Top 5 strategies for Cancer-related fatigue

Written By Ellen Conte

Fatigue is the most common side effect of cancer treatment, impacting 70-100% of people (1). While for some, the fatigue will lessen over the months following completion of treatment, for 30-65% it remains persistent for years (1, 2).

Symptoms

Cancer-related fatigue (CRF) can be experienced as physical weakness, reduced concentration and focus, low motivation, emotional irritability, and a sense of tiredness.

Causes

There are many causes and contributors to CRF - more than can be explored in one blog. Some of the key causes are inflammation, insomnia, nutritional deficiencies, depression and anxiety, physical deconditioning (“out of shape”), gut microbiome alterations, cortisol changes, mitochondrial damage, autonomic nervous system dysfunction (fight/flight vs rest/digest), anemia, and other underlying medical conditions (3). It is essential to recognize that the factors contributing to CRF are often interconnected, with multiple elements influencing an individual's experience.

Inflammation is considered the key driver of cancer-related fatigue. Inflammation can be caused by cancer itself, cancer treatments, and other lifestyle factors such as insomnia, smoking, and sedentary lifestyle. Although inflammation is considered the key driver of CRF, we must consider what other factors might be driving inflammation.

Management - my top 5 suggestions

The complexity of CRF underscores the need for comprehensive assessment and tailored treatment approaches that address the various contributing factors. However, there are several strategies that can be widely helpful as they target many of the causes. Here are my top 5 suggestions for managing CRF.

1. Nutrition - the “fatigue reduction diet”

This diet, which resembles the Mediterranean Diet, was found to improve fatigue (and sleep!) in breast cancer survivors who were fatigued by 44%, whereas the control group only improved by 8% (4). Although the study is small, it also represents a healthful way of eating that may have many other benefits. The details of the diet are as follows:

  • Omega 3-rich foods – 2 portions daily, which can come from oily fish (for example salmon, mackerel, herring, anchovy, sardine, and trout), and/or certain nuts and seed (walnuts, flaxseeds, hemp hearts, chia seeds).

  • Fruits – 2+ daily

  • Vegetables – 5+ daily (including at least 1 green leafy, 1 yellow/orange, 1 tomato)

  • Whole grains (rather than refined grains)

  • Other foods are expected to be consumed in addition to the above suggestions (for example other protein sources, dairy, olive oil)

2. Exercise

Exercise is the most effective treatment for CRF (5,6). Aerobic exercise (e.g. walking, jogging, biking, swimming, water aerobics), resistance exercise (e.g. weights), and mindful movement (e.g. yoga) have all demonstrated benefit. I usually recommend a mix of aerobic and resistance exercise, but start with what feels comfortable and accessible to you. Ideally, you’d work your way up to about 150 minutes/week of aerobic exercise, plus two 30-minute sessions of resistance exercise. Depending on your current energy level and physical fitness, you might start with a 10-minute walk daily. If you’re new to exercise, or have limitations due to your health, it’s a good idea to seek guidance from a professional.

Resources:

  • ACCESS and EXCEL programs with Dal/YMCA for those in Nova Scotia. Website

  • Fitness Blender (online videos)

  • Yoga with Adriene (YouTube channel)

  • Fitness classes at gyms, personal training

3. Mindfulness

Mindfulness-based therapies such as meditation and mindfulness-based classes have consistently been found to improve energy in cancer survivors (5). There are many different methods to achieve this benefit, and I’ve listed below some resources to get you started. Most often, mindfulness-based strategies will be practiced daily, or most days, with benefits seen after several weeks. Mindfulness practices work in many ways, including lowering inflammation, balancing cortisol (stress hormone), improving sleep, and balancing the nervous system (flight-or-flight vs rest-and-digest).

Resources

  • Mindfulness based cancer recovery - Link to online courses

  • Mindfulness based stress reduction - courses available in-person and a free online option here

  • Meditation apps: Calm, Insight Timer, Headspace, 10% happier

  • Books: Full Catastrophe Living (Jon Kabat-Zinn), Mindfulness based cancer recovery (Linda Carlson and Michael Specca)

4. Morning bright light exposure

Exposing your eyes to bright light in the morning (either though natural outdoor light, or a light therapy box) for 10-30 minutes may improve energy, nighttime sleep, and depression in cancer survivors (7). If practicing this, the instructions are to view bright light before 10am (ideally within an hour of waking), avoid wearing sunglasses, and do not look directly at the sun or light box.  If you are using natural outdoor light, this needs to be practiced outside (not through a windshield or windows). Morning light exposure helps to increase melatonin release at night and may improve cortisol levels during the day. Going for a morning walk outside is a great way to reap the benefits of bright light and exercise (plus time in nature!).

5. Testing and individualized guidance

Given there are many possible factors contributing to your fatigue, if the above four strategies haven’t resolved your concerns, you many benefit from individualized guidance. Fatigue management is well suited to a naturopathic doctor’s skillset, as it requires a holistic approach given the complexity of underlying causes. In a one-on-one setting, we can discuss your full physical and mental health history, recommend and review blood work (e.g. iron, vitamin B12, hemoglobin, thyroid), discuss herbs and supplements, provide more personalized nutritional guidance, and consider other lifestyle practices.

References

1.          Howell D, Keller-Olaman S, Oliver TK, et al. A pan-Canadian practice guideline and algorithm: screening, assessment, and supportive care of adults with cancer-related fatigue. Current oncology (Toronto, Ont). Jun 2013;20(3):e233-46. doi:10.3747/co.20.1302

2.          Fitch M, Zomer S, Lockwood G, et al. Experiences of adult cancer survivors in transitions. Support Care Cancer. Aug 2019;27(8):2977-2986. doi:10.1007/s00520-018-4605-3

3.          Bower JE. Cancer-related fatigue--mechanisms, risk factors, and treatments. Nat Rev Clin Oncol. Oct 2014;11(10):597-609. doi:10.1038/nrclinonc.2014.127

4.          Zick SM, Colacino J, Cornellier M, Khabir T, Surnow K, Djuric Z. Fatigue reduction diet in breast cancer survivors: a pilot randomized clinical trial. Breast Cancer Res Treat. Jan 2017;161(2):299-310. doi:10.1007/s10549-016-4070-y

5.          Bower JE, Lacchetti C, Alici Y, et al. Management of Fatigue in Adult Survivors of Cancer: ASCO-Society for Integrative Oncology Guideline Update. J Clin Oncol. Jul 10 2024;42(20):2456-2487. doi:10.1200/jco.24.00541

6.          Segal R, Zwaal C, Green E, Tomasone JR, Loblaw A, Petrella T. Exercise for people with cancer: a clinical practice guideline. Current oncology (Toronto, Ont). Feb 2017;24(1):40-46. doi:10.3747/co.24.3376

7.          Xiao P, Ding S, Duan Y, et al. Effect of Light Therapy on Cancer-Related Fatigue: A Systematic Review and Meta-Analysis. J Pain Symptom Manage. Feb 2022;63(2):e188-e202. doi:10.1016/j.jpainsymman.2021.09.010

Disclaimer: This blog provides general information for educational purposes only. It is not intended to be a substitute for professional medical advice. Always consult your naturopathic doctor, physician, or qualified health provider for medical concerns. Do not disregard or delay seeking professional medical advice based on this content

Ellen Conte
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Resources for those impacted by cancer