How do integrative experts manage fatigue?
Both medical groups and integrative experts provide recommendations for managing fatigue. Learn more about the approaches and meanings of recommendations.
Clinical practice guidelines
Recommends yoga as part of multidisciplinary approach to treat fatigue
For training programs that last at least 12 weeks, engaging in moderate-intensity aerobic training three times per week can significantly reduce cancer-related fatigue both during and after treatment.
Moderate-intensity combined aerobic plus resistance training sessions performed two to three times per week or twice weekly moderate-intensity resistance training may also be effective, and the latter particularly in prostate cancer.
The effect of exercise was strongest for moderate- to vigorous-intensity exercise, whereas the effect for low-intensity training was weak.
Recommendations for cancer-related fatigue:
Acupuncture
Mindfulness-based approaches
Yoga
Psychosocial therapies:
- Behavioral therapy
- Cognitive behavioral therapy
- Psychoeducational therapies/educational therapies
Moving More for non-cachectic patients with cancer (generally recommended):
- Physical exercise of moderate intensity and aerobic and functional resistance exercise are recommended in patients with cancer-related fatigue
- Physical activities like walking and home-based aerobic and resistance exercises are recommended to improve cancer-related fatigue and quality of life
Cognitive behavioral therapy: recommended to manage cancer-related fatigue
Information and counseling: recommended in cancer patients and their caregivers to help them in understanding CRF and to educate them about ways to either prevent fatigue, avoid it becoming a chronic condition or to manage it
Mind-body stress reduction: could be an option to improve cancer-related fatigue
Psychoeducation: recommended to manage cancer-related fatigue
Yoga: could be an option to improve cancer-related fatigue and quality of life
Not recommended due to moderate evidence against efficacy or for adverse outcome:
- Astragalus
- Coenzyme Q10
- Guarana
- L-carnitine
NCCN Clinical Practice Guidelines in Oncology: Cancer-Related Fatigue. Version 2.2022. ›
Therapies listed for treating fatigue:
Eating Well (active treatment or after treatment)
Moving More:
- Maintain optimal level of activity (active treatment or after treatment)
- Optimize level of activity (end of life)
Acupuncture (after treatment)
Bright white light therapy to treat fatigue among people in active treatment or after treatment. 1250–10,000 lux is most frequently self-administered in the early morning for 30–90 minutes. Timing needs to be adjusted for those who sleep during the day
Massage therapy (active treatment)
Psychosocial therapies:
- Cognitive behavioral therapy/behavior therapy (during active treatment or after treatment)
- Cognitive-behavioral therapy for insomnia (CBT-I) (active treatment or after treatment)
- Mindfulness-based stress reduction (after treatment)
- Psychoeducational therapy (active treatment or after treatment)
- Supportive expressive therapies (active treatment or after treatment)
- Stimulus control/sleep restriction/sleep hygiene (active treatment or after treatment)
Yoga (during active treatment or after treatment)
Therapies listed for treating fatigue:
Eating Well
Acupuncture
Psychosocial therapies:
- Cognitive-behavioral therapy (CBT)
- Mindfulness-based stress reduction
- Supportive expressive therapies
- Psychoeducational therapy
Recommends selectively offering or providing this service to individual patients based on professional judgment and patient preferences:
- Acupuncture after treatment
- Ginseng during treatment
- Hypnosis during treatment
- Yoga after treatment
Insufficient evidence to recommend for fatigue:
- Moving More
- Managing Stress
- Acupressure
- Biofield healing
- Coenzyme Q10
- Light treatment
- Massage
- Meditation
- Mind-body cognitive therapy
- Multivitamin
- Polarity therapy
- Qigong
- Reflexology
- Reishi mushroom
- Relaxation
Recommends against use for fatigue:
- Acetyl-L-carnitine during treatment
- Guarana during treatment
Recommendations for treating fatigue:
- Acupuncture (weak recommendation)
- Energy therapies, including Therapeutic Touch™, healing touch, reiki, polarity therapy, external qigong & electromagnetics (strong recommendation)
Integrative programs and protocols
Lise Alschuler, ND, FABNO, and Karolyn Gazella
Alschuler LN, Gazella KA. The Definitive Guide to Cancer, 3rd Edition: An Integrative Approach to Prevention, Treatment, and Healing. Berkeley, California: Celestial Arts. 2010.
Alschuler LN, Gazella KA. The Definitive Guide to Thriving after Cancer: A Five-Step Integrative Plan to Reduce the Risk of Recurrence and Build Lifelong Health. Berkeley, California: Ten Speed Press. 2013.
Approaches are described for certain cancer types, or along with certain conventional therapy treatments, or for particular conditions including fatigue.
Keith Block, MD
Block KI. Life over Cancer: The Block Center Program for Integrative Cancer Care. New York: Bantam Dell. 2009.
The integrative Block Program has recommendations to people who are at different places along the cancer continuum:
- Those who’ve been recently diagnosed
- Those in treatment
- Those who’ve concluded treatment and need to remain vigilant to prevent recurrence
Neil McKinney, BSc, ND
McKinney N. Naturopathic Oncology, Fourth Edition. Victoria, BC, Canada: Liaison Press. 2020.
This book includes descriptions and uses of many natural and complementary protocols for cancer in general and for specific cancers. It also includes information on integrative support during conventional cancer treatment.
Gurdev Parmar, ND, FABNO, and Tina Kaczor, ND, FABNO
Parmar G, Kaczor T. Textbook of Naturopathic Oncology: A Desktop Guide of Integrative Cancer Care. 1st edition. Medicatrix Holdings Ltd. 2020.
This book provides information on the treatment of 24 cancers, plus the most effective treatments of the most common symptoms affecting cancer patients while they undergo chemotherapy, radiotherapy, or surgery.
Traditional medicine
Practitioners of traditional medical systems, including traditional Chinese medicine and Ayurveda, offer therapies and approaches to manage fatigue. Some recommendations from traditional Chinese medicine are included in clinical practice guidelines on this page.
Learn more about traditional medicine and how to find practitioners.
Other expert assessments
Acupuncture
Acupressure
Ashwagandha
Astragalus
Circadian rhythm balance
Diet based on vegetables, fruits, whole grains, and legumes, with omega-3-rich foods
Ginseng
Guided imagery
Homeopathic therapies
Hypnosis
Meditation and mindfulness therapies
Melatonin
Physical activity
Tai chi or qigong
Touch modalities (massage, reiki, healing touch, Therapeutic Touch™, polarity therapy)
Yoga
Supplements for people with a deficiency: vitamin D, calcium, vitamin B12, folate, iron, selenium, and magnesium
Learn more
References