How to fight cancer-related fatigue

[David Baxter PhD]

How to fight cancer-related fatigue
By Sheryl M. Ness, Mayo Clinic
Feb. 13, 2010

Hi everyone, my name is Sheryl Ness. I'm a nurse and educator for the Cancer Education Program. I have many years of experience as a nurse, more than five years working directly with cancer patients, as well as serving as a writer and editor for a cancer survivor newsletter.

I've noticed many of you mention that fatigue is a big concern. Whether you're currently receiving treatment, have completed treatment, or are years post-treatment, fatigue can be a persistent, lasting effect from cancer treatment. It may seem like normal, daily tasks take more energy and your reserves are far less than before your treatment. Recently, Mayo Clinic completed a survey of the needs of cancer survivors, and identified fatigue as a major concern.

Cancer-related fatigue is different from the fatigue of everyday life, which is usually temporary and often relieved by a good night's sleep. Cancer-related fatigue is an overwhelming sense of exhaustion and persistent feeling of tiredness that can accompany cancer and cancer treatment. It's usually not relieved by rest or sleep.


Here are some strategies to help with cancer-related fatigue:

• Allow time earlier in the day for short periods of rest, so that night sleep is not disturbed.
• Talk with your doctor or nurse about a program of regular exercise. Mild to moderate exercise has been found to be helpful in reducing fatigue. Consider swimming, walking, yoga, etc.
• Balance rest, sleep, and activity. While sleep and rest are important, don't overdo it. Too much rest can actually decrease your energy level.
• Eat a well-balanced diet and drink plenty of liquids. Your body needs protein, carbohydrates, vitamins, minerals, and water to work efficiently. Meet with a nutritionist or dietitian to find the best plan for you.
• Don't be afraid to ask for help, it makes others feel needed and helps you get things done. For example, neighbors may pick up items for you at the grocery store while doing their own shopping.
• Use relaxation methods or creative outlets to reduce stress (i.e. deep breathing, imagery, meditation, music, art).
• Maintain your social life. Many people eliminate social activities all together when they are feeling fatigued. Include activities that are satisfying to you in order to replenish your spirit. These activities can actually add to your energy level.
• Work with your health care provider to keep symptoms like anemia, nausea, and fever under control.

Although fatigue can sometimes be difficult to cope with, it can be managed. What works for one person may not work well for another, it may take a little trial and error. Please add to this list of ideas to help manage fatigue. It's a real problem that many of you are experiencing. Feel free to share your thoughts and ideas on what's worked for you, or resources that you've found to be helpful.

 

[Daniel E.]

The best option for cancer fatigue isn't a pill

"Cancer patients already take a lot of medications and they all come with risks and side effects." For fatigue, at least, there are other options.

www.futurity.org

...Data show that exercise alone—whether aerobic or anaerobic—reduces cancer-related fatigue most significantly. Psychological interventions, such as therapy designed to provide education, change personal behavior, and adapt the way a person thinks about his or her circumstances, similarly improved fatigue.

A combination of exercise and psychological therapy has mixed results and researchers cannot say for sure what the best method is for combining treatments to make them effective.

Finally, the study shows that drugs tested for treating cancer-related fatigue—including stimulants like modafinil, which can be used for narcolepsy, and Ritalin, which treats ADHD were not as effective...

Researchers believe cancer-related fatigue might be the result of a chronic state of inflammation induced by the disease or its treatment. Most concerning, is that fatigue can decrease a patient’s chances of survival because it lessens the likelihood of completing medical treatments.

 

[David Baxter PhD]

This is not a criticism of your post at all, Daniel. For those who can do it, it is heartily recommended. But not everyone can do it.

The problem with that advice for me is that my energy levels are so low (and coupled with balance issues) that I am left with few realistic options for exercise at the moment. If I could do it, I don't doubt it would help. But I really can't do it.

And I do mean can't, not won't. I have to plan necessary chores and appointments in advance. I can do the laundry but nothing else that day. I can vacuum my apartment but I'll need to lie down after I do. The same with taking the recycling downstairs to the basement.

I need to plan cooking meals in advance or doing the dishes and then I'll need to rest afterwards. For cooking, I try to plan meals so that I have leftovers for the next day or sometimes two, depending on the meal.

I have another infusion appointment at the hospital tomorrow morning. I'll make sure that Mindy the cat is fed and if I can I will do the dishes before I leave but I know from past experience (with both chemo and immunotherapy) that when I get back home I will need to sleep in the afternoon and probably into the evening so nothing else will get done that day.

Even personal care like showering takes planning (even with a shower stool it takes a lot out of me).

So while I agree with the basic premise, there are many cancer patients like me for whom it is just not realistic.

And I can assure you that studies like the one cited are not fully representative of cancer patients. People like me are not included in those studies.

 

[Daniel E.]

It did seem like wishful thinking -- like the "law of attraction" (which has a grain of truth but ends up as "let them eat cake"). I got my latest dog -- the big boxer -- from an elderly lady dying of brain cancer. Eventually, the lady was super exhausted all the time (rather than some of the time) since she was doing chemo until the end. Even with a caregiver, she was too tired for us to even bring the dog over to visit.

Originally, I found the article since it validated my own experience with psychostimulants. I tried Provigil once years ago for depression-related fatigue, and it didn't help at all and gave me heart palpitations. The only drug that provided some energy for me was Wellbutrin/buproprion, and that went away in a few weeks or less.

Potential Role of Bupropion Sustained Release for Cancer-Related Fatigue: a Double-Blind, Placebo-Controlled Study - PubMed

Background: Cancer-related fatigue (CRF) is very common and can be experienced at all stages of disease and in survivors. CRF causes patients more distress than pain or nausea and vomiting. Different pharmacologic interventions have been evaluated for the management of CRF. The purpose of this...

pubmed.ncbi.nlm.nih.gov

 

[David Baxter PhD]

Yes medications designed to relieve fatigue or boost energy have their own limitations and I expect their own side-effects too.

I think medications to help sleep might be more effective for some people. I've never tried those because sleeping isn't usually my problem — sleeping at night can be but sleeping in 2-3 hour chunks I can do any time of day.

 

[Daniel E.]

I have to plan necessary chores and appointments in advance. I can do the laundry but nothing else that day. I can vacuum my apartment but I'll need to lie down after I do. The same with taking the recycling downstairs to the basement.

I need to plan cooking meals in advance or doing the dishes and then I'll need to rest afterwards. For cooking, I try to plan meals so that I have leftovers for the next day or sometimes two, depending on the meal.

I have another infusion appointment at the hospital tomorrow morning. I'll make sure that Mindy the cat is fed and if I can I will do the dishes before I leave but I know from past experience (with both chemo and immunotherapy) that when I get back home I will need to sleep in the afternoon and probably into the evening so nothing else will get done that day.

Even personal care like showering takes planning (even with a shower stool it takes a lot out of me).

Cancer-related fatigue is an overwhelming sense of exhaustion and persistent feeling of tiredness that can accompany cancer and cancer treatment.

I think the closest I have come to anything near the fatigue of what chemo could be like was when I was stoned for the first/last time on marijuana gummies. When the driveway alarm went off, it seemed like an act of valor to get up from the recliner, look through the window, answer the door, and have a one-minute conversation with my neighbor. Life seemed mostly on hold. But that was a very temporary experience.

 

[Daniel E.]

Fatigue in Cancer Patients in Palliative Care—A Review on Pharmacological Interventions

Fatigue is one of the most distressing symptoms experienced by cancer patients. The suggested biological mechanism for cancer related fatigue (CRF) includes immune activation triggered by tumor tissue or by anticancer treatment but other mechanisms have also been proposed. Previous large...

www.mdpi.com

The evidence is still weak for using pharmacological treatments on CRF [cancer-related fatigue] in palliative care patients—although methylphenidate [Ritalin] and corticosteroids might be considered...

In contrast to the ginseng study in advanced cancer patients mentioned above, ginseng has shown promising effects in studies performed in cancer survivors and cancer patients in an earlier stage of the disease [64,65,66]. One of these studies was a large multicenter, double-blind RCT (n = 364) showing that American ginseng was superior compared to placebo after 8 weeks treatment [64]. All three studies report that the treatment was safe and well tolerated with no serious adverse events.

 

[Daniel E.]

Astragalus root extract for fatigue:

https://www.sciencedirect.com/science/article/pii/S0944711321002415?casa_token=1ePgdnEdZv0AAAAA:RTMa3VaGUZh_qGZFoINSQqOo5hzDKQdtNvW2pYne_hBNK-k1Fp0xP1I6BLgHFCnV6XonFsztCg

Phytoconstituents in clinical trials

Phytoconstituent (Drug)	Clinicaltrials.gov identifier (NCT number)	Phase	Objective
Astragalus polysaccharide (PG2)	NCT01720550	Phase IV	Cancer related fatigue symptom clusters
	NCT03611712	Phase II
	NCT03314805	Phase II
	NCT01720563	Phase II
	NCT02740959	Phase II	[Effects of PG2 on Fatigue-Related Symptom Clusters]
AS-IV, calycosin 7-O-β-glucopyranoside, and labetyolin- Sentinel compounds (SQ001)	NCT04026321	Phase I	Study the pharmacokinetics. (Solid tumor refractory to standard therapy)

Note: Data retrieved from Home - ClinicalTrials.gov

 

[Daniel E.]

The most effective vitamins for boosting energy

Although a healthful diet and regular exercise can reduce fatigue, some vitamins and supplements can also boost energy. Learn which ones may have benefits here.

www.medicalnewstoday.com

Coenzyme Q10 (CoQ10) is an enzyme that exists naturally in the body, particularly in the heart, liver, pancreas, and kidneys. It is an antioxidant that improves energy and strengthens the immune system.

In a 2014 review, researchers found a consistent link between low levels of CoQ10 and fatigue.

Most people can get enough CoQ10 by eating a balanced diet that includes:

• oily fish
• liver or other organ meats
• whole grains

People with certain health conditions and those not getting enough from their diet might wish to ask their doctor about supplementing with CoQ10.

Those taking blood thinners, taking insulin, or receiving cancer treatment should check with a doctor before taking CoQ10.

Mild side effects of CoQ10 might include:

• diarrhea
• rash
• insomnia

The recommended dosage is 30–90 mg per day, but a person can take as much as 200 mg each day.

 

[Daniel E.]

Fatigue | Winchester Hospital

Fatigue​

Fatigue is a feeling of extreme tiredness. It can make it hard for you to focus and do daily tasks.

Therapy and healthy habits can help prevent it. Natural therapies have also been used to ease feelings of fatigue.

Natural Therapies​

Likely Effective​

Supplements that can help:

• Iron is an essential nutrient that is vital for blood blow. It is likely to improve fatigue in those with low iron levels. (Note: It should not be taken by people who have problems with their heart.)

Other therapies that are likely to ease fatigue are:

• Acupuncture
• Exercise therapy
• Foot reflexology uses pressure points on the feet to treat symptoms.
• Massage
• Mindfulness and relaxation is a form of meditation.
• Tai Chi and qigong combine gentle motions with meditation.

 

[Daniel E.]

Nutritional interventions for treating cancer-related fatigue: a qualitative review

Cancer-related fatigue is a debilitating syndrome that persists for many cancer survivors for years after treatment. Symptoms include early and persistent fatigue, functional decline, depression and cognitive difficulties. Inflammation, assessed using ...

www.ncbi.nlm.nih.gov

Cancer-related fatigue is a debilitating syndrome that persists for many cancer survivors for years after treatment. Symptoms include early and persistent fatigue, functional decline, depression and cognitive difficulties. Inflammation, assessed using pro-inflammatory biomarkers, is increased in cancer survivors with fatigue and treatments for fatigue are often aimed at reducing inflammation. Additionally, cancer and its treatment lead to nutritional complications, changes in body composition and nutritional deficiencies that potentially weaken the cancer survivor and impact cancer-related fatigue. We conducted a qualitative review of clinical trials that assessed nutritional interventions for preventing and treating cancer-related fatigue. Further studies were examined that used nutritional interventions to address inflammation and fatigue, due to the dearth of nutrition research directly related to cancer-related fatigue.

Dietary intake prior to, during and after cancer treatment appears to affect fatigue levels. Increased protein intake may help preserve lean mass and body composition. Dietary patterns that reduce inflammation, such as the Mediterranean diet and other plant-based diets, appear tolerable to cancer survivors and may reduce fatigue. Supplementation with ginseng, ginger or probiotics may improve cancer survivors’ energy levels. Nutritional interventions, alone or in combination with other interventions should be considered as therapy for fatigue in cancer survivors.

Keywords: cachexia, vitamin E, C, D, systemic inflammatory response, soy, dietary intervention, fat/omega-3, omega-6/fish

 

[Daniel E.]

Cancer treatment side effect: Fatigue

For many patients, cancer treatment can bring fatigue. But there are things you can do to alleviate this common side effect.

www.mdanderson.org

How a fatigue journal can help cancer patients

For many patients and survivors, cancer-related fatigue doesn't get better with rest. But keeping a fatigue journal often can help.

www.mdanderson.org

7 ways to fight cancer-related fatigue

Fatigue is a common side effect of cancer treatment, including chemotherapy and radiation therapy.We asked our Facebook community for advice for coping with cancer-related fatigue. Here's what our patients suggested.

www.mdanderson.org

 

[Daniel E.]

A Randomized Double-Blind, Placebo-Controlled Study of Oral Coenzyme Q10 to Relieve Self-Reported Treatment Related Fatigue in Newly Diagnosed Patients with Breast Cancer

Coenzyme Q10 (CoQ10) is a common antioxidant supplement with known cardioprotective effects and potential anticancer benefits.We performed a randomized, double-blind, placebo-controlled study of oral CoQ10 in female breast cancer patients with the primary ...

www.ncbi.nlm.nih.gov

Supplementation with conventional doses of CoQ10 led to sustained increases in plasma CoQ10 levels, but did not result in improved self-reported fatigue or QOL after 24 weeks of treatment.

 

[Daniel E.]

Fatigue (PDQ®) - PDQ Cancer Information Summaries - NCBI Bookshelf

Fatigue is the most common side effect of cancer treatment, but it can also be a presenting symptom. Fatigue has a negative impact on all areas of function and can last well beyond treatment. Get comprehensive information about fatigue and interventions in this summary for clinicians.

www.ncbi.nlm.nih.gov

Published in 2013, a study conducted in patients with advanced cancer (N = 152) demonstrated that managing symptoms (e.g., pain, nausea, and decreased appetite) can have a significant positive impact on fatigue.[5] In this 12-week study, patients were randomly assigned to receive either monitoring and protocolized treatment of physical symptoms coordinated by a nurse or usual care (symptom management included in the standard oncologic care). Patients in the intervention group received tailored treatment for any of the identified troublesome symptoms.

Fatigue levels, as measured by the Multidimensional Fatigue Inventory , showed significant improvement in the intervention group compared with the group receiving usual care. The intervention group also showed improvements in the following:[5]

• Specific fatigue dimensions.
• Interference by fatigue with daily life.
• Overall symptom burden.
• Symptoms of depression and anxiety.

Assessing patients for the appropriate target symptom for intervention is probably the most efficient way to help them improve their health-related quality of life and manage their fatigue symptoms.

Because the etiology and mechanisms regarding fatigue in cancer patients are varied, there is considerable need to personalize symptom management to provide goal-concordant care. Medical management is often directed at identifying specific and potentially reversible correlated symptoms, as in the following examples:

• Patients with fatigue and pain may benefit from titration of pain medications.
• Patients with fatigue and anemia may receive a transfusion of packed red blood cells (RBCs), nutritional interventions including iron-rich foods, supplemental iron or vitamins to correct an underlying deficiency, or injections of epoetin alfa.
• Patients with depressed mood and fatigue may be treated with antidepressants or psychostimulants.

 

[David Baxter PhD]

Cancer treatment side effect: Fatigue

For many patients, cancer treatment can bring fatigue. But there are things you can do to alleviate this common side effect.

www.mdanderson.org

How a fatigue journal can help cancer patients

For many patients and survivors, cancer-related fatigue doesn't get better with rest. But keeping a fatigue journal often can help.

www.mdanderson.org

7 ways to fight cancer-related fatigue

Fatigue is a common side effect of cancer treatment, including chemotherapy and radiation therapy.We asked our Facebook community for advice for coping with cancer-related fatigue. Here's what our patients suggested.

www.mdanderson.org

I've tried and/or implemented most of these and quite honestly not much seems to work. I don't know anybody or see anybody in the chemo clinic who doesn't list fatigue as one of the side-effects, often at or near the top of the list. I think it's just one of those things you have to learn to accommodate as best you can while you're being treated for cancer. My red blood cell counts are always low, for one thing, which I think probably reduces the amount of oxygen getting to the brain (I may be wrong about this).

 

[Daniel E.]

Anemia Worsens Prognosis for Colorectal Cancer Patients on... : Oncology Times

An abstract is unavailable.

journals.lww.com

“During chemotherapy, 65% of the patients—119 of 183—had documented hemoglobin less than 120 g/L,” she said. However, only 7% of the patients had hemoglobin levels under 80 g/L—a point at which intervention with blood transfusion may occur.

 

[Daniel E.]

Anaemia and the brain - PubMed

Characterization of mechanisms of anaemia-induced cerebral injury will contribute to the development of optimal therapeutic strategies for anaemic patients. Such strategies would include a clearer definition of transfusion triggers based on physiological endpoints. The overall goal of these...

pubmed.ncbi.nlm.nih.gov

(2004)

Reduced cerebral tissue oxygen tension has been measured directly at haemoglobin concentrations near 35 g/l, suggesting that hypoxia may contribute to anaemic cerebral injury.

The measurement of increased cerebral cortical neuronal nitric oxide synthase messenger RNA and protein levels in rats, at haemoglobin concentrations between 50 and 60 g/l, suggests that cerebral hypoxia occurred at these higher haemoglobin concentrations.

Anemia in the oncology patient: cognitive function and cancer - PubMed

Cancer-related anemia often develops from the infiltration of marrow by malignant cells, impaired hemoglobin (Hb) production related to chemotherapy or radiation therapy, iron deficiency, or low endogenous erythropoietin levels. Patients with cancer-related anemia may experience cognitive...

pubmed.ncbi.nlm.nih.gov

(2003)

Anemia-mediated cerebral hypoxia may cause symptoms such as headache, vertigo, tinnitus, and dizziness...

The use of epoetin alfa as a treatment option for patients with chemotherapy-associated anemia and an Hb concentration less than 10 g/dL has been recommended by the American Society of Clinical Oncology and the American Society of Hematology.

 

[Daniel E.]

Cognitive Function in Patients With Colorectal Cancer Who Do and Do Not Receive Chemotherapy: A Prospective, Longitudinal, Controlled Study | Journal of Clinical Oncology

Purpose Cognitive dysfunction is reported in people with cancer. Therefore, we evaluated longitudinal changes in cognitive function and underlying mechanisms in people with colorectal cancer (CRC) and healthy controls (HCs). Patients and Methods Participants completed cognitive assessments and...

ascopubs.org

(2015)

Cognitive dysfunction is reported in people with cancer. Therefore, we evaluated longitudinal changes in cognitive function and underlying mechanisms in people with colorectal cancer (CRC) and healthy controls (HCs)...

Patients with CRC had substantially more cognitive impairment at every assessment than HCs, with no significant added effect of chemotherapy. Mechanisms of cognitive impairment remain unknown.

https://onlinelibrary.wiley.com/doi/full/10.1002/ijc.30252

(2016)

Tumours may actively produce inflammatory mediators as a consequence of local oxidative stress or stimulate inflammation in response to their presence.116 These findings might account for baseline cognitive dysfunction. Nonetheless, the lack of significant differences in cytokine levels between recently diagnosed cancer patients and noncancer controls clouds definitive conclusions...

Cognitive impairment is particularly devastating to patients, and currently has no universally accepted mechanism. This review has proposed that, contrary to traditional beliefs, chemotherapeutic agents can in fact gain access to the CNS. Importantly, we suggest that this is likely due to upregulated and uncontrolled BBB [blood-brain barrier] transit.

 

[Daniel E.]

If I had to pick my own placebo or alternative therapy

Healing Purrs: How Your Cat Can Help You Heal | PurrfectPost.com

Can being near a purring cat help you physically heal? Research says it's possible. Learn how cat purrs might help humans.

www.purrfectpost.com

 

[Daniel E.]

Giving Yourself the Gift of Rest

Coping with cancer-related fatigue during the holidays.

www.psychologytoday.com

In the field of chronic pain, a strategy referred to as “activity pacing” is often recommended to help manage pain. Individuals struggling with chronic pain may find themselves getting stuck in a “boom-bust” cycle of activity.

On a “good day,” when pain is less intense, people often want to push themselves to do more to take advantage of the period of time when they are feeling well (boom) followed by days of increased pain and less activity as they recover (bust). If this pattern continues, over time, it can take longer and longer to recover and increases the likelihood of getting trapped in a cycle that may impact levels of pain over time.

Activity pacing helps interrupt this cycle by encouraging two main priorities: conserving energy for activities you value—instead of those you feel you “should” do—and planning and pacing activity so that “high energy” activities are mixed with “low energy” activities alongside periods of rest.

Researchers of cancer-related fatigue have found this “boom-bust” cycle also occurs in cancer recovery, and activity pacing can be very helpful for managing fatigue effectively. Setting limits before your body tells you to stop can go a long way toward avoiding the boom-bust cycle.