Treatments for Cancer-Related Fatigue

Those interventions The American Society of Clinical Oncology (ASCO) and the American Society for Integrative Oncology (ASIO) believe are associated with improvement are:

Cognitive Behavioral Therapy recognizes the connections between thought, feeling and action, and identifies patterns that appear detrimental to overall well-being. A person’s goals for change can be discussed and updated and methods of learning more beneficial strategies can be integrated into a person’s life.

Mindfulness Based Programs include meditation and relaxation and mindful awareness techniques that allow people to observe their feelings, thoughts and actions and remain more neutral and less reactionary when they occur.

Qigong and Tai Chi utilize a series of concise movements that incorporate mental concentration, balance and coordination, energy movement, and relaxation to induce homeostasis and integrate a mind-body connection that improves health and well-being.

Yoga has a history dating almost three millennia from India. It is a disciplinary practice designed to integrate the body, mind and spirit using postures and breathing to strengthen muscles, flexibility, and mental focus. With practice, a person’s overall well-being and relaxation are enhanced.

Acupressure and Moxibustion

American Ginseng is a ginseng species that is native to the eastern and midwest portions of the country, and 30% in America and 60% in Canada is commercially grown. 

Panax Ginseng is native to China and Russia and a protected plant. Most is commercially grown now. 

The active molecules in Ginseng plants are called saponins or ginsenosides and both American and Panax forms contain multiple saponins. Data on their relief of fatigue suggests that both improve fatigue associated with cancer.

In Chinese medicine, ginseng can be used as a single individual herb but most commonly it is combined in traditional formulas.

They did not recommend, due to lack of controlled trials, acupuncture, massage, progressive muscle relaxation, music therapy, CoQ10, Omega 3 fatty acids or mistletoe.

However, there are studies showing the effectiveness of other integrative therapies but the sample size and number of total studies are limited, but suggest opportunities for safe non toxic modalities that might offer improvement.

• CRF in Breast Cancer Treated with Reishi Mushrooms: Forty-eight patients receiving hormonal therapies for breast cancer were randomized to a treated group that received Ganoderma (Reishi) mushroom powder and a control group. TNF-alpha, IL6 ( inflammatory cytokines) and liver and kidney function were tested before and after treatment. Reshi is known to regulate cellular( T cell ) immunity and humoral ( B cell antibodies) immunity. In this study, treatment was associated with statistical clinical improvements in physical well being and fatigue, less anxiety and depression and improved quality of life. Also, the inflammatory markers decreased and no adverse effects occurred.

• Ginseng Nutritive Herbal Formula (Ren Shen Yang Rong Tang): This formula is a Chinese Formula utilized since the mid twelfth century. In a 2019 study, eighty three patients, 42 controls, 41 treated were treated. When given this formula and evaluated with the MD Anderson questionnaire on fatigue, the treated group had a significant reduction in CRF from both a clinical and statistical perspective.

• Acupuncture: A study reviewed 10 randomly controlled trials which included 733 acupuncture patients and 594 controls that showed acupuncture had an effect on functionality in cancer patients, regardless of ongoing cancer treatments, especially in breast cancer patients. Treatment indicated acupuncture can reduce CRF compared to sham acupuncture and usual care. Rare adverse effects were spot bleeding from a needle and bruising. 

Interestingly, the points or protocols used were not mentioned.

• It is important to understand that acupuncture, whether for wellness or illness, including CRF or other adverse effects of therapies, needs to account for both a person’s unique inherent strengths and weaknesses, their constitution, as well as their symptoms. This requires attention to the essential principle of practice in Chinese medicine, requiring an integrative treatment of one’s foundational source energies, the root issue, combined with symptoms, and the branches. Together they are mutually interconnected and require harmonization to successfully achieve progress benefits.

• Each acupuncture visit treats this combination of elements and levels of disease and will require modifications at each visit based on the examination and changes in signs or symptoms. 

Therefore, the concept of controlled studies, with each person receiving the same treatment, as seen in western medicine, contradicts the principle of individualized unique therapies for each person. It is truly personalized medicine!

• A recent review of animal studies as well as clinical patient studies, not cancer patients, with circadian rhythm sleep-wake disorders has shown that acupuncture can regulate clock genes, help restore the circadian rhythm by modulating the suprachiasmatic nucleus and regulate multiple neurotransmitters which together increase sleep and sleep time, decrease the time to fall asleep and improve sleep efficiency. This observation supports it as a therapy in the chronobiological harmonization of sleep. When sleep is improved fatigue is reduced

• Auricular(Ear) Acupuncture: Multiple databases were reviewed, that were randomized controlled studies, related to their effects on CRF. Six studies which included 394 patients compared standard care with auricular acupuncture versus standard care alone. The results indicated CRF and quality of life showed positive effects when auricular acupuncture was added to standard care. The authors however felt the results were inconclusive as there were too few studies and less rigor in the study protocols as are required, but recommended further studies as it was a safe treatment but needed better study design.