Cancer Related Fatigue

The fatigue that comes after cancer treatments can be physically, emotionally, and mentally distressing.  It has been described as a type of fatigue that cannot be alleviated with sleep alone, and it often takes a multi-factorial approach to treat it.  Besides exhaustion, people can experience memory loss, difficulty concentrating, nausea, and muscle weakness.  Paradoxically, they can also suffer from sleep disturbances.  Here we look at what causes cancer related fatigue, and what types of natural treatments have been shown to be effective in clinical trials.

What Causes Cancer Related Fatigue?

While there is ongoing discussion about the causes of chronic fatigue in people living with cancer, there are numerous pretty well agreed upon mechanisms:

• long term stress on the nervous system,
• long term psychological stress,
• changes in muscle metabolism and muscle loss,
• disruptions in circadian rhythms,
• chronic inflammation and oxidative stress, and
• hormonal changes due to early menopause in women or androgen deprivation in men.

It is also very important that other causes of fatigue are ruled out and, if necessary, treated.  Chemotherapy and radiation can cause a plethora of side effects, and therefore a thorough work-up should be required of all physicians.  If you have not had comprehensive blood work, ask your doctor to screen you for the following other possible causes of fatigue:

• vitamin B12 deficiency,
• iron deficiency,
• anemia,
• thyroid dysfunction,
• diabetes, and although not as common but still possible,
• cardiotoxicity.

How Can Cancer Related Fatigue Be Treated?

Many physicians may feel at a loss as to what to do for their patients who suffer from cancer related fatigue.  However, there is ample research on the topic of treatment options, and therefore seeking out a knowledgeable integrative medicine doctor is important.  The other important factor to appreciate is the amount of time one needs to dedicate to their recovery.  The following treatment options may seem simplistic, but with consistent and sufficient exposure, fatigue can improve substantially.

1) Cognitive Behavioural Therapy

Cognitive behavioural therapy (CBT) can involve a variety of methods including relaxation training, stress reduction, and ways to emotionally heal from the trauma of a cancer diagnosis and the ensuing treatments.  There have been several clinical trials supporting the use of CBT over multiple sessions.  As previously stated, long term psychological stress is a contributor to cancer related fatigue, even long after cancer treatments are over.  Emotional healing is a vital component to recovering from fatigue.

2) Exercise

The effect of light exercise on fatigue has been extensively written about, and there is vast consensus that exercise improves cancer related fatigue.  It is not necessary to join a gym or buy expensive classes, as many studies have been home based exercise programs where participants get an individualized work out plan.  Downloading a pedometer app on your phone or getting a Fit Bit or other type of similar device can keep you motivated.  Even relaxing types of exercise, such as Tai Qi or Qi Gong have been shown to reduce fatigue.  Decreased muscle mass is a common cause of fatigue, even in those without cancer.  Decreased muscle mass over time contributes to bone loss, decreased balance and frailty, and therefore a focus on maintaining or building muscle mass is extremely important.

3) Nutrition

Several studies have shown that people undergoing chemotherapy and radiation have vitamin and mineral deficiencies.  While this may not seem that important, it can be humbling to appreciate the power of substances like magnesium, B vitamins, zinc, and vitamin C, to name a few.  Correcting nutritional deficiencies can improve sleep, mood, concentration, and of course energy.  A recent study looked at a group of breast cancer patients who ate a diet high in whole grains, omega-3 fats and antioxidants through fruits and vegetables, and after three months, their fatigue was significantly improved.  Diet is a powerful tool that everyone can utilize, and if you do not know where to start, take advantage of my meal planning service.

4) Acupuncture

Acupuncture is the most studied complementary medicine service, and has also been shown to benefit cancer related fatigue.  Acupuncture can treat emotional stress, pain, cognitive dysfunction and reduces inflammation, so it is no wonder that acupuncture can also be beneficial for fatigue.  Several clinical trials have been conducted which show that anywhere from 6-12 treatments can be effective for the treatment of fatigue. If you have a needle phobia, acupressure has been shown to be just as effective.

5) Intravenous Vitamin C (IVC)

IVC is a frequently used complementary therapy that is becoming increasingly studied in clinical trials for its anti-cancer properties.  Major findings from studies, besides its ability to target cancer cells, is its positive role on quality of life parameters, such as appetite, insomnia, pain, and of course fatigue.  From my own clinical experience, fatigue is one symptom that is almost always improved with IVC treatments.  Intravenous vitamin C is safe to use with most types of chemotherapy, and can mitigate the side effects substantially.  The positive effect on fatigue can be seen after about 4-6 treatments.

There are other complementary therapies that have shown promise for their ability to improve fatigue, such as American ginseng and L-carnitine.  Ginseng has anti-cancer properties and is great at improving the ability to cope with stress. L-carnitine can help to prevent weight loss associated with advanced malignancy, and preserve muscle mass, which prevents fatigue.  There are numerous other supplements and herbs that can also be very helpful. There are a variety of therapies available, so if one doesn’t work for you, another one probably will.

Fatigue has a multifactorial cause, and therefore needs to be treated with a multi-disciplinary approach.  I have found the combination of intravenous vitamin C, certain supplements, dietary modification, exercise and stress management to be a great combination.  Fatigue can be very treatable, so do not hesitate to reach out for a recommendation of what might be best for you.