How to manage post-chemotherapy fatigue and dizziness?

Management of Post-Chemotherapy Fatigue and Dizziness

Physical activity is the most effective intervention for managing post-chemotherapy fatigue and dizziness, with exercise programs combining aerobic and resistance training recommended for all cancer survivors who do not have contraindications.

Initial Assessment and Evaluation

Focused Fatigue History

• Assess onset, pattern, duration, and change over time
• Identify associated or alleviating factors
• Screen using a quantitative scale (0-10):
  • 0: No fatigue
  • 1-3: Mild fatigue
  • 4-6: Moderate fatigue
  • 7-10: Severe fatigue 1

Laboratory Evaluation

• Complete blood count with differential (compare to end-of-treatment values)
• Comprehensive metabolic panel (electrolytes, hepatic and renal function)
• Thyroid-stimulating hormone (TSH)
• Consider additional testing based on symptoms 1, 2

Assess Treatable Contributing Factors

1. Medical conditions:

   • Anemia
   • Cardiac dysfunction
   • Endocrine dysfunction (especially thyroid)
   • Pulmonary dysfunction
   • Renal dysfunction
   • Nutritional deficiencies 1

2. Medication effects:

   • Review all medications
   • Consider persistent effects of sleep aids, pain medications, antiemetics 1

3. Psychological factors:

   • Depression (present in up to 33% of cancer patients)
   • Anxiety
   • Emotional distress 2

4. Sleep disturbances:

   • Insomnia
   • Hypersomnia
   • Sleep apnea (present in 30-75% of cancer patients) 2

5. Activity level:

   • Deconditioning
   • Decreased physical activity 1

Evidence-Based Management Strategies

Physical Activity (Category 1 Recommendation)

• Implement a structured exercise program combining:
  • 150 minutes of moderate aerobic exercise per week (walking, cycling, swimming)
  • 2-3 strength training sessions per week 1
• Walking programs are generally safe for most cancer survivors
• For patients with neuropathy, cardiomyopathy, or severe fatigue, refer to a physical therapist or exercise specialist 1
• Exercise has the strongest evidence base for managing cancer-related fatigue 1

Psychosocial Interventions (Category 1 Recommendation)

• Cognitive behavioral therapy (CBT) to address negative thought patterns
• Mindfulness-based stress reduction
• Psychoeducational therapies about fatigue patterns
• Supportive expressive therapies 1

Mind-Body Interventions

• Yoga shows benefit for post-treatment fatigue 1
• Acupuncture can reduce fatigue in cancer survivors 1
• Tai chi and qigong are beneficial during treatment and may help post-treatment 1

Sleep Management

• Maintain regular sleep schedule
• Limit daytime napping
• Avoid caffeine and alcohol before bedtime
• Create comfortable sleep environment
• Consider CBT for sleep (Category 1 recommendation) 1, 2

Energy Conservation Strategies

• Schedule activities during peak energy times
• Delegate non-essential tasks
• Use labor-saving devices 2

Nutritional Support

• Optimize caloric intake
• Correct electrolyte imbalances
• Consider nutritional consultation 1

Pharmacologic Interventions

For Specific Conditions

• Treat anemia if present
• Correct electrolyte imbalances
• Manage pain effectively 1

For Persistent Fatigue

• Psychostimulants (methylphenidate) may provide benefit in some cases but should not be routinely recommended 1
• American ginseng may be considered 1
• Avoid L-carnitine, antidepressants, and wakefulness agents specifically for fatigue management 1

Follow-Up and Monitoring

• Schedule regular follow-up visits
• Reassess fatigue levels using standardized scale
• Adjust treatment plan based on response 1, 2

Common Pitfalls to Avoid

• Attributing fatigue solely to one cause without comprehensive evaluation
• Overlooking psychological factors
• Dismissing fatigue as "normal" when it significantly impacts quality of life
• Prescribing exercise without proper assessment of underlying conditions
• Failing to recognize medication side effects as potential causes of fatigue 2

For dizziness specifically, evaluate for potential causes including vestibular dysfunction, medication side effects, anemia, orthostatic hypotension, and dehydration, and treat the underlying cause while implementing safety measures to prevent falls.