Make the little changes to stop fatigue from slowing down your recovery journey.

“In a long race, if I'm worried about fatigue, my concentration is the first thing to go.”
- Helio Castroneves

Cancer Related Fatigue (CRF) is often infrequently discussed or managed; for one, the focus is always on other symptoms such as pain, nausea, and vomiting, and for the other, fatigue is considered by many as an unavoidable symptom to be endured during the course of treatment. Also, as I mentioned in my last blog, there is no test to diagnose cancer related fatigue, so unless you bring it up as a problem, it may remain unaddressed.

Cancer-related fatigue (CRF) is defined by the National Comprehensive Cancer Centre Network as ‘a distressing, persistent, subjective sense of physical, emotional and/or cognitive tiredness, or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning’ (Berger et al, 2015b). 

CRF is a reality and your cancer recovery journey to a large extent relies on treating it. The treatment depends on a thorough evaluation by your cancer care team including a detailed assessment of your symptoms, a complete physical exam, blood tests, as well as taking into account your medications and supplements. Addressing different specific cancer-related problems, like anemia, depression or pain, might make you feel better, but many times, the cause for cancer fatigue may not be so obvious or may be multifactorial.

Whatever the cause, think of your baseline energy levels like a ‘bank.’ Daily deposits and withdrawals have to be made keeping in mind your essential activities of daily living. While your cancer care team will talk to you in detail about making lifestyle changes to help you cope with fatigue, here are a few tips to start with.

• Have a regular routine with balanced periods of rest and work. Maintain good sleep hygiene.
• Learn to prioritize and delegate so you use your energy effectively.
• Plan ahead and organize your schedule to include short periods of rest.
• Naps generally should not be more than 30 mins. Too much rest during the day can make it harder to sleep at night.
• While at work, maintain proper body mechanics like using a chair with good support, and bending at the knees and hips and not at the back.

Exercise is an often suggested modality and moderate activity for 3 to 5 hours a week may help with CRF. One study reported that breast cancer patients who took part in enjoyable physical activity had less fatigue and pain and were better able to take part in daily activities. Data from some clinical trials showed patients reported more physical energy, improved appetite and a greater sense of well-being with consistent exercise. Mind and body exercises such as tai chi and qigong may help relieve fatigue. These exercises are often called ‘meditation in motion’ because they combine movement, stretching, balance, and deep breathing with meditation. Yoga can also help. As always, any exercise program should be started only after consulting with your cancer care team.

CRF can worsen if you are not eating enough or not eating the right foods. Your appetite may decrease, you may have nausea and vomiting while eating or you may not even be able to digest certain foods. All of this may make it difficult to get the nutrients to fight fatigue with, but don’t give in. Make sure you are getting an appropriate balance of protein, fat and carbohydrates as well as enough fluids to combat dehydration. With regards to supplements, evidence based data in the scientific literature has shown that American ginseng (panax quinquefolius), an herb, can be used to treat fatigue when taken in capsules of ground ginseng root. In a clinical trial conducted by Mayo clinic, cancer patients who were either in treatment or had finished treatment, received either ginseng or placebo. The group receiving ginseng had less fatigue than the placebo group. This is not to be confused with Korean ginseng or other off-the shelf ginseng varieties which have not been proven to help with fatigue. As always, there are contraindications including if you are on blood thinners such as warfarin. You must talk to your oncologist before starting any herbal supplement.

“Cancer-related fatigue (CRF) has been reported by up to 40% of patients at diagnosis, 90% of patients treated with radiation and 80% of those under chemotherapy treatment ” Hofman M, Ryan JL, Figueroa-Moseley CD, Jean-Pierre P, Morrow GR. Cancer-related fatigue: The scale of the problem. The Oncologist. 2007;12:4–10. [PubMed] [Google Scholar]

Talking to a therapist may also help decrease fatigue by working on problems related to cancer that make fatigue worse, such as stress, fear, hopelessness and lack of support. It is likely that you will need a combination of modalities to help you deal with fatigue. Take time to understand what helps you most and don't be afraid to ask for help.

Yes, cancer-related fatigue is real. But that’s no reason to let it tire you out.