Fatigue After Cancer Treatment Can Last Two Years or More

Studies have shown that 70-80% of cancer patients receiving chemotherapy alone or in combination with radiotherapy experience debilitating fatigue. Out of this group, almost 50% experience fatigue most days during treatment. 

Cancer-related fatigue (CRF) limits a patient’s ability to concentrate, decreases stamina, and causes increased anxiety, depression, and sensitivity to light. This type of tiredness is a typical side effect of cancer treatments. CRF is different from the average tiredness that most people experience as a result of normal daily life in that it is not relieved by rest or sleep, nor does it correspond to the patient’s level of exertion.

While cancer patients expect that CRF will subside upon completion of their treatment, especially if they have achieved a cure, fatigue often persist for months or even years following treatment.

Although CRF remains a persistent and troublesome side effect, very little is understood on how best to treat it. Overall, pharmacological treatment for CRF has not been successful. The majority of exercise studies have yielded mixed results and findings for psychosocial interventions on CRF are also mixed.

Complementary and integrative medicine approaches utilizing therapeutic touch, acupuncture as well as herbal and nutritional supplements to enhance immune function are often sought by patients for CRF. Studies on the efficacy of these modalities are limited.

Pharmacologic Therapies

Trials of antidepressants have also not yielded significant improvement in CRF. Two psychostimulant medications, modafinil and methylphenidate, have been used for CRF with varying results. Modafinil has been shown to only be effective in severe CRF and The European Medicines Agency (EMA) has restricted its use due to the occurrence of psychiatric side effects.

Methylphenidate has been found to relieve moderate-to-severe CRF significantly better than placebo in patients with advanced prostate cancer and gynecological tumors. Trial data suggests that methylphenidate is most effective for patients with severe CRF.

In palliative situations, corticosteroids can temporarily improve CRF and increase patients’ physical activity but they are only prescribed for a limited time due to immune-suppressive effects and the risk that steroid-induced myopathy might worsen CRF with prolonged use.

Non-pharmacologic Therapies

Integrative approaches using stress management, acupuncture/acupressure, relaxation techniques, massage, and yoga are considered to be valuable in the management of fatigue to a certain extent since they tend to promote overall wellbeing.

Nutritional supplementation using lipid replacement therapy (LRT) plus antioxidants has been used successfully as an adjunct supplement to reverse the adverse effects of cancer therapy and restore mitochondrial function.

By administering nutritional supplements and antioxidants, chemotherapy adverse effects can sometimes be reduced and mitochondrial and other cellular functions can be restored. Recent clinical trials using cancer and non-cancer patients with chronic fatigue have shown the benefit of nutritional supplements in reducing fatigue and protecting cellular structures and enzymes from damage.

Cancer-related fatigue remains an elusive and debilitating symptom to overcome and can last well beyond treatment. The key to managing CRF may lie in therapies that help reverse cellular damage and promote optimal cellular function.