What is Cancer-Related Fatigue?

Inside: 4 enjoyable resources to help people who have/had breast cancer lessen cancer-related fatigue.

What is Cancer-Related Fatigue?

Do you wake up in the morning and immediately feel exhausted? Are you frustrated that you can barely make it through getting dressed, making breakfast, and taking a shower before you need to sit down? Are you so tired of having to ask for help to do the things that you did so easily before cancer treatment? You are not alone! Cancer-related fatigue (CRF) is the most common side effect of cancer treatment. We may hear that a person is tired after chemo treatment, but little attention goes to the fact that CRF can last 6 months after treatment ends and that 1 out of 3 breast cancer patients will continue to feel the effects for 5-10 years after treatment! (Bower et al, 2006) Many people don’t even bring up the issue of fatigue to their doctor. Fatigue may seem insignificant when discussing topics such as surgery, radiation, tumors, or pain to name a few, but managing fatigue is part of good oncology care. CRF impedes participation in activities that you love, relationships, your work and independence, all of which significantly impact your quality of life.

So what is CRF?

A general description of CRF is fatigue much greater and non-proportional to the level of activity performed, rest does not improve symptoms and the fatigue is experienced daily or almost daily for at least 2 weeks. You may feel a heaviness of limbs, have difficulty sleeping and even notice some short-term memory difficulties. According to the American Cancer Society, “It can be hard to think or move. Rest might help for a short time but does not make it go away, and just a little activity can be exhausting. For some people with cancer, this kind of fatigue causes more distress than pain, nausea, vomiting, or depression.”

CRF can be caused by multiple factors involving cancer and cancer treatment. Surgery, chemotherapy, tumors, stress, poor sleep, increased cell waste and radiation can all increase inflammation in the body. Growing research has shown a connection between inflammation and CRF. Inflammation also affects the neural connections in the part of your brain in charge of executive function, which helps us to plan, focus, multi-task and remember instructions. Therefore, you might also notice some changes in your cognition and mood with CRF.

Just like there are multiple factors causing CRF there are also multiple options to improve CRF. First of all, talk to your oncology team! The suggestions that follow are not medical advice and are simple guides to explore based on your individual situation. A few things that you can do are seek psychosocial support from an oncology counselor or therapist, see an oncology dietician, pharmacological treatment, energy conservation, exercise, and mindfulness/relaxation techniques.

There is a lot to discuss in each area of fatigue management, however, today I want to focus specifically on a few mindfulness and relaxation techniques. Mindfulness and relaxation techniques can improve sleep, decrease stress, improve focus and concentration, and improve mood. This in turn can improve fatigue and overall quality of life. There is evidence supporting mindfulness and relaxation techniques.

A 2015 study by Johns et al. assigned 35 cancer survivors with CRF to either a 7-week mindfulness-based stress reduction (MSBR) intervention or a wait-list control group. The participants were followed for 6 months. The MBSR intervention included mindfulness meditation, yoga, and self-regulatory responses to stress. The MBSR group showed significant improvements in fatigue, sleep, anxiety, vitality, and disability. Not only that, but improvements were maintained for 6 months. Although this is a small study and further research needs to be done, the current evidence is showing that mindfulness and stress reduction techniques can significantly improve CRF. Below are a few specific techniques that you can easily utilize in your daily routine.

Yoga Nidra:

Yoga nidra is known as yogic sleep. It’s an ancient technique that allows you to enter a deep state of relaxation. This is beneficial in reducing fatigue, anxiety and stress along with improving sleep. There are many different scripts and videos that can easily be found on the internet. Yoga nidra is usually done laying down or in a place where you can allow your body to be supported and completely relaxed. Here is a sample of a short yoga nidra practice.

Focus on your breathing and gently try to increase the length of inhales and exhales with slightly longer exhales.
Bring an intention to mind and repeat it to yourself 3 times.
Return to gentle breathing noticing your navel rise on the inhale and lower on the exhale
Notice the sensations that you are feeling such as temperature of the air, weight of your body on the floor, distant sounds.
Scan each part of your body starting on one side and then to the other. Bring your attention to each part of the body as you perform the scan. For example: each finger, palm of the hand, back of the hand, hand as a whole, forearm, elbow, upper arm, shoulder joint, shoulder, neck, each section of the face (forehead, eyes, nose, and so on), ear, scalp, throat, chest, side of the rib cage, shoulder blade, waist, stomach, lower abdomen, buttocks, whole spine, thigh, top and back of knee, shin, calf, ankle, top of foot, heel, sole, toes.
Notice your body as a whole
Restate your intention
Deepen your breath, begin to wiggle fingers and toes, and gently open your eyes

Relaxation Breathing:

4-7-8 breath or relaxation breath was developed by Dr. Andrew Weil and it helps with stress reduction and relaxation as the name would suggest.

This is beneficial in assisting with cancer related fatigue because it can help activate the parasympathetic nervous system or rest and relaxation state and suppress the sympathetic nervous system or fight or flight state. Benefits include decreased anxiety, improved sleep, improved concentration, and decreased pain to name a few.

To perform this breathing technique, begin by exhaling all the air out of your lungs. Inhale in your nose counting to 4. Retain the breath to the count of 7. Then exhale out of your mouth making a “whoosh” noise with you lips pursed for a count of 8. This is 1 cycle, repeat this for 3 cycles.

Walking Meditation:

Walking meditation is a way to bring intention and mindfulness to a task that we might normally do automatically. Initially this may feel silly and awkward. The main parts to focus on are noticing the basic components of each step. You can do this in a relatively small space since you only need to walk 10-15 steps in one direction and then turn around or you could do this while walking outside. Eventually you may be able to do the meditation while walking at a faster pace and get the added benefit of aerobic activity.

Find a peaceful place to perform your meditation and then notice the following components

the lifting of one foot;
the moving of the foot a bit forward of where you’re standing;
the placing of the foot on the floor, heel first;
the shifting of the weight of the body onto the forward leg as the back heel lifts, while the toes of that foot remain touching the floor or the ground.

Then the cycle continues, as you:

lift your back foot totally off the ground;
observe the back foot as it swings forward and lowers;
observe the back foot as it makes contact with the ground, heel first;
feel the weight shift onto that foot as the body moves forward.

Gentle yoga:

Gentle yoga is a form of Hatha yoga where the movements are performed very slowly as you gradually moved into postures. Frequently postures are held for longer amounts of time in a restorative manner. As with all forms of physical activity it should be cleared with your doctor prior to starting a yoga practice. Many cancer support groups offer gentle and restorative yoga virtually that you can do from the convenience of your own home.

When finding a mindfulness and relaxation practice it is important to find something that is enjoyable to you and that you can easily incorporate into your daily routine. This is because the benefits of stress reduction and relaxation on CRF are only significant with consistent daily practice. You can start with just a few minutes a day and build to 30 minutes or more!

ABOUT THE AUTHOR

Kara Lyons is an occupational therapist and private practice owner of Kara Lyons Wellness in Chicago, Illinois. Kara's practice is solely dedicated to empowering breast cancer patients during and after treatment. She is a certified lymphedema therapist, KickPink breast cancer rehab practitioner, and yoga instructor. You can schedule a discover call with Kara here.

Thank you for all you do to help prevent & alleviate the side effects of breast cancer Kara!

REFERENCES

Bower, J.E., Ganz, P.A., Desmond, K.A., Bernaards, C., Rowland, J.H., Meyerowitz, B.E. and Belin, T.R. (2006), Fatigue in long-term breast carcinoma survivors. Cancer, 106: 751-758. https://doi.org/10.1002/cncr.21671

American Cancer Society. What is Fatigue or Weakness. February 2020. Accessed December 2021. https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/fatigue/what-is-cancer-related-fatigue.html.

Johns SA, Brown LF, Beck-Coon K, Monahan PO, Tong Y, Kroenke K. Randomized controlled pilot study of mindfulness-based stress reduction for persistently fatigued cancer survivors. Psychooncology. 2015;24(8):885-893. doi:10.1002/pon.3648