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Can Sunlight Reduce Fatigue From Cancer?

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Published on December 21, 2017

Cancer fatigue is a common complaint with cancer patients, but what can be done to reduce this troublesome symptom? Andrew Schorr, Dr. Ishwaria M. Subbiah of The University of Texas MD Anderson Cancer Center and Dr. Christine Lovly of Vanderbilt-Ingram Cancer Center discuss cancer fatigue and treatments, such as sunlight therapy, that may help. Watch to hear their expert advice for moving past fatigue.

The Living Well with Lung Cancer series was a Patient Empowerment Network program produced by Patient Power. We thank Celgene, Helsinn, Novartis and Genentech for their support.


Transcript | Can Sunlight Reduce Fatigue From Cancer?

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

Andrew Schorr:

Dr. Subbiah, what about fatigue?  I want to spend a little time on that, your perspective, because that's just a universal complaint.

Dr. Subbiah:

Absolutely. I mean, fatigue is something that most of us have especially if you have small children all the time. 

And one of the most important differentiations that my chairman made when I started the fellowship was—he was like, Ishwaria, there's fatigue that you feel from not sleeping well for a week, and then there's cancer fatigue. And cancer fatigue is that fatigue that you may have felt when you had the worst flu in your life, and imagine a person having that all the time as they go through this—go through this diagnosis, and they go through the treatment. 

And so the people that I take care of, they have the fatigue from the cancer, and then on top of that they have treatment-related fatigue.  So, the drugs that are meant to help with the cancer itself, there are side effects for every class of anti-cancer drugs starting with chemotherapy, onto targeted therapy, onto immunotherapies, all of the various mechanism of immunotherapy, all of them cause fatigue on top of the cancer fatigue that you have. 

So now we're trying to deal with treatment-related fatigue and cancer fatigue.  And this is an area where it's one that's personally very important to me, because it's not one that people always talk about. 

It's not one that's easiest to quantify.  On the clinical trials for the cancer drugs, it is one of the side effects that's monitored. But when you talk to a patient they don't say I have grade 2 fatigue.  That may be what's on the paper, but you start to see how much it affects their lives.  And so, it's an area that we desperately need a lot more research on, and it's one that we are working on really tirelessly—unintended—just because it's—the impact is tremendous. 

Now, what do we have data for?  At this point in time, the interventions that we have data for—and I'll start with the mildest and then work my way to some that require prescriptions from your physician.  So clinical trial data has shown that natural light exposure, so spending time outside in direct light, in the sun, so with appropriate sun protection, when they measured the fatigue levels using the validated tools at the end of the natural light exposure, the people who spent time outside in the sun, they felt more energy I can say than those who didn't.

Andrew Schorr:


Dr. Subbiah:

They were just spending time in the sun.  They weren't outside running, they weren't mowing the lawn, they were—had light exposure.  And so, something as simple as that.  And anecdotally when you think about it, you know, you can think of patients who say, you know, I was at the beach last week and I felt great.  And you say, what were you doing?  Nothing, I was just sitting there.  And so, of course, the beach is a wonderful place.  Everyone will enjoy being there, but natural light exposure is among the mildest things that you can do without expending a lot of energy but still gaining some benefit from the energy levels within your body. 

Second intervention, a guided exercise program.  So, speak to your doctor, speak to your palliative care physician, speak to your supportive care physician.  Get involved with physical therapy.  There are varying degrees of physical therapy. 

Most of us have heard of physical therapy in the context of a surgery that someone's recovering from, whether they had a knee replaced or whatever.  There are physical therapy programs that are meant for someone who has advanced cancer, who has fatigue, who is going through treatment for their advanced cancer.  So, the goal is strength training, and it's a very—it's done in a structured way so that—that burden of trying to figure out what kind of exercise should I be doing, etc., it doesn't fall on you.  

So it's a great opportunity to reach out to your oncology team, your palliative care team, to the physical therapy team, the rehabilitation team on a guided exercise program so that you can maximize the strength that you do have. 

And also focus on energy conservation.  Your body may have had a thousand units of energy five years ago, but at the moment you may only have a hundred, because you're going through quite a bit. 

The meeting with the physical therapy team, the occupational therapy team, will help you decide how you want to spend those hundreds units of energy that you have.  Mowing the lawn may have been your job for the past 20 years of life. But if doing that at this point wipes you out for the rest of the day and the subsequent few days, then you start to think about, okay, how do I want to spend those hundred units of energy I have. 

And so working with the physical therapy team, the supportive care team, medical oncology team will help you work on a guided program for strength training based on what you're able to do at this point in time. 

The data that's out there for more medication interventions, the two that have the most data are methylphenidate hydrochloride (Ritalin), a drug most of us have heard of in the context of attention deficit disorders. So a very low dose of Ritalin, a 5 milligram dose once or twice a day, and there are some higher doses as well, but in certain context it has been shown to improve the levels of energy. 

So it's something that's worthwhile to speak to your oncologist about or your supportive care physician about, is this right for me?  Your therapy will be personalized to you.  Your doctor will go through your medical records, will review the risks and the benefits of it with you, and then you guys can decide together is this something that's going to help me?

And the same thing is true for a very low dose of steroids.  So dexamethasone (Decadron) has been tested.  It's something that you may have already come across before as a premedication before chemotherapy or blood transfusions.  It's in the family of steroids.  And so in certain contexts it may help getting a low dose, 4 milligrams once in the morning and then once again maybe at two in the afternoon.  In certain patients, it's been shown to improve their sense of energy. 

It doesn't mean that again you get out and mow the lawn, but you don't—may not feel that profound sense of fatigue where you aren't even able to move out of your, the place you were sitting.  And so maybe a little bit more active as a result of these interventions.  And so it's one of those—fatigue is a symptom that the impact is tremendous, and it needs to be spoken about more, and it's something that there are interventions out there and then more that we're working on, so. 

Dr. Lovly:

All right.  I just wanted to jump in and say one more thing about fatigue, because this is such a huge and impactful symptom that everybody experiences as they're going through this.  We're primarily talking about physical fatigue right now, but I would also say there is a significant component of emotional fatigue as well that goes along with going through the tremendous stress and all of the preparation and all of the logistics of coordinating your cancer care, and I think that emotional fatigue cannot be discounted. 

It's hugely impactful, can affect your physical well?being as well, and I think it's something that we need to continue to talk about more and more.  A lot of cancer clinics right now have psychologists or social workers who can really complement the care that their medical oncologist is giving them by allowing them cognitive behavioral therapy or just talking through some of the issues that are ongoing while a patient's undergoing cancer treatment, either themselves or their family members can partake in this kind of therapy. 

And I think this is just incredibly important as well when you think about physical fatigue and emotional fatigue and the role they have and the interplay they have on each other and what are the resources that we have available for this emotional fatigue that comes along with this tremendous stress of going through a cancer diagnosis. 

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

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