From the Guidelines
Cancer fatigue should be managed with a multifaceted approach that includes physical activity, energy conservation strategies, and potentially medication, as recommended by the most recent guideline update from 2024 1. To manage cancer fatigue, I recommend starting with 30 minutes of moderate exercise, such as walking, most days of the week, breaking it into shorter sessions if needed.
- Practice energy conservation by prioritizing important activities, taking short rest periods throughout the day, and maintaining good sleep hygiene.
- Nutritional support is crucial—eat protein-rich foods, stay hydrated, and consider small, frequent meals if appetite is poor.
- For severe fatigue, medications like methylphenidate (5-10mg once or twice daily) or modafinil (200mg daily) may be prescribed by your oncologist, as suggested by previous studies 1. Treating underlying contributors such as anemia, depression, or pain is essential, as they can exacerbate cancer fatigue. Cancer fatigue occurs due to the disease itself, treatments like chemotherapy and radiation, and related factors including inflammation, hormonal changes, and psychological stress, as noted in the 2024 guideline update 1. The body expends significant energy fighting cancer and healing from treatments, depleting resources needed for normal functioning. While fatigue may persist for months after treatment ends, these strategies can significantly improve quality of life and daily functioning, which is the primary goal of managing cancer fatigue, as emphasized by the American Society of Clinical Oncology 1.
From the Research
Definition and Prevalence of Cancer Fatigue
- Cancer-related fatigue (CRF) is a common and distressing symptom experienced by patients with cancer, affecting their quality of life, physical functioning, and social well-being 2, 3.
- It is most common in patients with locally advanced or metastatic incurable disease 2.
- CRF has deleterious effects on many aspects of patient quality of life, including physical, psychological, and social well-being 3.
Causes and Contributing Factors of Cancer Fatigue
- The aetiology of CRF is complex and multidimensional, involving many potentially contributing elements, such as tumour-related factors, comorbid medical/psychological conditions, and side effects associated with anti-cancer therapies or other medications 3.
- The disease itself, cancer treatments, and their side effects are also causes of cancer-related fatigue 4.
Management and Treatment of Cancer Fatigue
- A variety of specific interventions have been developed to manage CRF, including physical therapies, psychological therapies, and medication 2.
- Aerobic exercise, yoga, cognitive-behavioural therapy (CBT), and psycho-educational interventions have shown benefits in patients with earlier stage disease, those undergoing active treatment, and in cancer survivors 2.
- Medications such as methylphenidate and erythropoietin have been found to reduce fatigue severity in patients with cancer 5.
- Non-pharmacologic supportive strategies, such as exercises, education and counseling, sleep therapy, and complementary therapy, can also improve quality of life in patients with breast cancer experiencing CRF 6.
Barriers to Effective Management of Cancer Fatigue
- Barriers to the effective management of CRF exist both on the side of physicians and patients, and as a result, CRF often remains unrecognised and undiscussed in clinical practice 3.
- A change of approach is required, where fatigue is treated as central to patient management during and after systemic anti-cancer treatment 3.