Energy conservation/activity management

Energy conservation is the practice of using peak energy times to do certain tasks, while being careful not to exhaust yourself for the rest of the day. Activity management is a combination of selecting when to do certain tasks, pacing yourself, and determining what you can do versus delegate to others. This is an important topic for family discussion and support, which may include soliciting assistance from outside the family circle.

Education

Learning about cancer's effects on the body and how you can alter your self-care may help in coping with fatigue in a more positive way.

Massage and Healing Touch

Massage manipulates the body's soft tissues. It can be done to particular parts of the body or the whole body. The manipulation can be very gentle or it can be more forceful depending on the type of massage. Very vigorous massage, such as deep tissue or Swedish, should be avoided if your platelet count is low. Some massage is done with heated stones. Some cancer treatments can make your skin more sensitive to heat, so you should be very cautious about this type of massage. The objective of massage is to restore function and release tension. Healing Touch is a technique that may or may not involve lightly touching the person. It is said to restore energy fields around the body. Healing Touch is performed by a specially trained practitioner. Breathing techniques and relaxing music are often combined with these treatments.

Relaxation Techniques

Progressive relaxation combines breathing techniques, visualization, and body positioning to help ease tension in every part of the body.

Screening for other medical conditions

Many medical conditions besides cancer can contribute to fatigue (e.g., undiagnosed hypothyroidism, adrenal insufficiency). Simple blood tests can uncover these problems, and appropriate treatment can help alleviate fatigue caused by the conditions. Ask your physician if you have been screened for hypothyroidism, cardiac and lung problems, imbalances in sex or adrenal hormones, fluid or electrolyte imbalances, anemia, and depression. Sedative effects of some drugs and drug-drug interactions also can worsen fatigue.

Techniques to improve sleep quality

These consist of simple behavior modification practices, such as avoiding caffeine and stimulating activities in the evening, going to bed at the same time every night, avoiding long naps late in the afternoon, and using the bedroom solely for sleep and sexual activities. This can help normalize your internal "sleep clock" and maximize your quality of sleep.

Erythropoietin treatment falls in this category. It is given to correct anemia, which most patients with cancer will have sometime during their illness.

Anemia occurs when the amount of red cells in the blood is too low to supply your oxygen needs. Human recombinant erythropoietin can stimulate the bone marrow to make more red blood cells (RBCs). Having a greater number of circulating RBCs in the body may help lessen symptoms of fatigue.

This treatment carries with it a risk of hypertension and making your blood clot more easily. It can cause some tumors to grow more rapidly. Talk with your physician to see if erythropoietin might be appropriate for you.

Erythropoietin is given as an injection in the upper arm.

Acupuncture

Acupuncture is a family of procedures involving stimulation of anatomic locations on the skin. This may be done with slender hair-width needles, with or without the application of very mild electrical stimulation. Other forms of acupuncture use magnets or direct pressure applied to certain areas of the body.

Aromatherapy with foot soak and reflexology

Different plants used in aromatherapy can induce relaxation or stimulation. Reflexology stimulates specific points on the hands, feet, and ears to bring the body's organs and glands into balance.

ATP

ATP is an energy source for the body's cells. ATP may help restore metabolic and hormonal imbalances caused by cancer treatments. ATP is usually given as an IV infusion.

Bupropion (sustained release)

In two small clinical studies, bupropion helped lessen symptoms of fatigue and depression in patients with cancer. You will need a prescription to take bupropion pills.

Distraction/virtual reality immersion

Computer-generated visual and aural environments are a multisensory way to engage participants in a "new world" while blocking out their current and often stressful environments (e.g., during chemotherapy treatments).

Donepezil

It is not known how donepezil works to reduce fatigue; however, one study has shown a link between donepezil and reduction of fatigue. More studies are needed. You will need a prescription to take donepezil tablets.

Expressive writing

Writing down your experiences and stories may relieve some of the sustained stress that comes from having cancer. Several clinical trials are under way to document these effects.

L-carnitine

Oral or injectable forms of L-carnitine can compensate for the lack of this compound in a person's body. L-carnitine helps transport fatty acids across mitochondrial membranes, which is where energy is produced on a cellular level.

Methylphenidate

This drug increases dopamine levels in the brain, which stimulates attention and motivational circuits. This may have some benefit in improving symptoms of fatigue.

Medroxyprogesterone + celecoxib + enteral food supplementation

Small proteins called cytokines can affect cellular communication and cellular behavior, perpetuating symptoms of cancer, including fatigue. This combination of a hormone, an anti-inflammatory drug, and concentrated nutrition fed directly into the small intestine may help lessen fatigue from cancer.

Modafinil

Modafinil promotes wakefulness in adults who experience excessive sleepiness (i.e., narcolepsy). It may also lessen symptoms of fatigue from cancer.

Omega-3 fatty acids

Omega-3 fatty acids help reduce inflammation in the body and may help prevent cancer cell growth. Omega-3 fatty acids also have heart-healthy benefits. The purification process eliminates mercury and other toxins that might be present in fish. Some people can't tolerate oral supplementation because it may cause burping or "salmon breath." Some forms of oral omega-3 fatty acids do not have an associated "fishy" smell after ingestion.

Paroxetine

Paroxetine balances serotonin levels in the nervous system, which may impart some benefit in improving fatigue during and after chemotherapy treatment. Paroxetine may benefit women with hot flashes and patients who receive interferon alpha. Paroxetine's full effects may take two to four weeks to be felt.

Psychotherapy

Psychotherapy may provide insight, reassurance, and instruction to see oneself and cancer's challenges more realistically. Better coping skills may indirectly lessen fatigue.

Soy protein supplementation with nutritional counseling

Soy is called a "complete protein" because it contains all of the amino acids a body needs. Soy is protein-dense, which may help build body and muscle mass lost during cancer. Soy is one example of a healthy food choice. Nutritional counseling can encourage a healthy, balanced diet. Isoflavones in soy could raise estrogen levels in postmenopausal women, which is a concern because some types of breast cancer bind to estrogen receptors.

Yoga

Yoga involves poses (postures) and specific breathing patterns that help people relax into the stretches. This is said to help gently invigorate muscles, nerves, and glands.