Cancer-related fatigue

Why am I still so tired, and what can help?

There is tiredness, and then there is cancer-related fatigue.

You might sleep all night and wake up exhausted. A shower can feel like an achievement. Concentrating on a conversation can take more energy than you expect. Things you once did without thinking might suddenly require planning, rest or help from someone else.

And for some people, that tiredness doesn’t simply disappear when treatment finishes.

If this sounds familiar, you’re far from alone.

Cancer Support New Zealand’s Cancer Wellbeing Tracker, conducted by Ipsos New Zealand, found fatigue was experienced by seven in ten people surveyed who had cancer. It was also considered the worst symptom or side effect across different stages of the cancer journey.

The encouraging news is that there are things that may help.

If you’re too tired to read the whole article

Start here:

• tell your healthcare team if fatigue is affecting everyday life
• ask whether anything else could be contributing
• gentle, appropriate movement may help
• CBT and mindfulness-based programmes have evidence behind them
• qigong, tai chi and yoga may also be useful at particular stages
• rest when you need it
• you don’t need to try everything at once

One small step that feels manageable is enough.

Why am I so tired?

There may not be one simple reason.

Cancer and its treatment can contribute to fatigue, but pain, emotional distress, sleep problems, anaemia, thyroid problems, medications, nutrition and other health conditions may also play a part.

That’s why fatigue is worth mentioning to your healthcare team, particularly if it is new, getting worse or making everyday life difficult.

You don’t need to work out the cause yourself.

And you don’t have to accept feeling exhausted as something you simply have to put up with.

What can actually help?

A major 2024 clinical guideline from the American Society of Clinical Oncology and Society for Integrative Oncology reviewed 113 randomised controlled trials.

Among the approaches shown to improve cancer-related fatigue were exercise, cognitive behavioural therapy, or CBT, and mindfulness-based programmes. Tai chi and qigong were supported during treatment, while yoga was among the approaches supported after treatment. The certainty of evidence varied, so no single approach should be viewed as a guaranteed solution.

Find movement that feels possible

If you’re exhausted, being told to exercise can feel incredibly unhelpful.

This isn’t about pushing through fatigue.

Research supports physical activity appropriate to the person’s health, abilities and circumstances.

For you, that might mean a walk around the block. For somebody else, it could be gentle stretching, chair-based movement or slowly rebuilding strength.

There may also be days when rest is exactly what your body needs.

Our own New Zealand research offers an interesting lived-experience perspective. When people affected by cancer were asked which non-medical activity they felt had made the biggest impact on their wellbeing, exercise or sport was the most common answer, selected by 26%. This reflects what people reported rather than proving that exercise caused an improvement.

If you are unsure what movement is safe for you, particularly during treatment or following surgery, talk to your healthcare team first.

Give some attention to what else is taking your energy

Living with cancer can be exhausting in ways that have nothing to do with how many steps you have taken that day.

Appointments. Treatment. Worry. Decisions. Work. Family. Uncertainty.

Even while your body is resting, your mind may be carrying a lot.

CBT is a structured psychological therapy that works with thoughts, feelings and behaviours. Research supports CBT as one approach to reducing cancer-related fatigue during and after treatment. [ascopubs.org]

That doesn’t mean fatigue is “all in your head”.

It means your emotional wellbeing deserves support alongside your physical wellbeing.

If fatigue is having a significant impact on your quality of life, ask your healthcare team whether psychological support could be useful for you.

Explore mindfulness or gentle mind-body movement

Mindfulness-based programmes also have evidence behind them for cancer-related fatigue.

Tai chi and qigong have shown benefits during treatment, while yoga has evidence supporting its use following treatment. [ascopubs.org], [guidelinecentral.com]

Cancer Support New Zealand offers free mindfulness and gentle movement programmes including Qigong, Chair Yoga, Gentle Mat Pilates and Restorative Stretch.

Our classes are not treatments for cancer-related fatigue and are not identical to the interventions used in clinical studies. They offer gentle, accessible ways to explore movement and mindfulness as part of your wider wellbeing.

4. Look at sleep too

Being exhausted doesn’t always mean you’re sleeping well.

If you are struggling with both tiredness and disrupted sleep, tell your healthcare team. Sleep difficulties may deserve attention in their own right.

Let yourself do things differently

Sometimes managing fatigue is also about working with the energy you have rather than fighting against what you don’t have.

You might find it helpful to:

• do important things at the time of day when you normally have most energy
• break large tasks into smaller ones
• rest before you are completely exhausted
• accept practical help
• decide what genuinely needs doing and what can wait
• adjust expectations of yourself on difficult days

This isn’t giving in.

Your body is dealing with a lot.

There may not be one answer, and that’s okay

For one person, identifying something medical that is contributing to fatigue may make a difference.

For someone else, it may be appropriate movement.

Another person might benefit from support with sleep, CBT or mindfulness.

And what helps now might be different from what helps further down the track.

You’re not doing anything wrong if one thing doesn’t suddenly make you feel better.

Where could you start?

If you only do one thing, tell someone how tired you really are.

Explain to your healthcare team what fatigue is stopping you from doing, rather than simply saying you feel tired.

And if you’d like to explore gentle, practical ways to support your wider wellbeing, Cancer Support New Zealand is here too.

You don’t have to do everything.

Sometimes the first step is simply one small thing that feels possible today.

Research

The main evidence underpinning this article comes from the 2024 ASCO-SIO cancer-related fatigue guideline and Cancer Support New Zealand’s LGFBNZ Cancer Wellbeing Tracker 2024-25 Final Report 240924.pdf, conducted by Ipsos.

• Bower JE, et al. Management of Fatigue in Adult Survivors of Cancer: ASCO–Society for Integrative Oncology Guideline Update. Journal of Clinical Oncology, 2024.

• Chen X, et al. Exercise interventions on cancer-related fatigue and quality of life. BMC Nursing, 2023.

• Hosseini Koukamari P, et al. Cognitive-behavioural therapy and fatigue in cancer patients. Frontiers in Psychology, 2025.

• Lee J, Kim M. Mindfulness-Based Interventions for Reducing Cancer-Related Fatigue. Psycho-Oncology, 2026.

• Cancer Support New Zealand. Cancer Wellbeing Tracker 2024–25, research conducted by Ipsos New Zealand.