Persistent, severe fatigue is a common symptom among people with Hodgkin lymphoma and non-Hodgkin lymphoma (NHL). Fatigue can be caused by lymphoma itself, or it can be a side effect of lymphoma treatments like chemotherapy and radiation therapy. Fatigue from cancer or cancer treatment is called cancer-related fatigue. Unlike other tiredness, cancer-related fatigue cannot be resolved with a good night’s sleep.

Cancer-related fatigue can significantly affect day-to-day life. MyLymphomaTeam members have shared how fatigue interferes with their daily activities:

• “Trying to take a shower wears me out.”
• “I am normally a very active and high-energy person. Now it’s a chore to shower.”
• “Most days, I have to MAKE myself vacuum, wash clothes, and do other chores.”

If you’re living with lymphoma, you’re likely very familiar with fatigue — but you can take steps to feel better and lessen the impact of cancer-related fatigue on your daily life. This article talks about the causes of fatigue with lymphoma and offers eight ways to manage fatigue through treatment and lifestyle changes.

What Causes Fatigue in Lymphoma?

Cancer-related fatigue is the result of many intersecting variables. “Fatigue is tricky,” explained Dr. Timothy Fenske, a hematologist-oncologist who specializes in treating people with Hodgkin and non-Hodgkin lymphoma. “It can be a symptom of lymphoma. It can be a side effect of treatment. It can also be a sign of other problems that may be related or unrelated.”

The following factors can contribute to fatigue in people with Hodgkin lymphoma or NHL:

• Side effects of chemotherapy, radiation therapy, or other treatments
• Anemia (low red blood cell count), which may be caused by cancer cells in the bone marrow or by chemotherapy
• Dehydration from treatment side effects like vomiting and diarrhea
• Side effects of anti-nausea medications used to address chemotherapy side effects
• Strong pain medications for managing cancer-related pain
• Muscle weakness from inactivity
• Anxiety or depression
• Sleep disturbances
• Poor appetite

Life circumstances, like undergoing treatment while working and raising children, also were found to increase fatigue in a study of people with breast cancer.

Persistent Fatigue After Lymphoma Treatment

In some cases, fatigue continues for months or even years after lymphoma treatment ends. Persistent fatigue is a particular problem for lymphoma survivors who’ve received high-dose chemotherapy followed by a stem cell transplant.

“Sometimes post-treatment, people will have some fatigue that can linger for months or even, in some cases, a year later,” Dr. Fenske said. “Some people might be in remission — they’re done with treatment, but they never quite got back to where they were pretreatment.”

Members of MyLymphomaTeam report lingering fatigue after completing treatment. “Hubby is FINALLY starting to get his energy back six months after his last chemo,” a MyLymphomaTeam member wrote.

Another member commented, “I have been tired for six years. I don’t think you ever get over that.”

8 Strategies To Help Manage Fatigue

When you discuss fatigue with your doctor, they will try to understand various aspects of your treatment, lifestyle, and overall health that may be contributing to your tiredness. Your doctor will ask questions to learn how fatigue is affecting your daily activities. You may be asked to rank your fatigue levels, and your doctor may order a blood test to check for anemia.

“We have to separate out what’s just normal fatigue because the person’s got three little kids or a stressful job, and now they have cancer on top of it, and what’s actually a serious side effect or maybe even a sign of their lymphoma coming back,” Dr. Fenske explained. “You have to put it in context to try to figure out what level of fatigue we are dealing with and how persistent it is.”

Your doctor may recommend adjustments to your treatment plan or suggest lifestyle changes, like getting regular exercise and eating a healthy diet, to help you manage chronic fatigue and improve your quality of life. Depending on your circumstances, treatment for cancer-related fatigue may include some of the following strategies.

1. Address Anemia Caused by Cancer Treatment

Fatigue and weakness are common symptoms of anemia, a condition that occurs with a low red blood cell count. Your doctor will determine how to treat anemia related to cancer treatment, which might include boosting your iron levels and taking B vitamins.

2. Ask Your Doctor About Adjusting Dosages

Although pain management helps improve quality of life, certain pain medications or their dosage may make fatigue worse. If you believe that your pain medication may be making you more tired, talk to your doctor to see if the dosage or type of medication can be changed to lessen your fatigue while still managing your pain.

3. Take Care of Your Mental Health

Coping with the emotional impact of lymphoma can make fatigue worse. For example, depression can cause sleep disturbances and tiredness. Treatment for depression may include antidepressant medication or therapy. Talk therapy, such as cognitive behavioral therapy (CBT), can help decrease fatigue as you work on cancer-related issues such as stress, fear, and lack of social support, which may be making your fatigue worse.

4. Explore New Drug Options for Treating Fatigue

Researchers are studying certain drugs to see if they can help with cancer-related fatigue, including:

• Psychostimulants, which may improve energy, mood, and concentration
• Steroids, such as dexamethasone, for people with advanced cancer
• Bupropion, an antidepressant

While some of these drugs are still undergoing clinical trials (research studies that investigate potential new treatments), your doctor may be able to explore with you other medications that are proven to help with fatigue.

5. Look Into Dietary Supplements

Certain dietary supplements are also being studied for their effectiveness in managing cancer-related fatigue, including:

• Ginseng
• Coenzyme Q10
• L-carnitine

Before starting any dietary supplements, talk with your doctor to make sure these products are safe to take with your other medications and do not cause unwanted side effects.

6. Try To Get More Exercise

Physical activity during and after treatment for lymphoma can help improve your energy levels. One MyLymphomaTeam member shared, “Working through the pain and moving around seems to actually make me feel better than sitting.”

Staying active when you have lymphoma can be difficult, but there are many physical and mental benefits, such as improved mental health and better appetite. Consult your health care team before starting a new exercise program, especially if your lymphoma has spread to your bones.

7. Notch Up Your Nutrition

Consulting a nutritionist or dietitian can help ensure you’re taking in enough nutrients, especially if cancer treatments are causing nausea or vomiting. “Eat a lot of fruits and vegetables and drink plenty of fluids,” one MyLymphomaTeam member recommended to another living with fatigue.

Read about nutrition tips for feeling your best from registered dietitian Kimberly McCloskey, including suggestions for managing anemia and dehydration.

8. Shorten Naps To Feel Better Rested

Getting adequate rest at night and taking short naps during the day — a half hour or less — can help manage fatigue. Long naps can sometimes backfire, making you feel more tired and interfering with nighttime sleep. Establishing a consistent bedtime routine can also help reduce fatigue.

Find What Works for You

The best plan to manage severe fatigue will vary from person to person. Finding ways to take care of yourself and prioritize your most important tasks can help you balance rest and activity.

MyLymphomaTeam members have different approaches to finding balance. “I do what I can, when I can. I am not pushing myself,” a MyLymphomaTeam member posted.

Another member commented, “I rest when I need to, but I refuse to change my social activities.”

Talk With Others Who Understand

MyLymphomaTeam is the social network for people with leukemia and their loved ones. On MyLymphomaTeam, more than 18,000 members come together to ask questions, give advice, and share their stories with others who understand life with leukemia.

Are you living with lymphoma and fatigue? Do you have tips for managing fatigue? Share your experience in the comments below, or start a conversation by posting on your Activities page.