Cancer Related Fatigue

By Carrie Newsom, RN.

Cancer-related fatigue (CRF) is one of the most upsetting and difficult to treat symptoms in cancer patients. CRF is often described as a deep-seated tiredness that cannot be relieved by resting, napping or sleeping. The official definition from the National Comprehensive Cancer Network (NCCN) is “an unusual, persistent, and subjective sense of tiredness that is not proportional to recent activity and interferes with usual functioning”.

Who suffers from cancer-related fatigue?

A majority of cancer patients will suffer from CRF during treatment. Additionally, for many patients, this tiredness will continue even after treatment is completed. Below are several types of patients who are most at risk for CRF:

Leukemia: People with cancer of the blood and bone marrow (i.e. leukemias) are especially likely to suffer from CRF. In fact, an early symptom of leukemia is feeling run down with no explanation. Leukemia produces a prolonged inflammatory state via increased cytokines, which cause fatigue. These are the same molecules that make you feel tired and achy when you have the flu. These patients can also feel fatigued as a result of anemia (low red blood cell counts) resulting from their disease or treatment. A patient who is anemic has less oxygen getting to all the tissues in their body. This can make them feel tired and out of breath with minimal exertion.

Causes of cancer-related fatigue

A prolonged inflammatory state and decreased lung function are some of the ways cancer itself may cause fatigue. Treatments, especially combination therapy, may also cause increased tiredness. Other causes of fatigue may include increased stress, depression and anxiety associated with cancer diagnosis and treatment, pain associated with cancer, medications (e.g. antihistamines, anti-depressants, narcotic pain medications, anti-nausea medications), sleep issues, and other medical issues (e.g. hypothyroidism).

All patients should speak with their medical team about their fatigue. The medical team will assess for other causes of tiredness beyond their disease or treatment. The medical team may be able to fix some of these issues and lessen the patient’s fatigue level. (e.g. patients with anemia may need red blood cell transfusion, patients with hypothyroidism may need medication).

How to treat cancer-related fatigue?

The top intervention recommended for managing CRF is to exercise and increase physical activity. The Oncology Nursing Society says “exercise/physical activity has been confirmed as effective in the management of CRF in more than 40 meta-analyses or systematic reviews of randomized controlled trials”. The type of exercise studied varied from walking to cycling to weight training. The exact type, duration, and intensity of exercise most beneficial to patients at various stages in their disease and treatment has not yet been determined.

The Oncology Nursing Society specifically mentioned yoga as likely to be effective in treating CRF. Two randomized controlled trials in breast cancer patients (one in patients undergoing radiation and one in breast cancer survivors) showed yoga practice significantly improved fatigue, however, the effectiveness of yoga as a treatment for fatigue in all types of cancers has not yet been established.

The Oncology Nursing Society also considers relaxation breathing, meditation,mindfulness-based stress reduction, the plant American ginseng (Panax quinquefolius), cognitive-behavioural therapy, and managing the symptoms a patient may be experiencing (e.g. depression, pain, shortness of breath, insomnia) to be effective in treating cancer-related fatigue

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