Many cancer patients report suffering from significant
fatigue. Cancer-related fatigue is not simply feeling tired. It lasts longer
than ordinary fatigue, is more debilitating, and sleep does not relieve it. It
can affect all aspects of a patient’s life, and leave patients physically,
mentally and emotionally exhausted. There have been many studies of fatigue in
the past, and guidelines have been developed by the National Comprehensive
Cancer Network to help manage the fatigue. Though perhaps not as comprehensive
as we’d like to see, they do contain some useful strategies that patients can
adopt to help cope with their fatigue.
In 2012, researchers from the Mayo Clinic, led by Andrea
Cheville MD, decided to see how well patients with advanced cancers were being
advised about strategies for coping with cancer-related fatigue. They surveyed
160 patients with stage IV lung, breast, colon or prostate cancer about whether
they had received advice or treatments for their fatigue from their doctors.
The specific types of treatments were those mentioned in the National
Comprehensive Cancer Network guidelines: increasing exercise, seeking
psychosocial and behavioral help, and medications. Patients were asked about
how much information they had received, whether physicians had provided
specific instructions on treatment strategies, or given them a prescription to
address fatigue.
Very few patients had received comprehensive advice on
coping with fatigue. 15% of colon cancer patients and 17% of prostate cancer
patients had received advice on fatigue. 48% of breast cancer patients had been
told about psychosocial interventions, although only 10% of the entire group
received advice in this area. Over 37% received prescriptions for sleep
medications, though these are the least effective strategy for remedying
fatigue. The patients surveyed also demonstrated poor sleep habits: about a
third were napping during the day, which disrupts night-time sleep and worsens
fatigue. A little under 12% had received information about increasing exercise,
one of the most effective strategies for coping with cancer-related fatigue.
Unfortunately, it appears that the National Comprehensive Cancer Network
guidelines – which are based on the best available research in this area – are
not being communicated to patients.
To demonstrate the potential benefits of one of these
strategies, Cheville and colleagues did a randomized study in which stage IV
lung or colon cancer patients were randomly assigned to either usual care or to
a simple home-based exercise program of walking and strength training. 66
patients participated in the study. After 8 weeks, the exercise group had
better mobility, less fatigue and better sleep quality, showing how much even a
relatively simple exercise program can help advanced cancer patients!
For many years, we’ve recommended an individualized fitness
regimen to all of our patients. Our physical therapy staff works with patients
both during and after treatment. In addition, we offer patients a variety of
psychosocial strategies, including a comprehensive program for sleep problems
called Cognitive Behavioral Therapy for Insomnia. We also believe that the way
you eat can impact fatigue. Overemphasizing inflammatory foods and simple
sugars is certain to worsen fatigue for anyone, including cancer patients.
We look forward to the day when all cancer centers not only
recognize the potential value of these interventions, but then consistently
recommend these strategies to all of their patients struggling with
cancer-related fatigue.
For more information on The Block Center for Integrative
Cancer Treatment, call (847) 230-9107 or visit BlockMD.com.