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After treatment and remission

Why tiredness lingers

Treatment is over and the tests look good, but your strength has not come back yet. This topic explains why tiredness lasts so long after leukaemia and what helps.

Last updated: ~2 min read
A clear battery filling with golden light from the bottom up.
Figure 1.Energy returns gradually.

01Short answer

Cancer-related fatigue is one of the most common complaints after treatment and can last for months, sometimes longer. There are several reasons: the body is rebuilding blood, muscle and tissue; long bed rest reduces muscle strength; and anaemia, an underactive thyroid, poor sleep, pain, depression and some medicines all add to tiredness. According to the NCI and ACS, moderate regular physical activity is one of the best-studied ways to reduce fatigue. Spreading out activity and rest, a sleep routine and emotional support also help. If tiredness gets worse or comes with new symptoms, tell your doctor.

02Simple explanation

Fatigue is very common.

It may not fully go away with sleep.

Some causes can be treated.

Gentle movement helps.

Recovery is gradual.

03Scientific explanation

How common: according to the NCI, cancer-related fatigue affects most people having treatment and continues in some for months or years afterwards.

Causes: anaemia, hypothyroidism, infection, poor sleep, pain, depression, nutrition and medicines can increase fatigue (ACS).

Activity: research shows moderate aerobic activity (such as walking) reduces fatigue after cancer.

Deconditioning: long inactivity reduces muscle mass and heart and lung fitness, which adds to fatigue.

04What happens in the body?

What kind of tiredness is this?

Cancer-related fatigue is weakness, a feeling of “no energy”, and poorer concentration. Sometimes it comes even after a small task.

What is the body doing?

After intensive treatment, blood cells, muscles and the lining tissues are rebuilt. This takes a lot of energy.

Glowing cells dividing with small sparks.
Figure 2.The body rebuilds its cells.

Treatable causes

Your doctor can check for and treat anaemia, thyroid problems, low vitamin D, sleep apnoea and depression.

What helps?

Gentle walking, short rests during the day, a regular sleep time, and planning important tasks for the hours when you have more energy.

A quiet path in morning light with glowing footprints.
Figure 3.Gentle walking reduces fatigue.

How long does it last?

For many people strength returns slowly over months. After a transplant it can take longer. Try not to compare yourself with others.

When to call your doctor

Worrying signs — fever, bleeding, new pain, breathlessness — should be reported to your doctor between visits too. Getting in touch early is always better than waiting.

05From tiredness to strength

The steps of recovery.

Notice — Note the rhythm of tiredness.1NoticeNote the rhythm of tiredness.
Causes — Anaemia, thyroid and others are checked.2CausesAnaemia, thyroid and others are checked.
Plan — Activity and rest are spread out.3PlanActivity and rest are spread out.
Gradually — Strength builds over weeks.4GraduallyStrength builds over weeks.
EnergyReturns gradually.
CausesTreatable ones are found.
MovementStrength grows.

06What increases and reduces fatigue (simplified)

IncreasesReducesNote
InactivityGentle walkingBuild up slowly
Poor sleepA sleep routineSee “Restoring sleep”
AnaemiaTreating the causeYour doctor checks
Stress, depressionSupport, talkingAsk for help
Too much at oncePlanningTake breaks

* Your doctor gives personal advice.

07Key terms

Cancer-related fatigue
Lasting weakness linked to the illness and treatment.
Anaemia
Low haemoglobin.
Hypothyroidism
An underactive thyroid gland.
Deconditioning
Loss of fitness from inactivity.
Aerobic activity
Rhythmic movement such as walking.
Energy planning
Spreading your strength across the day.

08Key points

  • Fatigue is common.
  • It is not laziness.
  • Get the causes checked.
  • Gentle movement helps.
  • Plan your rest.
  • Recovery is gradual.

09Frequently asked questions

If I sleep a lot, will it pass?

Usually not; too much bed rest can make it worse. Gentle activity helps more.

Should I take vitamins?

Only if your doctor finds a deficiency and prescribes them.

Can I go back to work?

Often yes, in stages — talk to your employer and doctor.

When should I worry?

If tiredness gets worse or comes with fever, breathlessness or bruising.

Does this information replace medical advice?

No. This is general education; only your treating doctor can assess your situation.

10Questions for your doctor

Take these questions to your appointment. The ones you save are collected on the “My questions” page and stay on this device only.

  1. If I sleep a lot, will it pass?

  2. Should I take vitamins?

  3. Can I go back to work?

  4. When should I worry?

  5. Does this information replace medical advice?

My questions

12Sources

  1. National Cancer Institute (NCI). Fatigue and Cancer Treatment
  2. American Cancer Society. Cancer-related Fatigue
  3. MedlinePlus (U.S. National Library of Medicine). Fatigue
  4. MedlinePlus (U.S. National Library of Medicine). Complete Blood Count (CBC)
  5. National Cancer Institute (NCI). Follow-Up Medical Care
  6. National Cancer Institute (NCI). Cancer Survivorship
  7. Cancer.Net (ASCO). Follow-Up Care After Cancer Treatment
  8. Leukemia & Lymphoma Society (LLS). Long-Term and Late Effects of Treatment
  9. National Cancer Institute. Facing Forward: Life After Cancer Treatment
  10. Supportive Care in Cancer, 2016. From normal response to clinical problem: definition and clinical features of fear of cancer recurrence
Medical disclaimerThis information is for educational purposes only and does not replace medical advice.
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