Dealing with cancer-related fatigue

THE world observes the whole month of October as “Pink October” to raise awareness about breast cancer among women and encourage them to step up their efforts in the early detection of cancer.

According to the World Health Organisation, cancer is the leading cause of morbidity and mortality worldwide.

In Malaysia, a five-year report by the National Cancer Registry (2012-2016) highlighted that breast cancer is the highest cancer incidence among women, followed by cancers of the colorectal and cervix uteri and other types of cancer.

Nowadays, breast cancer can be treated effectively, especially if it is detected early. However, breast cancer survivors may experience adverse physiological and psychosocial outcomes due to the medical treatments received. These outcomes can negatively impact prognosis, health-related quality of life, and psychosocial and physical functions.

Breast cancer patients may also develop complications such as reduced muscle and bone masses as well as feeling extremely tired, which is also known as cancer- related fatigue (CRF).

CRF is one of the most notable symptoms associated with cancer and its treatment that has the greatest negative impact on quality of life. It is described as a distressing permanent feeling of tiredness or exhaustion that is not related to recent activity and interferes with common functioning. According to a research finding, fatigue levels were highest during chemotherapy and at the end of the chemotherapy session, remaining after one year and it took up to 10 years for the levels to come down.

Studies have identified several factors contributing to CRF, such as poor performance status, chemo- radiotherapy, emotional distress, insomnia, neuroticism, and inactivity. Thus, CRF may lead to physical inactivity, which in turn causes a further decline in physiological and psychological functioning.

It is widely known that exercise and physical activity positively affect health-related quality of life and physiological and psychological well-being in healthy people as well as those with chronic illnesses. Recent studies have explored how exercise can be a potential means of alleviating CRF.

Research findings have shown that exercise can reduce physiological changes hence improving the quality of life of breast cancer survivors in terms of body image/self-esteem, sexuality, sleep disturbance and social functioning. Furthermore, exercise interventions may also result in decreased anxiety, fatigue and pain.

The American Cancer Society recommends strength training two times a week and a minimum of 75 minutes of vigorous-intensity exercise a week or 150 minutes of moderate-intensity exercise a week. This may potentially reduce mortality risk by 40% as well as reduce fatigue levels.

Unfortunately, not many survivors keep up the recommended level of exercise.

A study conducted in Malaysia in 2014 led by a team of researchers from Universiti Putra Malaysia reported that only 22.6% of the women in the study increased their physical activity after a breast cancer diagnosis.

Since CRF is the most dominant symptom among women with breast cancer or survivors of breast cancer, they may benefit from personalised exercise prescriptions by physiotherapists.

Physiotherapists can design exercise routines based on patients’ fitness levels and teach them how to conserve energy with self-pacing and breathing control while performing exercises or activities of daily living.

Last but not least, women diagnosed with breast cancer and presenting with CRF should aim to achieve their primary goal of progressively increasing their exercise tolerance and returning to daily function guided by physiotherapy approaches and a strong belief that they can eventually overcome symptoms of fatigue.


PhD candidate, Exercise and Sport Sciences Programme, School of Health Sciences, Universiti Sains Malaysia


Senior lecturer, Centre for Physiotherapy Studies, Universiti Teknologi Mara, Selangor Branch

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