Mission Hope Cancer Center
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Mission Hope Cancer Rehabilitation Program

Managing Cancer-Related Fatigue: an Evolving Science

Article contributed by Debby Schobel, RN , MN
Cancer Survivor

“Why am I so tired?” Fatigue during and after cancer diagnosis and treatment is the most common troubling side effect faced by cancer patients. As such, it has received an impressive amount of attention and research over the past 20 years. Today, we have the benefits of that research as we support people and their families coping with this common challenge.

Thanks to ongoing advances in cancer care, more of us are living through and beyond an initial diagnosis. This has increased our focus on maintaining and restoring a high quality of life as we continue to survive. The National Comprehensive Cancer Network [NCCN], 2014 defined cancer-related fatigue (CRF) as “an unusual, persistent, and subjective sense of tiredness that is not proportional to recent activity and interferes with usual functioning.” This type of fatigue may appear as a generalized weakness, decreased mental concentration ability, difficulty with sleeping (too much or too little), and/or a change in how a person responds emotionally to the world around them. Research has shown that 80-100% of cancer patients report experiencing CRF at some point. Although most CRF resolves within 1-2 years of treatment, some patients experience CRF for many years after their primary treatment is completed.

Historically, the primary focus has been removing/ controlling the cancer and ensuring survival. That remains true, but we have also learned the importance of recognizing and managing side effects like CRF that impact our patient’s quality of life. Research has documented that CRF often has a negative impact on our physical, social, and mental functions as well as compromising our ability to fulfill daily responsibilities and to enjoy life. These concerns drove the research and the development of programs to provide interventions that pass the scientific rigor of quality, reproducible research. Fortunately, our patients here on the Central Coast have ready access to those interventions, at no cost to them. Now, the challenge is to actually connect patients with the highly effective programs that currently exist and evolve, based upon continuing research.

Although there is no one standard treatment for CRF, there is a logical approach which seems to deliver consistent positive results. The first step is for the patient to work with their physician to describe the fatigue they are experiencing. The physicians will work to identify and treat any underlying cause for the fatigue such as low blood counts, poor nutrition, sleep disruption and any other contributing health issues. These may include heart, liver, or kidney disease, persistent pain, depression, anxiety, and the many issues cancer patients deal with, beyond their cancer. Once these issues have been addressed, the cancer treatment team will recommend that the patient take advantage of interventions that current research has found most likely to be effective in improving CRF.

Although at first it may seem illogical, the most effective intervention for CRF—once the physical issues have been addressed by the physicians—is exercise. This does not start with going to the gym and working out. It starts with whatever level the patient is capable of and moves forward, gradually. Research has proven that even minimal activity (moving arms and legs while seated or walking in/around the home) during cancer treatment is beneficial in multiple ways. This activity level can be gradually increased as tolerated. Patients will be encouraged to work with one of our Mission Hope Cancer Rehabilitation professionals where they will be evaluated and guided along their recovery. The data supporting and confirming the positive impact of even minimal physical exercise in countering the effects of CRF is overwhelming. Each patient’s needs and concerns are considered as individual programs are created. For more information, please call the Cancer Rehabilitation Program at 346.3413.