If you suffer from cancer-related fatigue, an oh-so-common experience, your doctor might prescribe medications to help you…such as the antidepressant paroxetine…the narcolepsy drug modafinil…the steroid methylprednisolone…the ADHD drugs methylphenidate hydrochloride or dextroamphetamine. Yes, that last one is an amphetamine, which you might expect would give you a burst of energy short-term but wouldn’t help with long-term cancer-related fatigue (CRF). Right you are!

In fact, prescription drugs in general are the least effective treatments for this debilitating condition, finds the largest meta-analysis of studies ever conducted on the topic.

Good news: The new analysis found that exercise, along with specific kinds of psychological therapy, work to treat cancer-related fatigue much better than any medication. But timing is key. One approach works better during treatment…another once the surgery, radiation and/or chemotherapy are done.

Background: More than half of cancer patients experience some degree of fatigue—which can be severe. That terrible tiredness can exacerbate depression, sleep problems and pain. At its worst, cancer fatigue is a crushing sensation that’s often not relieved by rest and can persist for months or even years.

It is believed that cancer fatigue could be the result of a chronic state of inflammation induced by the disease or its treatment. This fatigue may decrease a person’s chances of survival because it lessens the likelihood that he/she will have the energy or the desire to complete medical treatments. That’s why the National Cancer Institute clinical oncology research program has named cancer fatigue a top research priority.

Study: Researchers at the Wilmot Cancer Institute at University of Rochester analyzed the outcomes of 113 studies that tested various treatments for cancer fatigue—exercise, psychological therapy, exercise-plus-psychological therapy and pharmaceutical medications. All the studies were randomized clinical trials, the gold standard for evaluating treatments. More than 11,000 patients were involved across these studies. Nearly half were women with breast cancer, and 10 studies focused only on men.

 Finding: While there’s no miracle cure, exercise alone—either aerobic or strength or a combination—was the most effective at relieving cancer fatigue. Psychological counseling, especially cognitive behavioral therapy (CBT)—already established as an effective way to improve sleep—came in a close second. What was definitive was that drugs for treating cancer fatigue don’t work very well.

Surprising finding: Studies that delivered a combination of exercise and psychological therapy had mixed results—some of these combination approaches were more effective than either exercise or therapy alone, but some were less effective. When the researchers took a deeper dive, they discovered that timing plays a role—exercise and counseling each seemed to be more effective at a different stage of treatment…

  • Exercise by itself was most effective during primary treatment, when a patient is undergoing surgery followed by radiation or chemotherapy or both. (Exercise can also make certain cancer treatments more effective, according to other research.)
  • Psychological intervention such as CBT, either by itself or in combination with exercise, conferred the most advantage once primary treatment had ended. While the researchers offered no definitive explanations, they did note that it can be overwhelming to commit the time to regular therapy sessions plus exercise when you’re already going through treatment. Once it’s over, a problem-solving approach such as CBT can help you take the steps that help you deal with emotions, fit in exercise, get better sleep and overcome obstacles to taking better care of yourself.

Bottom line: Medications for fatigue shouldn’t be the first thing your doctor recommends for cancer fatigue—far from it. Cancer patients already take a lot of medications that all come with risks and side effects, and any time you can eliminate a drug from the list it’s a good thing.

Instead, talk to your doctor about getting help with an exercise counselor trained in working with cancer patients. Ask about CBT as well. You may also find these Bottom Line articles helpful:Eat to Beat Cancer Fatigue,” “Acupuncture Relieves Cancer Fatigue”, and “Cancer Prehab: The First Thing You Need After a Diagnosis.”

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