The issue
It’s normal to feel some degree of fatigue during and after treatment for cancer: in fact, it’s almost expected. However, there is definitely a point where feelings of fatigue or tiredness warrant attention and action.
Cancer-related fatigue (CRF) is a phenomenon frequently experienced by cancer survivors. It’s defined as distressing periods of physical, emotional, or mental tiredness or exhaustion unrelated to activity and brought upon for seemingly no reason. We know this can make some things feel hard - even getting out of bed or getting through your work day. Cancer related fatigue differs from “typical” fatigue because it’s not improved by rest. CRF is thought to be the most common side effect of cancer treatment, with estimates ranging from 25% to nearly 100% during initial therapy. While typically these symptoms improve after treatment, ranges of 10% to 49% of cancer survivors are experiencing CRF several years after.
So, clearly: this is a huge deal. CRF can be really disruptive and challenging and it’s important to identify and address these symptoms so they don’t begin to impact your mental or physical health. It’s also important to know that there are validated screening assessments your care team can perform to help diagnose CRF if you are concerned.
If you are experiencing cancer related fatigue, read on. While there is no perfect solution, we’ve put together an explanation of what may be contributing, as well as a long list of approaches for you to consider in your own survivorship. We want to say up front we know CRF is a really tough symptom to live with and tackle, but we are here to support you every step of the way.
Why does this happen?
There is no single explanation for CRF, but there are several theories for why it occurs. While cancer treatments can be lifesaving, it can take the body time to recover from treatment itself. Also, occasionally the treatments can cause other medical issues that contribute to fatigue like low blood counts or low thyroid. The experience of cancer and its treatment can also impact sleep and mental health, causing exhaustion. Additionally, both cancer and cancer treatments cause some inflammation in the body, and an active immune system can contribute to a chronic stress response.
As you can see, there are many potential and likely overlapping drivers of fatigue related to cancer. While cancer-related fatigue may feel overwhelming, there are a number of things you can do to start to address it.
Take Action!
At OncoveryCare we understand how big of an issue this is for our community and how frustrating it can feel for survivors to experience cancer-related fatigue. While CRF and its treatment might look a bit different for everyone, think about what options you might like to try, and talk with your care team about customizing an action plan specific to your needs.
Assessing Contributing Factors:
- The first step in approaching CRF is making sure there isn’t anything contributing to fatigue that should be individually addressed. This can include basic lab tests for reversible causes of fatigue such as low blood counts, vitamin b12 or folate, or low thyroid; a thorough review of current medications to see if they could be contributing; adequate treatment of pain or nausea; and addressing any issues with insomnia or sleep (see our sleep & survivorship post).
Exercise:
- Exercise has some of the strongest evidence when it comes to treating cancer related fatigue. The American Society of Clinical Oncology (ASCO) recommends moderate physical activity, meaning:
- 150 minutes of aerobic exercise (like fast walking, biking, or swimming) per week
- An additional two to three strength training (such as weight lifting) sessions per week (unless contraindicated)
- The recommended exercise program length varies from 6 weeks to 6 months to see an improvement, but telling someone who is tired to exercise can be less than helpful!
- Exercise comes in all different forms. Finding an exercise that you enjoy and works for your fitness level and ability will help you be successful.
- Ideally, exercise should be a key component of all survivor’s lives. - check out our exercise posts for more about this!
Mental Health and Mindfulness
- In addition to exercise, meditation and mindfulness-based approaches have some of the strongest evidence for benefiting patients with CRF. This can take a lot of different forms - apps for meditation, structured therapy (either individual or group) or different mindful-based practices. There is even evidence that combinations of exercise with mindful components, such as yoga, can help certain survivors.
- While Cognitive behavioral therapy (CBT) is more commonly used for insomnia (as opposed to fatigue), studies have shown that it can be helpful for fatigue. This is likely due to the power of the mind body connection, and a good reminder of how important mental health can be in survivorship. We have a few CBT resources on our website you can try as well.
General Sleep Hygiene
- While by definition CRF is not necessarily improved by rest, it’s important to make sure your symptoms aren’t caused by insomnia or challenges with sleep hygiene. In order to have high-quality sleep, you should set up a quiet bed environment (ideally no screens) and avoid caffeine in the late afternoon. Check out our sleep and survivorship for a deeper dive into this topic, and in the meantime, consider things like sleep casts (podcasts for sleep).
Diet and Nutrition
- Fatigue can sometimes be related to nutrition and the foods we eat. This doesn’t necessarily mean folks aren’t eating the right foods, but sometimes treatments for cancer or cancer itself can impact the way our bodies absorb nutrients. Check out our general nutrition overview for information related to food as medicine in survivorship, and life hacks about how to add nutrient dense foods into your diet.
Acupuncture
- There has been a lot of attention paid to acupuncture as a potential treatment for CRF. Generally speaking, the research shows that acupuncture can be helpful for some people with CRF, interestingly the effect is bigger after treatment rather than during. This is potentially because acupuncture improves sleep efficiency and reduces sleep latency (time to fall asleep), and can improve symptoms related to CRF, but additional work is needed to show benefit across the board.
Medications
- Medications are really second line when it comes to CRF. There is some evidence that medications such as stimulants medications used to treat ADHD, may lead to improvements in CRF during treatment, unfortunately there is less evidence that they can make a real difference for patients who are post treatment and disease free. Given this limited evidence and potential for side effects; medications are not typically recommended for routine management of CRF in survivors.
Supplements:
- There have been really small studies looking at the usefulness of supplements such as Vitamin D and ginseng on cancer-related fatigue. While these supplements were shown to be safe for the majority of the patients studied, unfortunately there has not been any consistent evidence showing a benefit.
Taken together, while cancer-related fatigue can be a really challenging experience, the encouraging news is there are so many approaches to experiment with to see what might be helpful. The best evidence we have is for combining strategies including exercise and mindfulness, but there are so many other options for you to consider. And as always, we want to hear what’s worked for you! Send us an email or find us on any one of our social media platforms to share your thoughts and ideas.
