now far more mindful of what I eat, how much I sleep, the importance of relaxation activities, and how often and intensely I exercise all important factors in wellness activities after cancer.


Author: Elissa T. Bantug, MHS, CHES

Bio: Elissa T. Bantug, MHS, CHES, is Program Coordinator of the Breast Cancer Survivorship Program at Johns Hopkins Kimmel Comprehensive Cancer Center. A breast cancer survivor with an extensive history of breast cancer advocacy and outreach work with multiple cancer organizations, Elissa administers day-to-day program activities and serves as a liaison between grant projects and with funding agencies. She can be reached at

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PearlPoint Nutrition Services often features guest bloggers to write on a variety of topics related to cancer, nutrition, and survivorship. If you have an idea for a blog or would like to contribute to Pearls of Wisdom, email

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