February 12, 2021 | 5 minute read

Cancer-related fatigue (CRF) is defined as a persistent and overwhelming tiredness that is not alleviated from rest, and it’s caused by cancer and/or cancer treatment. Survivors experience this type of fatigue during normal activities that most people would find manageable – like making dinner or doing chores around the house. This feeling of fatigue can significantly impact quality of life.

Causes of Cancer-Related Fatigue

The cause of cancer-related fatigue is not entirely clear, but between 80-100% of people with cancer report experiencing fatigue.

Fatigue is greater in those:

• with anemia caused by cancer spreading to bone marrow or cancer drugs attacking red blood cells.
• with more extensive disease and later stages of cancer.
• who have received multimodality treatments including chemotherapy, radiation, hormonal therapy and/or surgery.
• with a longer history of treatment.
• who are dealing with accompanied symptoms such as pain, depression, anxiety and sleep disturbances.
• with underlying health conditions such as heart disease, diabetes, kidney disease, thyroid disease and anemia.

For many people, fatigue often lessens or stops when treatment ends, but symptoms can extend years into survivorship.

Treatment of Cancer-Related Fatigue

The first step toward reducing cancer-related fatigue is working with a healthcare team to manage symptoms like pain, depression, anxiety, anemia, sleep disturbances and any underlying health conditions.

The second-best treatment is to be physically active. Prolonged periods of being sedentary and not engaging in physical activity can lead to loss of skeletal muscle mass and strength. This weakened state leads to risk of injury, decreased cardiovascular fitness and muscle strength, and increased risk of anxiety and depression.

For most people with cancer, physical activity can be safely incorporated into cancer treatment. Studies show that people with cancer who exercise are less tired, experience an improvement in cancer-related fatigue and have greater strength and activity levels.

Currently, there are no specific recommendations regarding the amount, frequency and duration of physical activity required to reduce cancer-related fatigue. Many study participants engage in physical activity three times per week. ASCO guidelines recommend:

• 150 minutes a week of moderate aerobic exercise (being able to talk, but not sing while exercising)
• two days per week of strength training
• flexibility exercises throughout the week

These recommendations translate to 30 minutes of activity five days per week or 2.5 hours per week. Some observational studies suggest 3-5 hours of moderate activity per week may help people experience even fewer side-effects like CRF. Those who have cancer that has spread to bones, people with low blood counts (anemia/thrombocytopenia) or a fever or those who are at risk of falling should take caution when exercising and discuss a plan with their healthcare team first.

The National Comprehensive Cancer Network suggests that healthcare professionals encourage both cardiovascular endurance and resistance exercise, as well as a referral to physiatrist or supervised rehabilitation program – especially for those who are deconditioned.

Yoga is an excellent choice of activity for many people with cancer, as the nature of the practice includes gentle stretching with strength training in a format that is low impact. Yoga improves strength, flexibility and balance, and generally includes meditation. Yoga has been found to improve CRF, sleep disturbances, stress and cognition.

How to Begin Incorporating Physical Activity into Daily Life

• Check for exercise classes offered through the hospital or treatment center. Many places offer yoga, Pilates, tai chi or a fitness center with certified cancer exercise trainers.
• Start with a five-minute, slow stroll or one lap around the block, with a gradual and continual increase in frequency, duration and intensity level over time.
• Combine moderate aerobic exercise, such as riding a stationary bike or walking daily, with light resistance exercise for strength training.
• Partner with a friend or family member who will be patient but encouraging.
• Strive to build your strength and endurance by committing to daily exercise. Don’t give up.

Dietary Strategies

A poor diet can exacerbate cancer-related fatigue symptoms. Some helpful strategies include:

• Discuss fluid needs with a healthcare team, as dehydration can be a factor. Enjoy AICR’s flavored water recipes for delicious hydration ideas.
• Consume adequate amounts of high-quality protein. Meet with a registered dietitian to determine personal protein needs.
• Consume a variety of nutrients from whole, mostly plant-based foods. This is a time when the body’s need for nutrients is at an all-time high while it is healing and recovering. Look at the AICR Foods that Fight Cancer^TM for foods to incorporate.

Psychological Interventions that May Help

Support groups provide a safe place to talk to others who are experiencing similar CRF symptoms and learn tips and techniques. Many cancer treatment centers offer support groups. Another option is individual counseling, which can help survivors gain a greater understanding of CRF and learn techniques like mindfulness-based stress reduction.

Resources

• Mustian KM, Alfano CM, Heckler C, et al. Comparison of pharmaceutical, psychological, and exercise treatments for cancer-related fatigue: a meta-analysis. JAMA Oncol. 2017;1:961-968.
• Danhauer SC, Addington EL, Cohen L, et al. Yoga for symptom management in oncology: a review of the evidence base and future directions for research. 2019;125(12):1979-1989.