Welcome to Mayo Clinic podcast. Our topic today is managing fatigue during chemotherapy. I'm your host, Rich Dietman.

In today's podcast we're talking about managing fatigue, a common symptom during cancer treatment. My guest is Mayo Clinic cancer specialist, Dr. Tim Moynihan. Dr. Moynihan practices in the department of medical oncology at Mayo, and he's also cancer medical editor for MayoClinic.com. Dr. Moynihan, thanks for being with us.

Dr. Moynihan: Thanks for having me, Rich.

Rich Dietman: Is fatigue a normal part of chemotherapy treatment?

Dr. Moynihan: It is a very common part of chemotherapy treatment. It's not universal, but it is very common, not only from the chemotherapy itself but also from the underlying cancer or other treatments you're receiving at the same time.

Rich Dietman: What factors influence whether a person experiences fatigue during chemotherapy and how bad that fatigue is going to be?

Dr. Moynihan: Multiple things come into account there. One, what is the underlying condition of the patient? How healthy were they before, how active were they, how much reserve do they have? Somebody, for example, who is 85 and has multiple other conditions, may suffer more fatigue than an 18- or 20-year-old who is very healthy going into it. In addition, what type of chemotherapy you're getting may play a significant role. There are certain types of chemotherapy that are relatively benign and cause very little fatigue. There's other types of chemotherapy that are very aggressive and very difficult and cause substantial fatigue. Next is consideration of the cancer — how far spread the cancer is. How the cancer has affected your body may have substantial effect on it because the cancer itself can cause its own fatigue. And sometimes the chemotherapy, if we can shrink the cancer, actually helps to relieve the fatigue, rather than causing it because we shrunk the cancer which is actually the cause of the fatigue. On top of that, certain types of chemotherapy can make your blood counts drop. Now the blood counts, for example, for your red blood cells that carry your oxygen around, think it's very low, you may feel very fatigued and things like a blood transfusion or something else may help that to bring those levels up and relieve the fatigue. So it could be a side effect of the chemotherapy, could be the chemotherapy itself, could be the cancer, or it could be underlying medical conditions on top of that.

Rich Dietman: And what can a person do to reduce the chances of becoming chronically fatigued during chemotherapy?

Dr. Moynihan: A few things seem to be really helpful. One, decrease in stress in your life is very helpful, trying to get as much relaxation as you can. Two, following a balanced diet. Discuss with your physician if there's any particular types of diet that you should be following during chemotherapy, but trying to get a good, balanced diet is very helpful. Three, following up with your regular appointments, and your doctor will follow certain blood tests because sometimes if the blood counts drop, that may influence fatigue. In addition, there's some interesting evidence recently that exercise during chemotherapy may be very helpful, and those people who are able to maintain a routine exercise program during chemotherapy may experience less fatigue, fewer side effects of therapy, and it's possible that the chemotherapy and the treatments may be more effective in those people who are able to maintain an exercise program.

Rich Dietman: Is there any way of predicting, going into chemotherapy, how long the fatigue might be expected to last?

Dr. Moynihan: We have a general idea of that. For most chemotherapy regimens, and some are very severe at producing, produce very severe fatigue. Others produce very little fatigue. So we have a general idea, but each individual's a little bit different. So many people, after they complete their chemotherapy, do still note significant fatigue that may last weeks, or months even, after the chemotherapy is completed. But most people, fortunately, do recover their energy levels at some time after the treatment is done.

Rich Dietman: You talked about exercise and how it may help managing the effects of chemotherapy. Are there certain exercises that are particularly effective?

Dr. Moynihan: I think the most important thing is a regular habit of exercise, that's probably more important than any particular exercise. What we do want is not very severe or strenuous exercise, as this may not be a time to really push your body and try and do very hard exercise. It may be better to do more gentle exercise but fairly repetitive exercises that helps move the limbs, open up the lungs, get your heart to beat a little bit. This helps your digestion, it helps your sleep, often reduces stress, it's very helpful for your whole body, to relax with that.

Rich Dietman: Is there any evidence that establishing a regular exercise routine can protect a person from a relapse of their cancer?

Dr. Moynihan: There is, actually, some interesting data both in colon and breast cancer that those people who maintain an exercise program may have a lower risk of their disease recurring afterwards. It's fairly early in preliminary data, but it's very intriguing. It seems like those people who are able to maintain an exercise program do better. Is that due to actually the exercise itself, or is this a selection bias that those people who are able to maintain an exercise program are doing a little bit better anyway? We're not quite sure of that yet. But certainly it doesn't hurt anything, and it may be very beneficial.

Rich Dietman: Dr. Moynihan, we've been talking about chemotherapy. What about radiation treatment and fatigue?

Dr. Moynihan: Absolutely. Radiation by itself can cause very significant fatigue, and sometimes for certain cancers, we combine radiation therapy and chemotherapy together, because we know those two together work better against the cancer, than either treatment alone. But certainly that can be one contributing factor to fatigue on top of the chemotherapy and on top of the cancer itself.

Rich Dietman: Thanks very much Dr. Moynihan. We've been talking about managing fatigue during cancer treatment with Dr. Tim Moynihan, a cancer specialist at Mayo Clinic and cancer editor for MayoClinic.com. You've been listening to Mayo Clinic podcast. I'm Rich Dietman.

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