CRF: Cancer-related Fatigue

CRF: Cancer-related Fatigue

By Dr. Jessica Moore, ND

According to the Canadian Cancer Society, fatigue is the most common symptom for people with cancer and the most common side effect of cancer treatment. The National Comprehensive Cancer Network defines cancer-related fatigue (CRF) as “a persistent, subjective sense of physical, emotional and or cognitive tiredness or exhaustion related to cancer or cancer treatment, that is not proportional to recent activity and that significantly interferes with usual functioning”.  For those suffering from CRF, even the simplest of activities can seem daunting or unbearable. In the setting of cancer, chemotherapy or radiation, often times even a good night’s sleep won’t relieve symptoms of fatigue. Patients can be left with a weary burden of ongoing heaviness, lethargy and a reduced drive to participate in daily activities.

“Over 50-90% of cancer patients experience fatigue.”

Oncotherapies (ie. chemotherapy, radiation therapy, targeted therapy, hormone deprivation therapies etc) may lead to some or many disturbances in the normal function of the nervous system, metabolism, food intake, sleep or circadian rhythm, hormones, inflammation, emotional balance, thyroid function, bone marrow health, ability to detox or others. Because fatigue is a non-specific symptom (can appear with almost any disturbance to health), it’s not surprising that it shows up when a person is living with cancer or undergoing cancer therapies and their complex effects. The National Comprehensive Cancer Network now recommends that all cancer patients be screened for CRF.  Many clinicians will use a screening tool such as the Brief Fatigue Inventory (BFI) tool (ex.

The good news is that while exceedingly common, CRF is often highly treatable. Naturopathic and integrative therapies offer an array of useful, evidence-informed, supportive care to combat this pervasive issue and support quality of life. The focus is on relieving symptoms while trying to address the underlying cause and restore health along the way. The first step involves removing the obstacles by identifying reversible or treatable factors such as:

  • sleep disturbances
  • pain
  • emotional distress, grief, depression or anxiety
  • malnutrition
  • deconditioning
  • infection
  • nutrient deficiencies such as iron deficiency
  • anemia
  • inflammation
  • low thyroid function
  • side effects from medications
  • organ dysfunction

The approach to addressing these treatable obstacles should be individualized and take into account a person’s diagnosis, cancer therapy, medications, allergies, medical history, health goals, and personal comfort level with different therapeutic options.  Assessment may include discussion, physical exam, questionnaire, review of medical records/reports, and or laboratory testing. Therapies may include personalized nutrition/diet planning, nutritional IV therapy, lifestyle recommendations, therapeutic exercise, targeted supplementation, botanical medicine, physical therapies like acupuncture or emotional wellness support.

Let’s now review some of the many evidence-informed examples of supportive naturopathic and integrative therapies for cancer related fatigue.

Multiple trials have shown that nutritional intravenous therapy with vitamin C can significantly help to improve fatigue and quality of life in patients with cancer, during adjuvant chemotherapy, without interfering with the therapy. Furthermore, intravenous vitamin C appears to be very safe for patients with and without cancer.

Acupuncture is an effective therapy for many different cancer and cancer treatment related side effects. A 2018 analysis reviewed ten randomized controlled trials, including 1327 patients (acupuncture, 733; control, 594). The analysis concluded that “acupuncture had a marked effect on fatigue in cancer patients, regardless of concurrent anti-cancer treatment, particularly among breast cancer patients.”

Both resistance training and aerobic exercise appear to improve cancer-related fatigue and quality of life in patients with cancer. Exercise should be prescribed in a safe and appropriate manner. Professional supervision and routine follow-up to ensure safety and progress as often associated with greater improvement. A 2018 meta-analysis of 24 phase II and one phase III clinical trials, concluded that “low-intensity forms of yoga, specifically gentle hatha and restorative, are feasible, safe, and effective for treating sleep disruption, cancer-related fatigue”… and several other cancer treatment related side effects.

Mindfulness-based stress reduction techniques and meditation have been shown to reduce cancer related fatigue in several studies. Mindfullness-based practices are simple, low cost and can enhance many aspects of health and well-being.

A positive correlation between adequate vitamin D status, the absence of fatigue and the presence of physical and functional well-being has been identified in advanced cancer patients undergoing conventional cancer therapy. Vitamin D testing is done with a simple blood draw and dosing of vitamin D supplementation can be individualized for an optimal result.

In conclusion, fatigue is an extremely common effect of cancer and cancer treatments. There are many modifiable factors and actionable steps that can be taken to reduce this symptoms and support quality of life. It is important to use natural medicine, dietary choices and life-style habits that are safe and appropriate. There are many options for evidence-supported natural therapeutic choices that can be considered and utilized safely and effectively.


In Good Health,


Dr. Jessica Moore, ND


If you or a loved one is struggling with cancer-related fatigue or cancer treatment-related fatigue, considering scheduling a consultation with Dr. Jessica Moore. She is one of Canada’s only hospital and residency trained naturopathic doctors and maintains a focused practice in integrative and naturopathic cancer care.

References: Annals of Oncology 22: 1273–1279, 2017, Curr Oncol. 2018 Apr; 25(2): 139–148, Personalized Medicine Universe. 2012;1:49–53., J Korean Med Sci. 2007;22:7–11., Nutr J. 2012;11:7. doi: 10.1186/1475-2891-11-7, Support Care Cancer.2018 Feb;26(2):415-425. Medicine & Science in Sports & Exercise, 2017 33, 718–723. International Journal of Behavioral Medicine2005, Vol 12:4, pp 278–28Oncologist, 8 Suppl 1, 10–14.2015 Aug;24(8):885-93, Palliat Med.2016 Jan;30(1):89-96.

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