Fatigue is the most common symptom associated with cancer and cancer treatment. Current estimates suggest that between 60 and 90% of people with cancer suffer with at least some degree of fatigue. Fatigue associated with cancer manifests in many forms, some people find that they only need to take a short nap during the day to relieve their fatigue. Others find themselves feeling exhausted all of the time, yet unable to have a restful sleep.
For these people even the simplest of tasks, such as walking to the mailbox, can become physically overwhelming. Fatigue resulting from cancer and cancer therapy has been termed ?Cancer Related Fatigue? (CRF). Although there are not yet any definite answers about the causes of CRF, it is very clear that steps need to be taken to reduce its impact on people fighting cancer.
There are currently several hypothesis which try to explain the mechanisms of CRF. Some of the hypothesis suggest that this fatigue is the result of treatment side effects. For instance many people who undergo conventional cancer treatment like chemo or radiation develop a condition called anemia. The term anemia refers to a group of conditions in which the body has a decreased ability to utilize oxygen. This condition arises when the amount of hemoglobin, a blood protein which carries oxygen, is decreased. When there is less of an ability to carry oxygen, the tissues must do without, and this manifests as tiredness and fatigue.
Another cause of CRF that may be brought on by treatment is poor nutritional status. Simply put, when the body doesn?t have the raw materials it needs to carry out day-to-day operations, then one of the frequent results is fatigue. Conventional cancer treatments, as well as the disease itself, are notorious for diminishing people's appetites.
The non-treatment related causes of CRF are slightly more ambiguous. An interesting paper published in the December 2007 issue of the journal The Oncologist provided a good summary about the mechanisms of CRF well.
The current thoughts about the cause of CRF include: serotonin dysregulation, hippocampus-pituitary- adrenal Axis (HPA-Axis) dysfunction, circadian rhythm disruption, altered muscle metabolism, afferent vagal nerve activation, and cytokine dysregulation. All of these multi-syllabic fancy sounding phrases have one thing in common, inflammation.
Inflammation is developing into one of the primary causes for many of the chronic conditions affecting people's health today. Research about the health implications of inflammation is exploding, with new infor-mation becoming available everyday. Much of the inflammation that people experience today is lifestyle induced bad diets, bad habits, no exercise, prolonged stress, etc.
In CRF, inflammation is produced through the action of several substances called cytokines. Cytokines are a type of cellular communication device used by cells when they want to relay information to each other. When one cell wants to talk to another, it can't simply yell out ?hey you over there, listen to this.? In order for a cell to send a message it has to use communication chemicals, like cytokines. Cytokines deliver their chemical message by leaving one cell, floating through the body, and then attaching to a target cells.
In the case of CRF, many of the cytokines are delivering a pro-inflammatory message. Inflammatory cytokines associated with cancer and its treatment (chemo, radiation, surgery, biologic therapies) include Tumor Necrosis Factor Alpha (TNF-a), Interleukin 1 Be-ta (IL-1B), and Interleukin-6 (IL-6). These chemical messengers instruct their target cells to respond in an inflammatory manner. This can manifest in many different ways, including how the cell reacts to other stimulus in it's environment.
As an example of how inflammatory cytokines can cause cancer-related fatigue, consider the following explanation of serotonin dysregulation. Tumor Necrosis Factor Alpha (TNF-a) has been shown to be associated with problems in central nervous system functions, which can lead to a state of lethargy and weight loss. Specifically, cancer (or cancer treatment) induced TNF-a increases influence brain chemistry. Raised TNF-a levels cause the body to increase the amount of serotonin that is released into the synaptic cleft. Serotonin is an inhibitory neurotransmitter, which means that serotonin promotes relaxation. The synaptic cleft is where one nerve ?plugs in? to another. The quality of the connection between the two nerves depends on the level of neurotransmitters present at this junction.
High levels of TNF-a send a signal to the nerve tissue instructing it to put more serotonin into the synaptic cleft. This causes the inhibitory signal to be amplified. Too much serotonin is like too much of a sedative, it can cause exaggerated tiredness or fatigue.
Not only can TNF-a cause elevated levels of serotonin, it can also increase the body's ability recognize more serotonin in the synaptic cleft. In a way, this doubles the effect that serotonin has on the brain- not only does the TNF-a signal the body to make more serotonin, it tells the body to respond more drastically to serotonin's message.
Hopefully, this brief example of how an inflammatory cytokine influences neurochemistry and promotes fatigue makes sense. Remember that this is just one example of how inflammation can contribute to fatigue.
Knowing the mechanism can help to find a cure. There are a number of natural medicines that have the ability to reduce inflammatory signals. These natural agents not only have good research supporting their use and safety, but many are also compatible with conventional therapies. Some of these natural agents have even been shown to make conventional treatments work better with less side effects. Others have demonstrated the ability to kill cancer cells on their own.
Remember, it's very important to check with your doctor before taking any new medication or supplement. This is especially true for people fighting cancer.
Here are a couple of examples of natural medicines that may help with CRF. Curcumin
A derivative of the indian spice tumeric, this supplement has amazing anti-inflammatory and anti-cancer actions. Pubmed (www.pubmed.gov) lists over 800 references when searching for curcumin and cancer. An recent study analyzed the effect that curcumin had on chemotherapy induced increases in TNF-a levels. The study authors found that a single dose of the chemotherapy drug cisplatin increased TNF-a levels by 486%.
When curcumin was administered in an oral dose 2 days before, and three days after chemotherapy treatment, the TNF-a levels decreased significantly. TNF-a is not the only pro-inflammatory signal that curcumin modulates, it also has an inhibitory action against several other mediators of inflammation. It is this ability to affect several systems in the body that allows curcumin to work synergistically with several chemotherapy drugs.
Other natural medicines which may be beneficial in CRF include vitamin E, the herb boswellia, omega-3 fatty acids, certain amino acids, and activated vitamin B3.
According to a recent investigation, acupuncture led to a 36% improvement in CRF symptoms. Symptoms such as motivation, activity levels, and general fatigue were all measured.
Acupuncture is gaining favor as a great therapy for many cancer related side effects. Many women have used acupuncture to successfully treat the side effects of radiation therapy. More than one treatment is usually needed, and weekly visits may be the best way to get good results. Acupuncture is very relaxing and no, the needles don't hurt!
Several studies have been published regarding the use of exercise during and after cancer therapy. Nearly all of these studies have suggested that exercise is beneficial for alleviating symptoms of cancer-related fatigue. Thirty minutes of light exercise three times a week is a good place to begin. Start with easy, non-impact activities like walking, yoga, or Tai Chi. In addition to being a powerful way to combat fatigue, exercise is great for enhancing the immune system, detoxification, and relieving stress.
It seems like every post on CancerND mentions the importance of a good diet. Well, this post is no different. Many people fighting cancer are malnourished, at least to some degree. This may arise because of many reasons such as lack of appetite, compromised digestion, or just eating the wrong things. It is very impor-tant to consume the right amounts and types of protein, fats, and carbohydrates everyday. For more info on diet and cancer see the CancerND post about Acid/Base balance.
If you?ve tried the therapies listed above and still find that you are feeling fatigued, certain lab tests may shed light on the situation. As many of the symptoms of CRF seem to be related, at least in some ways, to serotonin, measuring serotonin levels in the body may be beneficial. Such testing is easy and relatively inexpensive, and usually doesn?t even require a blood sample.
Cancer related fatigue is a complex, multi-factorial problem that effects millions of people worldwide. Only recently has research been directed towards figuring out how CRF develops. Hopefully, a better understanding of CRF will lead to successful ways in which it can be treated.
~Dr. Jake Psenka
You may leave your questions regarding cancer related fatigue in the comments, or stop by Dr. Psenka’s website Cancer ND to suggest future article topics. To make an appointment with Dr. Psenka you can visit his Naturopathic Family Care website.