Cancer survivorship is increasing worldwide due to improvements in early detection and treatment. However, many survivors continue to struggle with long-term side effects even after treatment has ended. One of the most common and distressing symptoms is Cancer-related Fatigue (CRF), a persistent feeling of physical, emotional and mental exhaustion that is not fully relieved by rest or sleep. Unlike normal tiredness, cancer-related fatigue can interfere with daily activities, work performance, emotional wellbeing and quality of life for months or even years after treatment completion (Yang et. al, 2019).
Recent evidence suggests that nutrition plays an important role in reducing post cancer-related fatigue. Although nutrition alone will not eliminate fatigue, proper dietary strategies and selected supplements help improve energy levels, reduce inflammation and enhance overall wellbeing (Li et al., 2024).
Rebuilding Strength and Preventing Muscle Loss by Protein and Energy Intake
Adequate protein and calorie intake are essential during cancer recovery. Cancer treatment often causes muscle wasting or sarcopenia, which contributes significantly to weakness and fatigue. Protein helps repair tissues, preserve lean muscle mass and support immune function.
Research has shown that low protein intake is associated with greater fatigue among cancer patients receiving chemotherapy. A review on nutritional interventions for cancer-related fatigue highlighted that protein intake predicts fatigue severity more strongly than symptoms such as nausea or insomnia (Inglis et al., 2019).
Cancer survivors are encouraged to consume high-quality protein sources such as:
- Fish, eggs, poultry and lean meat
- Milk and dairy products, soy products
- Legumes and nuts
In some cases, oral nutrition supplements or high-protein supplements can be recommended, especially for individuals with poor appetite or significant weight loss. However, supplementation should be individualized and monitored by healthcare professionals (Li et al., 2024).
Iron and B Vitamins: Hidden Nutrient Deficiencies
Fatigue also can be linked to anemia or micronutrient deficiencies. Iron deficiency is common among cancer survivors, particularly those who experienced blood loss, chemotherapy-related anemia or poor food intake. Iron is necessary for oxygen transport and energy production. Iron deficiency will cause persistent tiredness, dizziness and weakness.
Similarly, supplementations with B vitamins including vitamin B6, vitamin B12 and folate, play important roles in red blood cell formation, neurological function and energy metabolism. Inadequate intake of these vitamins will worsen fatigue symptoms.
Although supplementation benefit individuals with confirmed deficiencies, routine high-dose supplementation is not always recommended and supplementation should be carefully evaluated based on individual clinical needs (Van de Roovaart et al., 2024). Therefore, nutritional assessment is important before starting supplements.
Foods rich in iron and B vitamins include:
- Lean red meat, liver
- Green leafy vegetables
- Fortified cereals
- Eggs, fish
- Whole grains, legumes
Omega-3 Fatty Acids and Inflammation
Chronic inflammation is believed to contribute to cancer-related fatigue. Omega-3 fatty acids, particularly EPA and DHA found in oily fish, have anti-inflammatory properties that supports recovery and reduce fatigue. Foods rich in omega-3 include:
- Salmon, sardines, mackerel, tuna
- Chia seeds, walnuts
A recent dietary intervention study among lymphoma survivors found that improving diet quality through whole foods, colourful fruits and vegetables, whole grains and fatty fish helped reduce chronic fatigue and improve quality of life in many participants (Weinhold et al., 2023).
Hydration and Fatigue Management
Dehydration is another overlooked contributor to fatigue. Some cancer survivors experience inadequate fluid intake due to nausea, dry mouth, swallowing difficulties or reduced thirst sensation after treatment. Even mild dehydration can impair concentration, physical performance and energy levels. Adequate hydration supports circulation, nutrient transport, temperature regulation and kidney function (Li et al., 2024).
Cancer survivors are encouraged to:
- Drink water regularly throughout the day
- Include hydrating foods such as fruits and soups
- Limit excessive caffeine and sugary beverages
- Monitor urine colour as a simple hydration indicator
Fluid needs vary depending on age, body size, medications and medical conditions. Individuals with kidney or heart conditions should seek personalized advice from healthcare professionals.
Conclusion
Post cancer-related fatigue remains one of the most challenging long-term effects faced by cancer survivors. Nutrition plays an important supportive role in managing fatigue by improving energy intake, reducing inflammation, preserving muscle mass and supporting overall recovery (Zuo et al., 2023).
Adequate protein intake, iron and B vitamin sufficiency, omega-3-rich foods and proper hydration can help improve energy levels and quality of life among cancer survivors. In addition, appropriate supplements such as oral nutritional supplements, omega-3 or vitamin B complex will support recovery and reduce fatigue, especially in individuals with poor intake or nutrient deficiencies. However, supplements should be used wisely under professional guidance and should complement, not replace, a balanced and nutritious diet (Van de Roovaart et al., 2024).
References
- Yang, S., Chu, S., Gao, Y., Ai, Q., Liu, Y., Li, X., & Chen, N. (2019). A Narrative Review of Cancer-Related Fatigue (CRF) and Its Possible Pathogenesis. Cells, 8(7), 738. https://doi.org/10.3390/cells8070738
- American Society of Clinical Oncology & Society for Integrative Oncology. Management of Fatigue in Adult Survivors of Cancer: ASCO–Society for Integrative Oncology Guideline Update. Journal of Clinical Oncology, 2024.
- Weinhold KR, Light S, Bittoni AM, et al. A Remote Whole Food Dietary Intervention to Reduce Fatigue and Improve Diet Quality in Lymphoma Survivors: Results of a Feasibility Pilot Study. Nutrition and Cancer, 2023.
- Li M, Zhang Y, Liu J, Zhang D. Complementary and Alternative Medicine: A Narrative Review of Nutritional Approaches for Cancer-Related Fatigue. Medicine, 2024.
- Zuo S, Cheng H, Wang Z, et al. Nonpharmacological Interventions for Cancer-Related Fatigue: A Literature Review. Asia-Pacific Journal of Oncology Nursing, 2023.
- Van de Roovaart HJ, Stevens MM, Goodridge AE, et al. Safety and Efficacy of Vitamin B in Cancer Treatments: A Systematic Review. Integrative Cancer Therapies, 2024.
- Inglis JE, Lin PJ, Kerns SL. Nutritional Interventions for Treating Cancer-Related Fatigue: A Qualitative Review. Nutrients, 2019.
