When I talk to my patients about what is impacting their ability to be active, severe fatigue comes up as a big issue.

What is cancer-related fatigue? The National Comprehensive Cancer Network (NCCN) defines cancer-related fatigue (CRF) as a distressing, persistent, subjective sense of physical, emotional, and/or cognitive tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning.

One way to determine whether you have CRF is by answering a screening questionnaire.

There are multiple causes of CRF. A few that should be considered in a cancer patient that screens positive for CRF includes:

• Medication side effects
• Pain
• Emotional distress
• Anemia or low blood cell count
• Not sleeping well
• Nutritional deficits
• Deconditioning – being sedentary
• Other conditions such a thyroid dysfunction, etc.

Cancer patients should talk to their doctor about investigating potential causes contributing to severe fatigue. If there is a medical condition responsible for fatigue (i.e., low thyroid levels), medication may be indicated. There are also ways to improve fatigue when no single medical condition is the underlying cause.

Exercise helps reduce fatigue, though it may be more difficult to initiate when diagnosed with CRF. The 2018 NCCN guidelines provides the following recommendations:

1. Start an exercise program including both aerobic and resistance training
2. Yoga
3. Cognitive behavioral therapies (even just for sleep disturbances)
4. Massage therapy
5. Education and counseling on:
   • Monitoring fatigue levels
   • Setting priorities and expectations
   • Pacing yourself
   • Delegating
   • Schedule activities at peak energy
   • Limit naps to <1 hour to not interfere with night sleep patterns
   • Postpone non-essential activities

Seek advice from specialist or supportive care provider

Bottom line: You are not alone — CRF is a common problem for breast cancer patients. Moving helps. Find a friend. Seek help. Stay on top of your symptoms. Delegate. Prioritize your sleep.