A comprehensive review published in Maturitas has revealed promising non-pharmaceutical strategies to address two of the most prevalent and challenging issues faced by cancer survivors: fatigue and sleep disturbances. With approximately 100 million cancer survivors worldwide, these findings offer new hope for improved quality of life post-cancer treatment.
Exercise: The Frontrunner in Fatigue Management
The strongest evidence supports the use of exercise in managing cancer-related fatigue (CRF). The American College of Sports Medicine recommends moderate-intensity aerobic exercise or combined aerobic and resistance training, both during and after cancer treatment. A systematic review of 46 articles showed that 44 demonstrated small to moderate positive effects of exercise on CRF, with minimal adverse events reported.
Professor Bogda Koczwara AM, one of the paper’s authors, told the Oncology Network, “Fatigue and sleep disturbances are some of the most challenging adverse consequences of cancer and its treatment, requiring a multidisciplinary, holistic approach with lifestyle and integrative interventions playing an important role in their management.”
“These interventions can support patients’ self-management and have potential beneficial effects on other cancer symptoms as well.” Professor Bogda Koczwara AM
Mind-Body Practices: A Holistic Approach
Yoga emerged as an effective mind-body intervention. A meta-analysis in breast cancer patients found a small to moderate effect size for fatigue when yoga was compared to usual care (SMD −0.31, 95% CI −0.52 to −0.10, 17 trials). The benefits were more pronounced for those who had completed active treatment (SMD −0.80, 95% CI −1.52 to −0.09, 4 trials). Attending a guided class was an important nuance as home-based yoga had no effect on fatigue.
Other mind-body practices also showed promise:
- Tai Chi demonstrated benefits for fatigue compared to non-exercise therapy (SMD −1.11, 95% CI −1.53 to −0.69, 3 trials) in breast cancer patients, though this was reported with very low certainty evidence.
- Qigong was found to be moderately effective for alleviating CRF (SMD 0.46, 95% CI 0.15 to 0.78, 13 trials), with larger effects seen in those with elevated fatigue at baseline.
- For sleep disturbances, mindfulness-based interventions showed a moderate to large immediate effect (SMD −0.74, 95% CI −1.10 to −0.37, 9 trials) compared to waitlist control or usual care, with effects persisting after 6 months.
Acupuncture and Massage: Targeted Relief
The authors reported inconsistent evidence for the benefits of acupuncture for sleep disturbances. A meta-analysis of 13 studies found that acupuncture and related techniques were not more effective for sleep disturbances in cancer survivors when compared to sham control, wait list control or medication.
Massage therapy also had mixed results. The authors noted a number of smaller pilot studies on various touch therapies including reflexology in selected cancer survivors populations suggested benefits on anxiety, relaxation and sleep, underlining the importance of a personalised approach for each cancer survivor to assist with management of symptom clusters.
Diet and Supplements: An Area for Further Research
While evidence for specific dietary interventions is limited, some studies suggest potential benefits. A Mediterranean diet intervention was found to attenuate CRF during chemotherapy, especially in those with lower baseline adherence to the diet. Another study reported improvements in fatigue with an anti-inflammatory diet in lung cancer survivors undergoing chemotherapy. It was noted that evidence for intermittent fasting was very limited but a systematic review found one study of fasting before and after chemotherapy reported reduced fatigue.
Evidence for nutrient supplements remains inconclusive, with limited high-quality studies available. However, preliminary evidence suggests that ginseng may have a modest effect on alleviating CRF (SMD −0.21, 95% CI −0.42 to 0.00, 7 trials).
Sleep Disturbances: A Complex Challenge
For sleep issues, the evidence is more mixed. Exercise showed a small effect on subjective measures of sleep quality and sleep disturbances in breast cancer survivors (SMDs −0.27 to −0.32). Cognitive behavioural therapy was best practice for insomnia.
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Implementation Challenges and Future Directions
Despite the promising evidence, these interventions remain underutilised in clinical practice. The review highlights several barriers to implementation, including lack of dedicated cancer survivorship or integrative oncology clinics, limited public funding for allied health services and geographical disparities in access to services, particularly in rural areas.
As the global population of cancer survivors continues to grow, this research underscores the potential of lifestyle and integrative approaches in addressing the long-term effects of cancer and its treatment. With further research and improved implementation strategies, these interventions could become standard components of comprehensive cancer care, offering survivors new tools to regain control over their health and well-being.
Paper: Carolyn Ee, et al. Lifestyle and integrative oncology interventions for cancer-related fatigue and sleep disturbances. Maturitas, 2024, 108056. Access online here.
