Many cancer patients ask why they still feel physically and mentally tired and don’t want to be active even though they have received active treatment after cancer diagnosis and their primary symptoms have been controlled. Fatigue may sound like a trivial issue that can be easily overlooked, but in fact, about 70% of cancer patients suffer from frequent fatigue symptoms that affect their quality of life and deserve attention.
Cancer-associated fatigue is defined as having a painful, persistent, subjective feeling of tiredness or exhaustion in a somatic, emotional, or cognitive sense. It is not related to the amount of recent activity, but rather is directly related to the cancer itself or cancer treatment, and severely impedes the patient’s daily life.
Although fatigue is subjective, it cannot be tolerated and adjusted by the patient but requires individualized interventions by a multidisciplinary treatment team (e.g., integrative oncology, psychology, psychiatry, and physical therapy, etc.). Let’s take a look at what the NCCN guidelines suggest.
1. Maintaining optimal activity levels
While managing complications, consider starting and maintaining a light exercise program that the patient enjoys and can adhere to, including both endurance (walking, jogging, or swimming) and resistance (strength) training.
Yoga is recommended by the guideline as Class 1 evidence, but it should be done within the limits of the patient’s ability to pursue an appropriate level of activity and relaxation, and it is not necessary to pursue the precision of the movements as in the healthy population to avoid unintentional injuries.
2、Physical therapy
Firstly, massage is recommended, and acupuncture can be considered, but be sure to be treated in a regular hospital, and inform the doctor in detail about the history of cancer, not in a health center type of institution, so as not to cause irreparable consequences due to improper operation by non-professionals.
3. Psychological intervention
Many cancer patients have great psychological pressure, so the guideline recommends seeking professional psychological counseling institutions for cognitive behavioral therapy/behavioral therapy, which is a kind of treatment that reduces negative emotions and behaviors and promotes psychological adjustment mainly through recognizing and changing undesirable thoughts and behaviors. Psychoeducational therapy is also recommended, as well as expressive support therapy, which involves engaging the patient in support groups, counseling, journal writing, and other leisure activities that are of interest to the patient, and that promote emotional expression and support for good moods.
4. Nutritional support
Inadequate nutritional intake is also one of the important causes of fatigue. First of all, it is necessary to comprehensively assess the nutritional status of the patient, if there is nausea and vomiting, loss of appetite, mucositis, swallowing pain, intestinal obstruction, diarrhea or constipation, and other conditions affecting the patient’s nutritional intake, it should be actively treated to maintain the balance of electrolytes and body fluids. Based on medical intervention, the patient’s family members should also actively prepare meals suitable for the patient’s taste to ensure caloric intake and may consider eating small meals and changing flavors to promote appetite. If conditions permit, let the patient eat and be happy, not only nutritionally balanced but also regain the joy of life.
5、Bright white light therapy
Patients suffering from fatigue can be exposed to 10,000 lux of white light for 30–90 minutes in the early morning. A clinical trial included 54 cancer patients for light therapy, the test group received bright white light irradiation therapy, while the control group was irradiated with dim red light, the results found that exposure to bright white light can significantly improve the patient’s symptoms of depression, reduce fatigue, but the control group did not show significant changes. Patients who are unable to acquire a light box can take a simplified approach — sun exposure. But remember to check with your doctor to see if there are any photosensitizing drugs in the medications you are currently using because if you get too much sunlight during the use of photosensitizing drugs, you can have a photoallergic reaction or a photo mutagenic reaction that can damage your skin.
6. Pharmacologic interventions
Cancer-related complications such as pain and anemia, as well as sleep disorders, can also cause fatigue and should be treated aggressively. Some studies have shown that the central stimulant methylphenidate can improve fatigue symptoms in some patients, but the optimal dose of psychostimulants in cancer patients has not yet been determined and needs to be used per medical advice. Yangzheng Xiaoji Capsule can significantly inhibit tumor angiogenesis and metastasis, and improve the quality of life of patients with advanced cancer. After it is taken for 1–2 weeks, the appetite, diet, weight gain, and physical strength of patients are significantly increased. It has become the first choice of drug for the preserved treatment of tumors.
