From the Guidelines
To treat post-chemotherapy fatigue, clinicians should recommend exercise, cognitive behavioral therapy, and mindfulness-based programs as the first line of treatment, as these interventions have been shown to reduce the severity of cancer-related fatigue symptoms in adults who have completed cancer treatment. According to the most recent and highest quality study 1, exercise, including aerobic, resistance, or a combination of both, should be tailored to the individual patient's abilities and may be supervised or unsupervised.
- Key recommendations for managing post-chemotherapy fatigue include:
- Exercise: aim for 30 minutes of moderate-intensity physical activity, such as walking or swimming, 3-5 times weekly 1
- Cognitive behavioral therapy: to address psychological aspects of fatigue and improve overall well-being 1
- Mindfulness-based programs: including mindfulness-based stress reduction, mindfulness-based cognitive therapy, and mindful awareness practices, which can be delivered in person or via a web-based program 1
- Sleep schedule: establish a consistent sleep schedule with 7-8 hours of sleep nightly and incorporate short daytime naps if needed
- Nutrition: focus on protein-rich foods, complex carbohydrates, and iron-rich foods, and stay well-hydrated with 8-10 glasses of water daily
- Medication options, such as methylphenidate or modafinil, may be considered for severe fatigue, but should be discussed with an oncologist and used with caution, as the evidence for their use is conditional and based on moderate-quality evidence 1.
- Additionally, clinicians may recommend yoga, acupressure, or moxibustion to reduce the severity of cancer-related fatigue, although the evidence for these interventions is low and the recommendation is conditional 1.
- It is essential to note that wakefulness agents, such as modafinil or armodafinil, and psychostimulants, such as methylphenidate, should not be routinely recommended to manage symptoms of cancer-related fatigue in adults who have completed cancer treatment, as the evidence suggests that their undesirable effects may outweigh their desirable effects 1.
From the Research
Treatment Options for Post-Chemotherapy Fatigue
- Exercise has been shown to be an effective intervention in reducing fatigue during cancer treatment 2
- A combination of interventions, such as sleep promotion, instruction and education, exercise, and distraction and relaxation, may be the most effective approach in managing cancer-related fatigue 2
- Self-care strategies, including receiving support from family and friends, having a healthy diet, taking part in hobbies or distraction activities, and exercising, can help alleviate fatigue 3
- Erythropoiesis-stimulating agents (ESAs) have been found to provide a small but clinically important improvement in anaemia-related symptoms, which can contribute to fatigue 4
Self-Care Activities
- Resting and taking it easy can be an effective self-care strategy for managing fatigue 3
- Adjusting mood and being more positive can also help alleviate fatigue 3
- Spending time chatting with friends and socializing can be beneficial in reducing fatigue 3
- Engaging in physical activity, such as walking or other exercises, can help improve physical fitness and reduce fatigue 5, 3
Role of Health Professionals
- Health professionals should provide adequate and systematic information regarding fatigue and related self-care strategies at the beginning of chemotherapy 6
- Continuous assessment and individual guidance of patients throughout their treatment can help manage fatigue effectively 6
- Nurses can play a crucial role in promoting the use of evidence-based fatigue management strategies, including exercise and socializing 3