Cancer-related fatigue is reported in 14% to 96% of patients undergoing cancer treatment. Fatigue experienced as a side effect of cancer treatment is differentiated from fatigue experienced by healthy people in their daily lives.
Healthy fatigue is frequently described as acute fatigue that is eventually relieved by sleep and rest. Cancer-related fatigue is described as chronic fatigue because it is present over a longer period of time, interferes with functioning, and is not completely relieved by sleep and rest.1 The pattern of fatigue associated with cancer treatment varies according to the type and schedule of treatment. For example, people treated with cyclic chemotherapy regimens generally exhibit peak fatigue in the days following treatment, then report lower levels of fatigue until the next treatment.
According to research by lead author, Karen Mustian, PhD, MPH, from the University of Rochester Medical Center, exercise and psychological therapy are more effective than medications and should be recommended first to patients. The objective of the study, published in JAMA Oncology, was to perform a meta-analysis to establish and compare the mean weighted effect sizes of the four most commonly recommended treatments for cancer-related fatigue: exercise, psychological therapy, combined exercise, psychological therapy, and medications to identify the independent variables associated with treatment effectiveness.2
A review of 113 unique studies (11,525 participants; 78% female; mean age, 54 [range, 35–72]) published from January 1, 1999 through May 31, 2016, were included. Exercise, combined psychological therapy, and exercise interventions improved cancer-related fatigue during and after primary treatment whereas medication interventions did not. Data show that exercise—whether aerobic or anaerobic—reduced cancer-related fatigue most significantly.
Mustian has been studying exercise in cancer patients, and her studies often test gentle yoga, walking, resistance bands, and other forms of therapy to help lessen side effects.3
This research gives clinicians a valuable asset to alleviate cancer-related fatigue. Our cancer patients must be educated about fatigue before it occurs and taught about self-care strategies necessary to manage fatigue. Specific techniques for the management may include:
- Differentiate fatigue from depression.
- Assess for the presence of correctable causes of fatigue (e.g., dehydration, electrolyte imbalance, dyspnea, or anemia).
- Encourage activity/planned exercise programs within individual limitations, making realistic goals.
- Evaluate the efficacy of fatigue interventions on a regular and systematic basis.
How will our colleagues integrate these evidence-based recommendations into practice?
- National Cancer Institute. Fatigue (PDQ®)–Health Professional Version. 2017 Jan 13.
- University of Rochester Medical Center. Research Shows Exercise is a Boon for Cancer Patients. 2017 Mar 2.
- Mustian KM, Alfano CM, Heckler C, et al. Comparison of Pharmaceutical, Psychological, and Exercise Treatments for Cancer-Related Fatigue: A Meta-analysis. JAMA Oncol. 2017 Mar 2.