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What Clinical Interventions Are Available to Help CLL Fatigue?

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Published on August 16, 2021

Expert Discusses Clinical Interventions for Cancer Fatigue

Fatigue is one of the most common, debilitating symptoms of chronic lymphocytic leukemia (CLL). In this segment, Carmen Escalante, MD, discusses the clinical interventions being used at MD Anderson’s Cancer Fatigue Clinic to help patients fight their cancer fatigue and improve their quality of life.

Support for this series has been provided by Janssen Oncology and Pharmacyclics LLC. Patient Power maintains complete editorial control and is solely responsible for program content.

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Transcript | What Clinical Interventions Are Available to Help CLL Fatigue?

Reducing Cancer Fatigue Through Clinical Interventions

Dr. Escalante: There's a number of trials that have been done, especially on exercise, but a lot of the data was compiled in the early 2000s when the NCCN, the National Conference of Cancer Network, put a group of us together to come up with cancer-related fatigue guidelines. So, if anyone wants to go and look at it, they are there, and as well as all the interventions that have data. In addition, ASCO put together a cancer-related fatigue guideline, probably about 10 years ago or so that I'm a part of. And they have a guideline, they're very similar to NCCN. But as far as interventions, and I tell my patients this, the one that has the best data that has done studies, although some of the studies are small, but have different cancer patients, different kinds of exercise interventions is exercise or activity. And patients first think I'm a little crazy because they're telling me they're fatigued and I'm telling them the best intervention is exercise.

But exercise, in all those clinical trials, the thing that was improved was fatigue and quality of life in those trials. And we know that exercise, and I make this point to my patients as well, it's not only good for fatigue, but for decreasing cardiovascular risk, for weight control, for mental health issues, such as depression and anxiety. So, it is a change in behavior trying to get people to exercise, especially patients that may not have exercised at all prior to a cancer diagnosis. But the key is in trying to get a feel of what type of exercise they can do. For example, patients that are really heavy or have knee or low back problems may not be able to walk very well or those types of things, so, water-based exercises may be very helpful. Yoga. You know, it varies. And some of my patients that are in very good condition run or do other things, but I tell them to rotate it, so they don't get bored.

Pre-pandemic, I recommended group exercises because it's much harder for you to quit. You get that guilt factor and it becomes a social intervention because you meet people and they ask what happened to you if you don't show up. But through this pandemic, videos on TV or doing it at the house or doing something outside where you're not around other people have become more prevalent, but exercise is number one. Now, behavioral interventions also has good data, and those include things like prioritizing activities, energy conservation, things like looking at how you do things. For example, if you like gardening, sitting at a table and potting plants versus trying to get down on your knees. And thinking about how you do things at home, whether there's things you can delegate, what's important, most important to you, and taking an assessment of the situation, are there tools?

What Are Some Examples of Behavioral Interventions?

For example, some of my patients like to cook, but standing near the stove or being in the kitchen is tiring. So, getting a stool to sit on to chop or to stir the pot or to wash dishes. So, those are some. And it has very good data as well. Things that we have used that the data is less clear, include stimulants. Stimulants or drugs like methylphenidate, which has been used in the majority of trials that have looked at stimulants, and Ritalin has been the trade name. None of the pharmaceuticals or stimulants have been approved by the FDA for cancer-related fatigue.

So, if we use them, we use them off-label and that gets into another issue, in that depending on the patient's insurer, they may or may not pay for them. Now, because methylphenidate has been around a long time, there's a generic formulation. And so, many of my patients pay out of pocket because it's still pretty cheap, but it's not for everyone, and the data is not as convincing as exercise and behavioral interventions. And so, I don't use it on all my patients and it sometimes works, and sometimes doesn't. When we study it, we have to use a placebo.

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