Fatigue in cancer survivors is finally getting much deserved attention from the American Society of Clinical Oncology (ASCO). It is the international professional organization of cancer specialists, with over 35,000 members, including me. In April, ASCO published guidelines to help cancer specialists care for adult survivors of cancer who are experiencing fatigue. By publishing guidelines, ASCO is saying that cancer fatigue is a real and important problem, that cancer fatigue has identifiable causes, and that cancer fatigue can be helped.
The guidelines define cancer-related fatigue as a distressing, persistent, subjective sense of physical, emotional and/or cognitive tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning. In plain language, it is tiredness that makes you feel worse than you expect, that drags you down longer than you expect, and that slows you down more than you expect it should.
Fatigue in cancer survivors in common, with as many as 30 percent enduring persistent fatigue many years after cancer treatment. The guidelines recommend that doctors should screen cancer survivors for cancer fatigue, with questions and questionnaires. If moderate or severe fatigue is identified, the doctor should screen for medical causes for fatigue. These include heart disease, poorly controlled diabetes, low thyroid function, chronic obstructive pulmonary disease, anemia, arthritis, sleep disturbance, pain, anxiety and depression.
When fatigue has been identified and other medical conditions treated as well as they can be, what more can be done for fatigue? There are four strategies.
- One is physical activity, specifically, moderate exercise for 150 minutes per week. Brisk walking is a good place for anyone to start. For survivors with mobility or pain issues, physical therapy is the place to start.
- Two is counseling to help cope with cancer fatigue. Counselors familiar with the challenges of cancer survivorship can be a big help to cancer survivors coping with fatigue and other issues. Some of these challenges are highlighted in a video on the National Cancer Institute website, entitled Moving Beyond Breast Cancer. You can watch it by clicking here.
- Three is mind-body interventions, such as mindfulness meditation, yoga and acupuncture. Other strategies that may offer some benefit include biofield therapies (touch therapy), massage, music therapy, relaxation, reiki and qiqong.
- An four is supplements and prescription drugs. Small pilot studies have suggested that Ginseng at 1000 mg twice daily and vitamin D at 2000 IU once daily are beneficial. Prescription drugs, such as methylphenidate (Ritalin) and modafinil (Provigil), have been used for fatigue in cancer survivors. Multiple prospective clinical trails, however, have failed to show a benefit for these drugs. For this reason, I recommend methylphenidate only in a few limited situations. I agree with the national experts who say that fatigue in cancer survivors is best managed through exercise and yoga. The Center for Integrative Oncology and Survivorship exists to help cancer survivors cope with symptoms like fatigue. It offers a number of free yoga classes.
To learn more about living with cancer-related fatigue, call the Center for Integrative Oncology and Survivorship at (864) 455-1346.
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