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Click here to return to the Medical News Today home page. Researchers compared a variety of treatments for cancer-related fatigue to find that exercise or psychological interventions fared best, while drug treatments were less effective. Based on their findings, the authors suggest that doctors should recommend exercise or psychological therapies to patients with cancer-related fatigue in the first instance, rather than turning to medications. Lead author Karen Mustian, Ph. Fatigue is the most common side effect for patients being treated for cancer.
As well as tiredness and lack of energy, cancer-related fatigue may cause confusion, irritability, poor memory, and depression. Not only can this reduce patients' quality of life by preventing them from engaging in day-to-day activities, but it may also discourage them from completing their cancer treatment. Current guidelines suggest that exercise, medication, and psychological interventions such as cognitive behavioral therapy , may be effective for reducing cancer-related fatigue, but which treatment is best? Mustian and colleagues set out to answer this question.
The researchers analyzed data from randomized clinical trials that evaluated the effects of physical activity, medication, and psychological interventions, as well as a combination of both physical activity and psychological interventions, on cancer-related fatigue. In total, the studies included 11, patients aged between 35 and 72 who had been diagnosed with cancer, all of whom had cancer-related fatigue.
Almost half of the studies consisted of women with breast cancer , while 10 of the studies enrolled men with other cancer types. The researchers found that exercise and psychological interventions were equally effective for reducing cancer-related fatigue, as determined by measures on various fatigue assessments - including the Piper Fatigue Scale and the Multidimensional Fatigue Inventory. Drug treatments, which included modafinil and Ritalin, were found to be less effective than both exercise and psychological interventions.
Based on these findings , the team says that doctors should focus less on recommending drug treatments for patients with cancer-related fatigue, and more on physical activity and psychological therapies. So any time you can subtract a pharmaceutical from the picture it usually benefits patients.
Education for the management of cancer-related fatigue
It's a really simple concept but it's very hard for patients and the medical community to wrap their heads around it because these interventions have not been front-and-center in the past. Our research gives clinicians a valuable asset to alleviate cancer-related fatigue. Learn how exercise is the best lifestyle change for reducing breast cancer recurrence. MNT is the registered trade mark of Healthline Media. In general, patients who are receiving chemotherapy typically have a peak in fatigue days after treatment, or at the time when blood counts are low nadir.
For patients receiving radiation, fatigue tends to reach a peak at the end of treatment, improving anywhere from months following therapy. These may be the normal time frames, but many patients report fatigue persisting for many months or years after therapy, even if the cancer is in remission.
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Researchers have found several abnormalities that are related to CRF, but it is uncertain if these changes actually cause CRF or are just associated with it. There are several medical and psychosocial conditions that can either cause fatigue or increase CRF see table 1. If it is determined that a patient has one or more of these conditions, the condition s should be treated first and foremost. There are several other theories as to why cancer patients suffer from this fatigue.
The first involves cytokines, which are proteins released by cells that act as a messenger for the immune system. These proteins regulate many functions of our immune system, including inflammation, immune function, and stimulating the production of all blood cells. Researchers have found that cancer causes an increase in the release of certain cytokines, and levels of these cytokines were found to be higher in people experiencing CRF, suggesting they could be a cause.
It is also known that some cancers cause people to have higher "resting energy consumption", in other words they burn more calories at rest than someone without the disease, and thus require more energy to carry out daily activities. A decrease in the production of certain hormones has also been found in patients with CRF, which may contribute to the feeling of fatigue. These are all theories, and none has been proven to be the cause. In fact, it is likely there is not one single cause, but rather a combination of factors.
It is understood that a lack of physical activity can aggravate or cause fatigue. This may be because deconditioned muscles require a person to exert more energy and effort to perform a task. For this reason, exercise has been studied as a preventive measure and has been shown to work best when started before fatigue sets in, but exercise also can help to relieve fatigue associated with cancer and treatment. Only two interventions have been proven truly effective in large clinical trials to relieve or prevent fatigue: correction of anemia and exercise.
One reason it has been difficult to evaluate new therapies is due to a lack of understanding of the exact cause of CRF, as well as the lack of an animal model in which to do preliminary studies. You can't exactly ask a mouse to rate his fatigue!
Cancer-Related Fatigue | Leukemia and Lymphoma Society
In addition to anemia and exercise, we will discuss some other ways to manage fatigue that have been shown to be helpful. Anemia in a cancer patient can have many causes including: bleeding, bone marrow involvement of disease, chemotherapy, radiation therapy, organ dysfunction heart, lung, liver or kidney disease , or nutritional deficiencies.
Anemia is believed to be one factor contributing to fatigue, and its correction has alleviated fatigue in clinical trials. One way to correct anemia is through the use of blood transfusions; in some cases, this may be the best method, particularly if the patient is bleeding or having symptoms. Despite many safe guards, blood transfusions are not without risk and can lead to transmission of viruses, allergic reactions, and lung injury. In the case of anemia that develops over the course of cancer therapy, anemia can often be corrected by stimulating the bone marrow to make more red blood cells.
In our bodies, a decrease in the red blood count or hemoglobin causes the kidneys to release a protein called erythropoietin, which in turn stimulates the bone marrow to make more red blood cells. Synthetic or man-made versions of erythropoietin can also stimulate the same response. There are studies that have shown these growth factors are not beneficial to all cancer patients. They may increase the risk of blood clots, hypertension high blood pressure , tumor growth, and even cause death.
Therefore, your doctor will have to decide if growth factors are appropriate to treat your anemia. In most studies, correction of anemia resulted in decreased fatigue and an increase in quality of life. It makes sense that these positive changes were greatest in patients whose tumors also responded to therapy, but studies also found that an increase in hemoglobin in those with progressive disease also resulted in improved quality of life, compared to patients with lower hemoglobin. Correction of anemia is one intervention in the treatment of fatigue, but not every cancer patient with fatigue has anemia.
No doubt, when this intervention was first suggested, people probably thought it was ridiculous. How can you ask someone with this level of fatigue to exercise? Well, many studies have proven that exercise improves fatigue ratings and overall quality of life. People found themselves in a better mood, with more energy, feeling more rested, and better able to concentrate.
Now, this does not mean running a marathon, but rather refers to light exercise, such as taking a walk, doing some simple arm exercises to lift cans of soup, marching in place, non-strenuous swimming, or pedaling on a stationary bike. Make sure your healthcare team knows of your plans and has approved the exercise. Certain exercises may not be recommended, especially for those with bone metastases, low blood counts, or other health conditions. It is important to do something that you enjoy and start off slow then progress as you can. Most exercise study participants started before or early during the course of cancer therapy in an effort to prevent fatigue.
It can be much harder to start a program once fatigue has set in, but it is not impossible. It is important to know that even if you are experiencing fatigue, even light exercise can help you feel better. Patients who are already experiencing fatigue can start with a short walk and increase the distance each day or week as you are able. It may be helpful to ask someone to walk with you as encouragement.
A walk to a nice park or garden may help a person relax and take his or her mind off worries. Remember, the type of exercise is not that important; do whatever form of exercise you enjoy that is approved by your healthcare team. The important thing is that you do some activity!
You will feel much better once you get started. Distract Yourself. Allow yourself to shift your focus from fatigue and what you may not be accomplishing by listening to music, reading a book, looking at pictures, meeting friends, watching a movie, going for a walk or enjoying time in nature.
Stay Active. Staying physically active may help some people ease fatigue. Before starting an exercise program, always consult with your doctor or nurse practitioner. Focus on activities that will help you gradually build strength but that do not deplete your energy level.
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Light exercise, such as walking, can also help you relax and sleep better. Practice good nutrition. Patients with cancer are at risk for malnutrition and other problems resulting from either the cancer or the cancer treatment loss of appetite, nausea, vomiting and inability to absorb nutrients. It is important for patients to eat a balanced diet that provides sufficient fluid, calories, protein, vitamins and minerals. Iron intake is vital, so try to consume iron-rich foods such as green leafy vegetables and red meat. Maintain energy levels by eating frequent small meals or snacks throughout the day.
You may find it useful to work with a dietitian to create a plan to suit your caloric needs and to learn about easy-to-prepare, healthy meals and snacks.
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Drink plenty of noncaffeinated liquids throughout the day. Adequate hydration is very important in preventing and treating fatigue. See Food and Nutrition. Address Sleep Habits. The following suggestions may help improve sleep quality: Engage in relaxing activities before bedtime, such as taking a warm bath or shower, reading, writing in a journal, yoga, meditation or listening to calming music.
Go to bed at the same time every night. Use the bedroom for sleep only. Keep the bedroom cool, quiet and dark. Use comfortable bedding and sleepwear. Avoid caffeine, alcohol or high-sugar foods before bedtime. Avoid video game playing, television, computer, cell phone use and social media use before bed and overnight. Forego daytime naps that may interfere with nighttime sleep. If you need to nap, do not sleep for longer than 30 minutes.
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