Fighting fatigue among cancer patients

Cancer-related fatigue is defined as a persistent, subjective sense of tiredness related to cancer or cancer treatment. It interferes with usual functioning and is not relieved by rest and not attributable to activity. When patients talk about fatigue they often describe having low energy, having trouble thinking clearly, lacking motivation and having lack of pep.

Almost all cancer patients experience this in their disease trajectory and it is present right after surgery. The problem of fatigue is higher with advanced disease, during active treatment. Fatigue is affected by everything from diet to chemotherapy to anemia to cardiac function. And all of the symptoms can interact with one another to further fatigue.

“That’s why one tiny intervention is not going to make a huge dent in this problem,” said Debra Barton, RN, PhD, AOCN, FAAN, associate professor of oncology at Mayo Clinic Cancer Center, at the 6th Annual Chicago Supportive Oncology Conference. “We have to study multifaceted approaches and realize that there are cognitive and spiritual aspects as well as physical aspects of fatigue.”

She pointed to some areas of current study, particularly inflammation and the neuroendocrine system, which may not function properly among people with fatigue.

Barton was lead author on a pilot trial with ginseng, completed in 2006. Unlike other herbs that have been studied, she said, there is good data supporting ginseng as a treatment for fatigue. The study compared American ginseng with a placebo over eight weeks. Participants were randomly assigned to take 750 milligrams, 1,000 milligrams, or 2,000 milligrams of ginseng or placebo each day for eight weeks. About 25% of those on the two highest doses reported their fatigue was “moderately or much better,” compared with only 10% of those taking lowest dose or placebo. People taking the two highest doses also reported generally feeling better, with improvements in mental, physical, spiritual, and emotional well-being. And they said they were more satisfied with their treatment.

Ginseng, which has a basis in traditional Chinese medicine as an adaptagen, is being studied for diabetes, cancer treatment and symptom management. Barton’s study was among three studies, all financed by the National Cancer Institute, on complementary and alternative cancer medicines.

“We need to change the paradigm for seeing what works,” Barton said. “We can’t just throw one thing at a symptom because we’re just not going to hit those home runs.”

In prevention and management of fatigue, she said, clinicians need to address comorbidities and look at pharmacologic interventions such as psychostimulants (drugs having antidepressant or mood-elevating properties) and anti-inflammatories. Non-pharmacologic management techniques may include studying sleep habits, stress management and exercise levels.

“The potential benefit of exercise with patients is worth a conversation. It’s difficult to talk about exercise with people who are already fatigued. But it’s really about activity—tai chi and yoga, etc., and in an aging population we need to reframe the exercise discussion.”