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Research into cancer fatigue

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This page tells you about research into cancer fatigue. There is information about

 

What we know about fatigue

There has been a lot of research interest in cancer fatigue in the past few years. Since treatment for pain and sickness has improved, many people with cancer say that fatigue is the symptom that has the most impact on them. A UK survey, published in 2003, looked at knowledge of cancer fatigue amongst doctors and people with cancer. They found that more than half of cancer patients had fatigue at some point.

Although the doctors they interviewed said they gave advice and treatment to about half their patients, only 1 in 7 of the patients (14%) recalled having been given any. The most common advice was to improve diet, take more exercise and rest. The commonest treatment was a blood transfusion. Carers were affected too. 1 in 5 carers had to take 3 or more days a month off work because their relative needed so much help. You can read a summary of this article on line.

There is now a greater understanding about how many people have fatigue and health professionals and people with cancer are becoming more aware of how fatigue can affect them and what can be done to help.We need more research to understand exactly what causes it to be able to develop new treatments.

If you have cancer and have signs of fatigue, let your doctor or nurses know. There are things that can help control it. If you are not sure how to tell your doctor about your fatigue, here are some suggestions for questions to ask your doctor.

 

Research into how cancers cause fatigue

In many cancers, levels of chemicals that cells use to communicate are increased. These are called cytokines. Researchers are investigating the link between cytokines and fatigue. Cytokines include interleukins and a chemical called tumour necrosis factor (TNF). The higher than normal levels of cytokines could cause fatigue by affecting hormones and chemicals that nerves use to communicate. Interferon is a biological therapy that causes tiredness and this may be due to increasing the production of interleukin and TNF in the body. All body chemicals are finely balanced and any upset in one area can easily affect another. This theory has been suggested to explain chronic fatigue syndrome (ME) and could also apply to cancer.

 

Research into reducing fatigue

Researchers are looking into a number of different treatments that may help to reduce fatigue. At the moment research shows that exercise seems to work the best to reduce fatigue.

Exercise

Exercise can increase your energy levels and help you to feel better about yourself and your condition. You can see progress in a short space of time. Generally speaking, the more you do, the more you are able to do and the better it works at reducing fatigue. It depends on your individual situation as what you will be able to do and you should speak to your doctor or physiotherapist before starting exercise. People over the age of 65 appear to gain the greatest benefit but we need more research to find out how much people need to do and how often they should exercise. 

Anaemia

If you are anaemic, the best treatment for fatigue is one that increases your haemoglobin and red blood cell count. Blood transfusions are commonly used to treat anaemia. A drug called erythropoietin (EPO) can also be used for some people. It boosts the production of red blood cells by the bone marrow. Some recent research has shown that EPO may also increase the chance of some types of cancer coming back after treatment. Further research is being carried out to see when EPO can be safely used.

Ritalin and modafinil

Researchers are looking into whether drugs such as ritalin or modafinil can help relieve tiredness during treatment. These drugs are usually used to treat attention and concentration problems. One small study in the US showed that ritalin (Dexmethylphenidate) can reduce tiredness due to advanced gynaecological cancer. It also improved mood. A larger randomised study, also in the US, found that ritalin significantly improved tiredness symptoms. Because ritalin made some other symptoms worse, such as headache and dry mouth, more research is needed.

There is information about a trial of modafinil to treat extreme tiredness in people who have advanced lung cancer, on our trials database.

To find trials about extreme tiredness or fatigue go to advanced trials search, choose ‘controlling symptoms' from the trial types listed, and then type ‘fatigue’ in the search box.

Steroid (dexamethasone)

Researchers looked at whether a steroid called dexamethasone could help with cancer fatigue. One American study showed that a small dose of dexamethasone twice a day for 2 weeks did help improve fatigue. 

Acupuncture

Early studies suggest that acupuncture may help to reduce fatigue by stimulating energy points in the body. The ACU.FATIGUE trial is a big study which looked at acupuncture to help women with severe tiredness (fatigue) following chemotherapy treatment for breast cancer. Up to 40 out of every 100 women (40%) have moderate to severe levels of fatigue which can sometimes last for years. The women had acupuncture carried out by a therapist for 20 minutes once a week for 6 weeks. The women having acupuncture had reduced fatigue and their quality of life improved. This trial does not show how well it works in the long term. The researchers recommend that further research is carried out before acupuncture is recommended for the treatment of cancer related fatigue. You can find out about other trials for acupuncture to relieve tiredness on our clinical trials database. There is detailed information about acupuncture in our section about complementary therapies.

Support

In the research literature, support can mean anything from

  • Information about cancer
  • Going to a support group meeting regularly
  • Individual counselling or
  • Psychotherapy

A number of research reports show that support can reduce fatigue, improve anxiety and mood, and help to combat other physical symptoms, such as pain and sickness. A small study has looked at whether a telephone support service run by nurses can help people with chemotherapy related fatigue. This study is no longer recruiting patients and we are waiting for the results.

Researchers for the RESTORE study have developed an online tool to help support people living with fatigue. The researchers want to find out if it is better at helping people than information leaflets.

Mindfulness

Mindfulness is a form of meditation which aims to increase your awareness of the present moment. If you are able to worry less about the past and future, it may help to reduce stress. There is information about a study looking at mindfulness as a way of helping with fatigue, anxiety and depression in women who have secondary breast cancer, on our clinical trials database. The trial is now closed and we are waiting for the results.

 

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Updated: 6 March 2014