Cancer-related Fatigue

Cancer-related fatigue (CRF) is one of the most common chronic symptoms and side effects of many cancer treatments. Coping with this fatigue is important for improving quality of life—during treatment and beyond. Lifestyle changes, alternative health techniques, exercise, and supplements can help increase energy and enjoyment.

What is cancer-related fatigue?

CRF goes beyond the normal, everyday tiredness of doing too much or not getting adequate rest. Day-to-day activities seem overwhelming, while the level of fatigue is out of proportion to the activity or amount of energy exerted. The feelings of being tired, worn-out, heavy, or lacking energy go deep, and a good night’s sleep is not enough to restore depleted energy.

What causes it?

CRF is a double-barrelled attack. One, it is often a symptom of cancer itself. Two, it is caused or exacerbated by traditional cancer treatments including surgery, chemotherapy, radiation, bone marrow transplants, and biologic therapies.

Because the effects of cancer and its treatments are widespread, CRF often has multiple causes. Many cancer patients already experience tiredness from a battery of pre-treatment tests and the emotional stress of dealing with the diagnosis, so it’s no surprise fatigue worsens with treatment.

Studies looking at the role of treatment in CRF point to a variety of causes, including

• additional energy needed to repair and heal tissue damaged during treatment
• buildup of toxins left in our bodies after cancer cells are killed
• effects of biologic therapy on our immune systems
• changes in sleep-wake cycles

What are its effects?

CRF’s effects are far-reaching, affecting many aspects of life ranging from making everyday activities more difficult to affecting our ability to work and from changing our self-perceptions to negatively impinging on our relationships with friends and family.

In short, CRF is not “just a little bit of tiredness.” It’s a real and potentially debilitating condition with huge short-term and sometimes long-term impact on our quality of life.

Who gets CRF?

Although the numbers vary depending on the type of cancer, treatment, and patient profile, according to the US National Cancer Institute, CRF affects between 14 and 96 percent of patients undergoing cancer treatment, and between 19 and 82 percent of patients post-treatment.

The good news is that the level of fatigue usually decreases after treatment is finished. The bad news is that for many patients some degree of fatigue can last for months or years. A number of studies have indicated that even 10 years after treatment up to 30 percent of cancer survivors still suffer from fatigue, a greater proportion than the general population.

The older we are, the more advanced the cancer, and the more treatments we receive, the more likely we’ll suffer from long-term fatigue. Plus, some long-term treatments such as tamoxifen also contribute to CRF.

Coping with CRF

When fatigue strikes, we don’t have to hide in bed with the covers over our heads. We can take action by paying attention to our body’s physical and emotional needs, making appropriate lifestyle changes, using complementary alternative medical practices, and taking supplements.

Lifestyle changes

Whether dealing with short-term or longer-term fatigue, the best advice is to listen to our bodies and give them what they need. That means

• devising a regular sleep routine and taking short naps as needed
• scheduling activities that make the best use of energy
• letting go of less important activities
• asking family and friends for help
• avoiding stressful situations
• avoiding temperature extremes, smoke, and fumes
• eating nutritious foods to boost our immune system

Talking to a therapist about the emotional side of cancer—stress, anxiety, and depression—which can worsen fatigue, may also help. Join a cancer support group to find information and talk to others coping with CRF. Call 1-800-263-6750 or contact your local Canadian Cancer Society to find a local group.

Complementary alternative medicine (CAM) techniques

Whether before, during, or after traditional cancer treatments, a variety of CAM techniques may help relieve stress and decrease fatigue. Some hospitals integrate CAM with traditional treatments.

Qigong, tai chi, yoga: Researchers have looked at the trio of mind and body exercises: qigong, tai chi, and yoga. The results indicate that combining the physical aspects of movement, stretching, balance, and controlled breathing with the more spiritual aspect of meditation helps lessen fatigue.

Meditation, hypnosis, relaxation therapies, biofeedback: Other forms of mindfulness-based meditation lessen anxiety, stress, and mood and sleep disturbances, all of which are factors in fatigue. Hypnosis, relaxation therapies, and biofeedback also help combat side effects.

Acupuncture, reiki, massage: A 2012 study showed acupuncture can significantly reduce CRF, while other studies have documented its ability to reduce fatigue-causing nausea and vomiting. Reiki and gentle massage are also helpful.

Supplements

While a number of herbs and supplements look promising for managing symptoms and side effects, more rigorous studies are needed. Be sure to check with your health care practitioner before taking any supplements.

• Two studies out of the Mayo Clinic suggest that ginseng may help relieve CRF.
• Other studies have shown ginger’s ability to control nausea, a cause of fatigue.
• Researchers studying inflammation and fatigue suggest omega-3 might have a positive effect on CRF.

Among the pervasive effects are

• inability to complete daily activities
• decreased interaction with family and friends
• reduced participation in social events and community activities
• mood changes
• mental/attention fatigue affecting attention, memory, understanding, and the ability to think clearly
• loss of work or school time
• money problems from a job leave or loss, plus cancellation of work-related health insurance
• lowered self-esteem

Other common causes of CRF include

• anemia
• hormone level fluctuations
• infection
• respiratory and/or heart problems
• pain
• stress, anxiety, and depression
• appetite loss, insufficient calories or nutrients, or the body’s inability to absorb nutrients
• dehydration, often from severe diarrhea or vomiting
• loss of weight, muscle, and/or strength
• medications for cancer or other conditions such as opioids and antidepressants
• insomnia and other sleep problems
• decreased activity

Exercise does a body good

We know exercise is good for us—physically, emotionally, and mentally. Cancer doesn’t change that. In fact, decreased physical activity can cause fatigue.

Studies and clinical trials of breast cancer survivors who participated in moderate physical activity reported decreased fatigue as well as less pain, better appetite, ability to do more daily activities, and a greater satisfaction with life—all of which feed back into increased energy. Recent studies point to similar findings for other types of cancers.

While any exercise is useful, a review of studies shows moderate to vigorous intensity offers the greatest value, with three to six hours a week as the optimal amount.

• Helpful hintsSelect an enjoyable exercise or activity, such as walking, swimming, stationary cycling, low-impact or water aerobics, or gardening.
• Include aerobic, resistance, and flexibility exercise, adapted as required.
• Start slowly and build up gradually.
• Keep a regular schedule.

Safety precautions

Consult a health care practitioner before starting, as specific rehabilitation needs depend on the treatment and type of cancer. Be aware of the following safety precautions from the Canadian Cancer Society and other cancer organizations.

• Don’t exercise if diagnosed with anemia, abnormal sodium or potassium levels, or bone metastases.
• Skip gyms and other public exercise locations when white blood cell counts are low.
• Avoid pools during radiation, as chlorine can cause skin irritation.