Fatigue: a common symptom in cancer
In cancer, the patient’s journey is often marked by periods of fatigue, sometimes intense. “Fatigue is very common in patients, but it is often underestimated by healthcare professionals. Studies have shown that patients rate fatigue as the symptom that affects them the most, while doctors value pain more. Fortunately, they are starting to realize it ”, notes Dr. Ines Vaz-Luis, medical oncologist at the Gustave Roussy Institute (Villejuif).
Faced with cancer, we would tend to think that fatigue is a lesser evil. However, the risk is to fall into a vicious circle. The more this fatigue sets in, the less the patient wants to move. Little by little he loses his muscles and his appetite, his morale wanes and, in the end, his condition worsens. Hence the importance of identifying specific causes and dealing with them.
Cancer fatigue: multiple possible causes
Different factors can explain this exhaustion, starting with the disease itself. The size of the tumor and the presence or absence of metastases are parameters that affect the intensity of fatigue.
THE’anxiety related to the severity of the disease also matters a large part. “If stress and depression are present as soon as cancer is diagnosed, the person is more likely to complain of fatigue afterwards”, notes the oncologist. the stress can indeed disrupt sleep and generate difficulty falling asleep or nocturnal awakenings. Logically, a patient who does not sleep well does not get enough rest and accumulates fatigue.
In this context, the patient’s environment (the feeling of loneliness or, on the contrary, the fact of being supported by his spouse, his family and his friends) and his socio-economic situation (unemployment, financial difficulties … .) count for a lot. A patient overwhelmed by worries will inevitably experience fatigue more severely.
Fatigue: a symptom of worsening disease?
At each consultation with the oncologist, fatigue should be assessed in all its components. “Faced with intense fatigue, we must exclude all medical reasons, check if there is not a anemia (iron deficiency), a nutritional deficit, an endocrinological or cardiological problem that we can correct. But it is true that this fatigue is sometimes an early sign of relapse or worsening of the disease ”, admits Dr. Vaz-Luis. You have to know how to listen to this alarm signal.
Cancer treatments can cause fatigue
This fatigue can also be linked to cancer treatment (chemotherapy, radiotherapy, hormone therapy, etc.). It depends a lot on the intensity and size of the doses administered. These treatments have, moreover, significant side effects such as anemia, nausea and vomiting which themselves affect the general condition of the patient.
This fatigue is sometimes stubborn.
“90% of patients complain of fatigue during treatment and for a third of them, it persists and can be severe several years after the end of treatment”, estimates Dr Vaz-Luis.
Women treated with hormone therapy after breast cancer are particularly concerned. In them, it is the side effects, in this case hot flashes which sometimes wake them up at night and joint pain, which causes fatigue. “In hormone therapy, we can help women deal with their fatigue problem. We have effective pharmacological strategies, that is to say antidepressants or neuroleptics, even if patients are sometimes reluctant to take this type of drug ”, emphasizes the oncologist.
Fatigue and cancer: what effective strategies?
There is no such thing as a fortifying drug. From psychostimulants are sometimes offered to patients on treatment for advanced cancer, but their effectiveness has not been formally demonstrated.
“On the other hand, we can manage this fatigue, using strategies such as physical activity or cognitive-behavioral therapy. They are effective and we should use them more ”, says Dr Vaz-Luis.
Physical activity: proven effectiveness
Rest is beneficial for recovering after an effort or a difficult moment. But it should not be prolonged too long, otherwise you will lose your physical condition. The simple act of walking is a powerful antifatigue, whose effectiveness has been proven especially in cancer patients. A brisk walk will tone the muscles, oxygenate the tissues and improve breathing.
Studies have shown that physical activity is capable of reduce the fatigue induced by cancer treatments by around 30%. “Through different mechanisms, physical activity has an anti-inflammatory effect. However, we know that inflammation is a factor in promoting fatigue ”, explains the oncologist.
Moreover, by remaining active, the patient maintains a certain confidence in his abilities. He feels better physically and morally. He is, quite simply, less tired in his body and in his head. Regular physical activity could also reduce the risk of cancer recurrence by 25 to 30%.
In the context of the disease, it can only be a physical activity adapted to the person and practiced in a gentle and progressive way. The recommendations are to practice an activity of moderate intensity, such as brisk walking, for 150 minutes each week, or 75 minutes at a more sustained pace, plus two or three sessions of muscle building every week.
To better guide patients, the ARC Foundation publishes a information booklet clear and practical on the benefits of physical activity, downloadable for free.
After cancer, a care package including physical activity, nutritional and psychological follow-up was put in place at the start of 2021, up to a limit of 180 euros per year and per patient.
Psychological support to better manage your fatigue
Cognitive Behavioral Therapy (CBT), under the supervision of a specially trained psychologist, helps to better manage his emotions and to organize his life in order to face, with strong arms, the illness and the fatigue that it causes. CBTs are also very helpful in solving sleep problems.
Oncology departments have integrated these psychotherapies and often recommend them to their patients.
“These CBTs allow the patient to learn to live with the disease. They help reduce this tendency to catastrophize which occurs with each event, in some patients, ”emphasizes the oncologist.
To calm the mental fatigue, yoga and meditation would also be effective. But the level of scientific evidence for their anti-fatigue efficacy is not as high as that of physical activity and CBT.