Several non-drug options help with fatigue during, after cancer treatment

(Story corrects name to Roger in paragraph 3)

(Reuters Health) - Non-drug approaches that work best at relieving cancer-related fatigue may differ during and after cancer treatment, according to an analysis of past trials.

During treatment, relaxation practices had the strongest fatigue-reducing effect, but after cancer treatments are complete, yoga provided the biggest benefit.

“During and after cancer therapy, fatigue is one of the most frequent and distressing symptoms,” said lead author Roger Hilfiker of the University of Applied Sciences and Arts Western Switzerland Valais in Leukerbad.

Cancer-related fatigue is considered a “distressing, persistent, subjective sense of physical, emotional, or cognitive tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning,” the authors write in British Journal of Sports Medicine.

Depending on the types of cancer patients have and the treatments they receive, more than a quarter experience this kind of severe fatigue, and it can last for five years or more after treatment, the study team writes.

“Although there is a huge amount of scientific literature on this topic, it remains one of the symptoms for which cancer patients express high unmet supportive care needs,” Hilfiker told Reuters Health by email. “It seems the available research is not yet fully implemented in clinical practice.”

The researchers reviewed 245 studies published between 1989 and 2017 that evaluated non-pharmaceutical interventions to reduce cancer-related fatigue during chemotherapy and radiotherapy or afterward. More than half of the studies involved women with breast cancer.

The analysis focused on conventional physiotherapy-related interventions such as movement therapy, relaxation, massage, yoga and Tai Chi and excluded trials that investigated nutritional supplements, acupuncture, acupressure, Reiki healing and expressive writing.

Hilfiker and colleagues found that during cancer treatment, relaxation exercises such as meditation and stretching were the most effective, followed by massage, combined exercise and cognitive-behavioral therapy, and combined aerobic and resistance training. Healing touch, dance, music, Tai-Chi, and cognitive-behavioral therapy alone landed at the bottom of the list.

After cancer treatment, yoga was the most effective, followed by breathing exercises, combined aerobic and resistance training, dance and combined exercise and cognitive-behavioral therapy. At the bottom of the list, massage, relaxation, resistance exercise alone, aerobic exercise alone and cognitive-behavioral therapy alone were less effective.

“Relaxation seems to be an important part during cancer treatment,” Hilfiker said. “This might be very important for patients who are not motivated or not able to engage in more demanding physical activities.”

The next step is to look at the intensity, frequency and volume of exercise to understand what to recommend to patients, said Leorey Saligan, a principal investigator in the Symptom Management Branch of the National Institute of Nursing Research in Bethesda, Maryland.

“There’s been a big shift in the paradigm, especially in oncology research, in looking at treatments for patients,” Saligan, who wasn’t involved with this study, told Reuters Health. “This information can empower patients because they know they have options.”

Saligan is researching cancer-related fatigue and interventions from a biological perspective, aiming to understand what happens in the body to reduce the fatigue. If specific types of patients respond to specific types of therapies, doctors may be able to better recommend options to their patients.

“If we can predict which patients are at risk for fatigue based on their biological makeup, we can plan their interventions way ahead of time,” Saligan said. “We can now tell patients to go out and exercise, and next we want to be able to tell them how long, how often and how fast.”

SOURCE: British Journal of Sports Medicine, online May 13, 2017.