From the Guidelines
Managing cancer-related fatigue requires a multifaceted approach, with the most recent and highest quality evidence suggesting that regular, moderate exercise, such as walking for 15-30 minutes daily, is a crucial component of fatigue management, as it improves physical conditioning and endorphin release 1.
Key Components of Fatigue Management
- Exercise: Establishing a regular, moderate exercise routine, like walking, to improve physical conditioning and endorphin release, which can help reduce fatigue 1.
- Energy Conservation: Planning important activities during peak energy times and taking short rest periods throughout the day to conserve energy.
- Nutrition and Hydration: Ensuring adequate nutrition with small, frequent meals rich in protein and complex carbohydrates, and maintaining proper hydration with 8-10 glasses of water daily.
- Sleep Improvement: Establishing consistent bedtime routines and limiting daytime napping to 30 minutes to improve sleep quality.
Medications and Therapies
- Psychostimulants: Medications like methylphenidate (5-10mg twice daily) or modafinil (100-200mg daily) may help, but should be used under medical supervision 1.
- Antidepressants: Selective serotonin reuptake inhibitors might benefit patients with concurrent depression.
- Cognitive Behavioral Therapy: Addressing negative thought patterns contributing to fatigue perception.
- Complementary Approaches: Yoga, meditation, and acupuncture may provide additional relief.
Importance of Healthcare Team Communication
Regular communication with the healthcare team is essential, as fatigue can sometimes indicate disease progression, medication side effects, or treatable conditions like anemia, which might require specific interventions such as erythropoietin-stimulating agents or blood transfusions 1.
From the Research
Management Strategies for Cancer-Related Fatigue (CRF)
- The management of CRF involves a treatment algorithm that includes regular evaluation of fatigue levels, identification and treatment of underlying causes, and nonpharmacologic and pharmacologic interventions 2.
- Nonpharmacologic interventions may include:
- Moderate exercise programs to improve functional capacity and activity tolerance
- Restorative therapies to decrease cognitive alterations and improve mood state
- Nutritional and sleep interventions for patients with disturbances in eating or sleeping
- Psychosocial interventions, such as counseling and education, to help patients cope with fatigue 2, 3
- Pharmacologic interventions may include:
- The evaluation of fatigue is intrinsically multidimensional, and several validated questionnaires can be used to measure fatigue in patients with cancer 4, 6.
- Treatment of fatigue should depend on its cause, and a comprehensive assessment should include a thorough review of systems, review of medications, assessment of comorbidities, nutritional/metabolic evaluation, and assessment of activity level 2, 5.
- Management of fatigue is cause-specific when conditions known to cause fatigue can be identified and treated, and nonspecific therapies may be useful in short- and long-term CRF management in many patients 4.