How Patients With Cancer Can Best Use Diet, Exercise to Manage the ‘Life-Altering’ Effects of Fatigue

Approximately 70% to 100% of patients with cancer experience cancer-related fatigue during the first year of diagnosis, and up to 50% continue to experience it after one year.

This can greatly affect their quality of life; however, regular exercise, a healthy diet and other holistic therapies may help, according to an expert.

It is important to recognize that cancer-related fatigue is not the same as an everyday tired feeling, explained Heidi Donovan, a professor of nursing and medicine at the University of Pittsburgh. Cancer-related fatigue is a distressing, persistent, subjective sense of physical, emotional and cognitive tiredness or exhaustion related to cancer, treatment or prevention that is not proportional to recent activity and interferes with usual functioning.

“If you look at how people facing cancer describe cancer-related fatigue, it’s things like these words (in the definition),” she said during a presentation at the 13th Annual Joining Forces Against Hereditary Cancer Conference. “It’s debilitating, it’s life altering, it makes you feel drained, it’s overwhelming. (Patients) feel exhausted, washed out, sometimes confused … frustrated, upset and depressed. It just makes (them) feel depleted.”

Cancer-related fatigue can affect a patient’s physical and psychological health, as well as their social life. It may leave them feeling anxious, depressed and feeling guilty as well. And although they are fatigued, patients often experience poor sleep because of these symptoms.

“Fatigue affects all parts of (a patient’s) life, but then … each of these different factors that are affected by fatigue creates this vicious cycle where each one then contributes back to increasing fatigue,” Donovan explained. “So it’s a really important symptom to make sure we’re not letting just go and accepting it as something you have to deal with.”

What Patients Can Do

Donovan highlighted a few strategies that patients can incorporate into their routine that may help them combat their cancer-related fatigue. She noted that prior to engaging in any of these strategies, it is imperative that patients talk to their health care team to determine what is the safest option for them.

Monitoring

“One of the first things I always tell people with cancer or after cancer is if you have a problem that’s bothering you, the first thing you should do is begin to monitor it and be purposeful about it,” she explained.

Patients should identify their fatigue and how severe it is. Next, understand what makes it worse and better. Then determine the timeline — if it’s consistent or comes and goes at specific times. It is also important to understand the results of the fatigue, particularly how it affects daily life and emotions. Donovan suggested keeping all this information in a fatigue journal.

“It makes (a patient) realize when it’s time to seek help and it gives (them) the tools to communicate more effectively with (their) health care provider as (they) go in to be evaluated,” she said.

Exercise

Donovan called exercise “the silver bullet” as it has previously demonstrated to be effective in managing many side effects from treatment. Exercise can improve energy, well-being, outlook on life, strength, flexibility and balance. It may also decrease symptoms such as fatigue, pain, depression and inflammation.

A combination of exercises would be best for reducing fatigue, Donovan explained. This includes cardiovascular exercise for 30 minutes a day, such as walking, light jogging, biking, swimming or yard work. Strength and resistance training should also be done two to three times a week. Additionally, patients should work on stretching and flexibility, with activities such as yoga, for five to 15 minutes every day.

Supplements

Supplements have gained interest in treating fatigue the past couple of years. However, the evidence behind many supplements is not strong enough to support a benefit, Donovan noted.

But one supplement she highlighted to have some benefit in treating fatigue is Wisconsin Ginseng. In a large study, the supplement significantly decreased fatigue, especially for patients who were undergoing treatment, but also for those who had finished. Of note, it is not regulated by the Food and Drug Administration, so there is no standardized dose. It is important to talk to a health care provider prior to taking supplements, she advised.

Acupuncture

According to more recent evidence, acupuncture has improved side effects of cancer treatment such as pain and fatigue. Specifically, following the regimen of 20- to 30-minute sessions three times weekly for two to three weeks, then twice weekly for two weeks and then weekly for six weeks thereafter significantly improved fatigue.

Of note, side effects of acupuncture include infection, bleeding, bruising or dizziness.

Diet

Donovan noted that diet is a very important aspect to consider when experiencing cancer-related fatigued. She added that the Mediterranean diet has demonstrated to be the best anti-inflammatory diet, which may result in reduced fatigue.

The Mediterranean diet is plant-based, so two-thirds of a plate should be vegetables, fruit, whole grains or legumes. Lean proteins are also recommended, such as chicken or fish. This diet also includes limiting intake of salt, saturated fats, sugars and processed foods.

Sleep Hygiene

“Everybody who’s suffering from fatigue should ensure they have a good sleep routine,” Donovan said.

Good sleep hygiene may help some patients who are struggling with fatigue and would include a consistent bed and wake-up time. There should be no stimulants such as caffeine, alcohol, exercise and screen time right before bed. Instead, Donovan suggests partaking in a soothing activity such as listening to music, reading or stretching.

The environment a patient is in is also important and should be a comfortable sleep space. They should be able to set aside worries for the next morning and practice evening gratitude.

The 5 Ps

Although there are many remedies to try, overcoming cancer-related fatigue can still be challenging. Donovan explained that there is a five-P rule to follow when working on fatigue in order to keep the “energy bank stocked up,” which include:

• Prioritize: Patients should conserve energy for tasks that lift them up and fill the energy bank.
• Plan: Be realistic and break down big tasks into small ones. Patients should manage their schedule and be sure they are not saying yes to everything.
• Pace: Balance activities throughout the day and week. And watch for warning signs that may deplete energy.
• Positioning: Body position can play a big part in exerting too much energy during tasks. For example, Donovan noted, try sitting down while folding laundry instead of standing.
• Perspective: Cancer-related fatigue is a medical condition, and deserves to be evaluated and treated as such, Donovan said.

It is important for patients to be gentle with themselves and do things that lift them up during this time.

“For most people, I can offer you hope that this will get better over time,” she concluded.

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