Immunotherapy Fatigue: What It Is and How to Cope

Yes, immunotherapy can cause fatigue, and it’s one of the most common side effects reported during cancer treatment. Fatigue can range from mild tiredness to severe exhaustion and may start suddenly or build up over time. ^[1] In some cases, immunotherapy can affect the thyroid gland, and thyroid changes (hypothyroidism or hyperthyroidism) can contribute to fatigue, so teams often monitor thyroid levels. ^[1]

What Fatigue Feels Like

• A persistent sense of being tired, weak, and low on energy that’s not relieved by sleep or rest. ^[2]
• It can occur at any point during treatment and may persist for months after therapy ends. ^[3]
• It often differs from “normal tiredness” because rest alone doesn’t fix it. ^[2]

Why Immunotherapy Can Cause Fatigue

• Immune activation and inflammation from treatment can contribute to tiredness. ^[2]
• Endocrine effects, especially thyroid dysfunction, are a recognized cause of fatigue during checkpoint inhibitor therapy. ^[1]
• Multiple factors cancer itself, medications, sleep problems, pain, decreased nutrition can interplay to worsen fatigue. ^[4]

When to Alert Your Care Team

• New or worsening fatigue that affects daily activities, or is accompanied by dizziness, headache, nausea, weight change, or low blood pressure, may signal an immune-related endocrine issue (e.g., thyroid or adrenal). ^[5]
• Healthcare teams may order labs such as thyroid function tests and morning cortisol when fatigue is significant. ^[5]

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Practical Coping Strategies

Rest Smart

• Take short naps (about 15–20 minutes) to relieve daytime fatigue and support nighttime sleep. ^{[6] [7]}
• Plan tasks during times you usually feel more energetic and pace yourself to avoid overexertion. ^[8]

Keep Moving (Light Exercise)

• Gentle activity like walking can reduce fatigue and help you tolerate treatment better. ^[6]
• Regular light exercise improves energy, strength, sleep, and day-to-day function. ^{[9] [10]}

Hydration and Nutrition

• Drink enough non‑caffeinated fluids (about 8–10 cups or as directed) to stay hydrated. ^[8]
• Address appetite and nutrition since inadequate calories or nutrients can worsen fatigue. ^[4]

Sleep Hygiene

• Create a calming bedtime routine and limit caffeine or alcohol at night to improve sleep quality. ^[11]

Ask for Help

• Delegate chores and errands to family or friends to conserve energy for essential activities. ^{[8] [11]}

Consider Integrative Options

• Relaxation-focused approaches like yoga, tai chi, qigong, massage, acupuncture, or cognitive behavioral therapy may help some people, with clinician guidance. ^[12]

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Structured Action Plan

• Report fatigue early to your care team, especially if it is sudden or severe, or limits daily activities. ^{[3] [5]}
• Request an endocrine assessment (thyroid panel and morning cortisol) if fatigue is significant or linked with other symptoms. ^[5]
• Adopt short, regular naps and gentle daily walks, adjusting intensity to your current energy level. ^{[6] [9]}
• Hydrate consistently and optimize nutrition; consider meeting with a dietitian if intake is low. ^{[8] [4]}
• Use pacing, scheduling, and social support to manage workload and avoid energy crashes. ^{[8] [11]}

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Quick Reference Table: Fatigue Management During Immunotherapy

Area	What to Do	Why It Helps
Rest	Short naps 15–20 min; pace tasks	Prevents overexertion; supports nighttime sleep [6] [8]
Activity	Gentle exercise (e.g., walking)	Lowers fatigue; improves tolerance to treatment [6] [9]
Hydration	8–10 cups non‑caffeinated fluids	Dehydration worsens fatigue [8]
Sleep	Consistent routine; limit caffeine/alcohol at night	Better sleep quality reduces daytime fatigue [11]
Monitoring	Check thyroid and cortisol if significant fatigue	Detects treatable endocrine causes [5] [1]
Support	Ask family/friends for help	Conserves energy for priorities [8] [11]
Integrative	Yoga, tai chi, CBT, massage/acupuncture (with guidance)	Relaxation and function benefits [12]

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What to Expect Over Time

• Fatigue can fluctuate during treatment and may peak at certain times; it often improves after therapy but can persist for months or longer. ^[3]
• With consistent self-care and medical evaluation for reversible causes, many people experience meaningful improvement. ^{[6] [9] [11]}

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Key Takeaways

• Fatigue is common with immunotherapy and can be significant, but it is manageable with a combination of medical evaluation and daily strategies. ^{[1] [2]}
• Endocrine monitoring (thyroid and adrenal) is important because treatable hormone changes can drive fatigue. ^{[5] [1]}
• Short naps, gentle exercise, hydration, sleep hygiene, and asking for help are practical steps that make a real difference. ^{[6] [8] [9] [11]}