Overcoming Cancer-Related Fatigue
By Berfin Mahmut, PT, DPT, CLT-LANA, OnCS
Fatigue is a common symptom experienced by many cancer survivors, both during and after treatment. In fact, it is now recognized as one of the most common and distressing adverse effects of cancer and cancer treatment, affecting over 90% of people with cancer.
What is cancer-related fatigue?
Cancer-related fatigue is most common among people with cancer who undergo chemotherapy, radiation therapy, bone marrow transplant, or biological therapies. Unlike the fatigue experienced by the general population, which is usually acute, activity-related, and relieved by rest, cancer-related fatigue is characterized by chronic fatigue that is disproportionate to recent activity or exertion. In addition, cancer-related fatigue is not fully alleviated by rest or sleep. Due to its intensity and persistence, chronic-related fatigue can significantly impact daily activities, mood, social relationships, and survivors’ quality of life.
According to National Comprehensive Cancer Network (NCCN) cancer-related fatigue (CRF) is defined as “a persistent, distressing, subjective sense of physical, cognitive, and/or emotional tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and that significantly interferes with usual functioning”.
Several factors can contribute to cancer-related fatigue, such as pain, emotional distress, sleep disturbances, anemia, poor nutrition, inactivity, medication side effects, and comorbidities. Studies suggest that while moderate to severe fatigue may require both pharmacological and nonpharmacological interventions, mild fatigue can often be managed with non pharmacological approaches alone.
How to manage cancer-related fatigue
Effective fatigue management often depends on self-management techniques, which are strategies designed to help individuals engage in daily activities and accomplish tasks. By applying these techniques, survivors can enhance their overall quality of life. Below are some common self-management strategies that can help in reducing fatigue symptoms.
Energy Conservation Techniques: Energy conservation involves the strategic management of one’s personal energy to prevent exhaustion. This involves practical tactics that help us set achievable goals, prioritize tasks, and regulate our activities. For example, maintaining a daily diary to identify peak energy times, which enables us to tackle crucial tasks during these periods while rescheduling or delegating less essential tasks.
Sleep Quality: Sleep disturbances are common, affecting 30-75% of cancer survivors, yet they are often overlooked. Many people with cancer experience disrupted sleep patterns, struggling to sleep at night, and relying on daytime naps. Establishing a consistent sleep routine by going to bed when sleepy, maintaining a regular bedtime, and waking up at the same time each morning can help regulate sleep patterns. Although short daytime naps can help restore energy, it’s best to keep them under an hour to avoid interfering with nighttime sleep. Engaging in relaxing activities such as reading, journaling, or meditation before bed can also help one unwind and prepare for sleep. Creating a dark, comfortable, and quiet sleep environment can further promote better sleep quality. Additionally, avoiding caffeine, alcohol, and sugary foods before bed can contribute to a more restful night’s sleep.
Physical activity and exercise: Many cancer survivors experience decline in physical conditioning. Although several factors contribute to the decline in physical conditioning and activity among survivors, fatigue is a primary factor. Research consistently demonstrates that exercise can significantly improve fatigue, enhance functional capacity, and boost the quality of life for cancer survivors and that it is more effective at alleviating cancer-related fatigue than pharmaceutical interventions.
However, starting an exercise program can be daunting for many cancer survivors, especially during active treatment. Many people with cancer are unaware that exercise can help alleviate their symptoms, and even those who are aware may be unsure about the type of exercise to perform and how frequently to engage in it.
Studies show that moderate-intensity aerobic training, performed three times a week for 12 weeks, significantly reduces cancer-related fatigue both during and after treatment. A combination of aerobic and strength training, performed 2-3 times a week, can also be effective in reducing fatigue. However, the ideal duration of a combined exercise program for significant improvements is not clearly defined. Typically, considerable reductions in fatigue are seen with exercise sessions lasting over 30 minutes and programs lasting beyond 12 weeks. It is always advisable to consult a healthcare provider or fitness professional who can tailor the exercise regimen according to factors like the survivor’s age, type of cancer, treatments undergone, and fitness level. The program should start with low intensity and short duration, progressing slowly. Low to moderate-intensity exercise is more effective for managing fatigue than high-intensity exercise. Therefore, often a low-intensity exercise is sufficient, especially for people with cancer who are still undergoing treatment or experiencing severe fatigue.
Additionally, mind-body practices, such as yoga and meditation, are often effective and can help reduce fatigue by directly alleviating emotional distress, anxiety, and depression.
Nutrition: Certain cancer medications can cause nausea, vomiting, and decreased appetite, potentially leading to nutritional deficiencies. Offering the body appropriate food types and quantities can often address these issues and alleviate fatigue. However, if symptoms are severe or if comorbidities like anemia are present, it may be crucial to consult with a nutritionist. Fatigue can often be alleviated by addressing anemia and adjusting your diet.
Seek social support: Building a strong social support system is essential throughout the cancer survivorship journey. This support is important not only for emotional well-being, but also for addressing practical needs. Reaching out to loved ones and friends can be highly beneficial; their support with daily tasks can enable survivors to focus on essential tasks, preserve energy, and allocate more time for rest.
Consult with your doctor: Certain medical conditions and/or specific medications can contribute to fatigue. It’s important your doctor assesses these factors and implements effective treatments. Depending on your specific medications and health history, your healthcare team may recommend new medications or adjust your current ones to help manage fatigue. However, some individuals may hesitate to report high levels of fatigue, fearing it could lead to changes in their treatment plan. Others may refrain from mentioning it to avoid being perceived as complaining or may believe that fatigue is simply a part of their condition that must be endured without intervention. It’s important to communicate any symptoms to your healthcare team so they can fully understand your situation and provide appropriate care.
Berfin Mahmut is a Doctor of Physical Therapy, a certified lymphedema therapist, and a cancer exercise specialist who specializes in cancer rehabilitation at Mount Sinai in New York, NY.
