Cancer-related Fatigue: Everything you need to know!

Definition, causes, and symptoms 

Cancer-related fatigue is characterized by a lack of energy, a feeling of weariness, or generalized exhaustion. It is different from the normal fatigue felt at the end of the day, and it can be particularly problematic and impactful on the patient's quality of life.

This type of fatigue can manifest in various ways, including feelings of heaviness in the limbs, general weakness, difficulty learning new things, concentrating, or thinking clearly. There can also be a decrease in motivation, frustration, or even chronic sadness.

Moreover, this fatigue is only partially relieved by sleep and rest. It is a type of fatigue that can occur even with minimal activity levels.

The causes are varied and numerous. Indeed, the fatigue can be a consequence of treatments (chemotherapy, radiotherapy, hormone therapy, etc.) or simply a result of the disease itself. Cancer pain can cause fatigue, but the psychological impact of the disease can also be draining.

Diagnosis

According to guidelines, all cancer patients should be routinely screened for the presence and severity of fatigue, starting from diagnosis, at regular intervals during and after treatment, and when clinically indicated.

If this has not been done, it is essential to spontaneously report any symptoms or suffering to the healthcare teams. They will then assess the fatigue with standard questions about its duration, progression, impact on daily life, etc.

To obtain as accurate a picture of the fatigue level as possible, there are scientifically validated patient questionnaires that doctors can use for diagnosis.

Specifically in breast cancer, an algorithm developed in 2022 to predict severe fatigue from the diagnosis of breast cancer revealed that years after their diagnosis, more than 30% of patients treated for breast cancer report experiencing severe fatigue.

As the researchers present, this predictive algorithm can be useful for doctors. From this algorithm, seven main risk factors emerge, which are: young age at diagnosis, overweight, smoking, anxiety, insomnia, pre-treatment pain and pre-existing fatigue.

Therapeutic management 

The management of fatigue depends on many factors such as age, overall health, and the stage of the disease.

Several management solutions are possible and should be discussed with the referring physician.

Firstly, when possible, it is advisable to engage in physical activities such as brisk walking, aerobics, or stationary cycling at a light to moderate intensity.

Practising physical activity during and after treatment is beneficial as it has been identified that prolonged inactivity leads to a decrease in muscle mass and strength. This reduction can also impair the ability to perform simple movements like climbing stairs, which could lead to a loss of self-esteem and an increased risk of anxiety and depression.

Other recommended therapies include psychoeducation, a method that teaches patients how to better adapt their lives to their condition and treatments to minimize related stress. Cognitive behavioural therapies (CBT) can also help manage emotions and thus improve overall quality of life.

However, medical treatments such as psychostimulants and antidepressants are not recommended. Only corticosteroids may be recommended in certain cases of metastatic cancer. The same applies to so-called nutritional treatments (dietary supplements), which are generally not recommended either. There is not enough robust scientific evidence to support their use.

Daily fatigue management 

Fatigue affects each patient differently, but some techniques can sometimes help manage it on a daily basis. Here are a few examples:

First, prioritize, focusing on what is essential to ensure that you can do what you want or what you need most.

It is also important to maintain a healthy diet, rich in proteins, and to stay well hydrated. For the most personalized and appropriate advice, it is recommended to consult a dietitian as part of the treatment process.

If possible, establish good sleep habits. It can be beneficial to ensure good night sleep and avoid sleeping too much during the day. Short naps of about twenty minutes are preferable to long ones, which can affect the quality of nighttime sleep.

Key takeaways

The management and handling of fatigue should be tailored to each individual and to each type of cancer, but it is crucial, if excessive fatigue is felt, to discuss it with your doctor and the medical teams following your case to improve your quality of life as much as possible.

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