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Fatigue

People with cancer commonly experience fatigue as a result of the challenges of cancer and particularly of cancer treatments. This type of fatigue “may feel like persistent physical, emotional, and mental exhaustion. Cancer-related fatigue is different than feeling tired after not getting enough rest. It interferes with daily life. It does not match the person’s level of activity. It does not improve with rest.” Fatigue may continue long after cancer treatment ends.¹

Managing Fatigue

Several complementary approaches can be helpful for fatigue. The Society for Integrative Oncology (SIO) clinical practice guidelines list integrative therapies with evidence for effectiveness in fatigue:³

• Acupuncture
• Panax ginseng (American) (About Herbs)
• Massage therapy from a therapist trained in oncology massage
• Mind-body approaches including these:
• Cognitive-behavioral therapy (CBT)
• Mindfulness-based stress reduction (MBSR)
• Hypnosis
• Qigong
• Tai chi
• Yoga
• Regular physical activity
• Therapies based on a philosophy of bioenergy fields, including these:
  
  • Reiki
  • Healing Touch
  • Therapeutic Touch®

SIO cautions that acetyl-L-carnitine (CAM-Cancer) and guarana (About Herbs) should not be recommended for improving fatigue during treatment.

A diet designed to address fatigue in breast cancer survivors has shown positive results in a small pilot study.⁴

Medical cannabis may also help relieve fatigue. A study involving responses from more than 1200 cancer patients in Israel found that the majority of patients reported relief from symptoms including fatigue.⁵

Integrative Plans, Protocols and Medical Systems

• Plans, protocols and programs
• Abrams & Weil integrative medicine approaches⁶
• Alschuler & Gazella complementary approaches⁷
• Block program⁸
• McKinney protocols⁹
• Traditional systems
  • Ayurveda
  • Traditional Chinese medicine

Commentary

Laura Pole, RN, OCNS, October 18, 2018: Janie Brown is an oncology nurse and co-founder of a cancer retreat program and centre in Vancouver, British Columbia. Her BCCT story, The Power of the Integrative Approach in Breast Cancer Treatment (see in Personal Stories below), is a treasure trove of helpful information. She describes how her partner with breast cancer and her team made decisions about chemotherapy, wove in useful complementary therapies to prevent and minimize treatment side effects and created a caring community. The integrative plan staved off the usual chemotherapy side effects of peripheral neuropathy, mucositis, fatigue, nausea and neutropenia.

Written by Laura Pole, RN, MSN, OCNS, and reviewed by Nancy Hepp, MS; most recent update on October 18, 2018.

1. Cancer.Net. Fatigue. American Society of Clinical Oncology. March 2017. Viewed February 8, 2018.
2. Markham MJ. 8 Ways to Cope With Cancer-Related Fatigue. American Society of Clinical Oncology. January 10, 2017. Viewed February 13, 2018.
3. Deng GE, Frenkel M et al. Evidence-based clinical practice guidelines for integrative oncology: complementary therapies and botanicals. Journal of the Society for Integrative Oncology. 2009 Summer;7(3):85-120; Deng GE, Rausch SM et al. Complementary therapies and integrative medicine in lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013 May;143(5 Suppl):e420S-e436S; Greenlee H, DuPont-Reyes MJ et al. Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment. CA: A Cancer Journal for Clinicians. 2017 May 6;67(3):194-232; Meneses-Echávez JF, González-Jiménez E, Ramírez-Vélez R. Effects of supervised exercise on cancer-related fatigue in breast cancer survivors: a systematic review and meta-analysis. BMC Cancer. 2015 Feb 21;15:77.
4. University of Michigan Health Lab: Diet Could Help Breast Cancer Survivors Beat Fatigue;Zick SM, Colacino J et al. Fatigue reduction diet in breast cancer survivors: a pilot randomized clinical trial. Breast Cancer Research and Treatment. 2017 Jan;161(2):299-310.
5. Bar-Lev Schleider L, Mechoulam R et al. Prospective analysis of safety and efficacy of medical cannabis in large unselected population of patients with cancer. European Journal of Internal Medicine. 2018 Mar;49:37-43.
6. Abrams DI, Weil AT. Integrative Oncology, 2nd Edition. New York, NY: Oxford University Press. 2014.
7. Alschuler LN, Gazella KA. The Definitive Guide to Cancer, 3rd Edition: An Integrative Approach to Prevention, Treatment, and Healing. Berkeley, California: Celestial Arts. 2010; Alschuler LN, Gazella KA. The Definitive Guide to Thriving after Cancer. Berkeley, California: Ten Speed Press. 2013.
8. Block KI. Life over Cancer: The Block Center Program for Integrative Cancer Treatment. New York: Bantam Dell. 2009.
9. McKinney N. Naturopathic Oncology, 3rd Edition. Victoria, BC, Canada: Liaison Press. 2016.

View All References

More Information

• American Society of Clinical Oncology: 8 Ways to Cope With Cancer-Related Fatigue
• National Cancer Institute: Fatigue and Cancer Treatment
• SIO clinical practice guidelines:
• Deng GE, Frenkel M et al. Evidence-based clinical practice guidelines for integrative oncology: complementary therapies and botanicals. Journal of the Society for Integrative Oncology. 2009 Summer;7(3):85-120.
• Deng GE, Rausch SM et al. Complementary therapies and integrative medicine in lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013 May;143(5 Suppl):e420S-e436S.
• Greenlee H, DuPont-Reyes MJ et al. Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment. CA: A Cancer Journal for Clinicians. 2017 May 6;67(3):194-232.
• National Comprehensive Cancer Network: NCCN guidelines on Cancer-Related Fatigue (login required)
• Meneses-Echávez JF, González-Jiménez E, Ramírez-Vélez R. Effects of supervised exercise on cancer-related fatigue in breast cancer survivors: a systematic review and meta-analysis. BMC Cancer. 2015 Feb 21;15:77.
• Lorenzo Cohen and Alison Jefferies: Anticancer Living: Transform Your Life and Health with the Mix of Six
• Michael Lerner: Choices In Healing: Integrating the Best of Conventional and Complementary Approaches to Cancer
• Keith I. Block, MD: Life over Cancer: The Block Center Program for Integrative Cancer Treatment
• Lise Alschuler, ND, FABNO, and Karolyn Gazella: The Definitive Guide to Cancer, 3rd Edition: An Integrative Approach to Prevention, Treatment, and Healing
• healthjourneys: Meditations
• Ted Schettler, MD, MPH: The Ecology of Breast Cancer: The Promise of Prevention and the Hope for Healing
• Donald I. Abrams, MD, and Andrew T. Weil, MD: Integrative Oncology, 2nd Edition
• American Society of Clinical Oncology: Cancer.Net
• Wayne Jonas, MD: Your Healing Journey: A Patient’s Guide to Integrative Breast Cancer Care
• September 2018 Issue of the Journal of Alternative and Complementary Medicine
• Barbara MacDonald, ND, LAc: The Breast Cancer Companion: A Complementary Care Manual: Third Edition