Fatigue
This is an overview of CAM treatments that have been evaluated by CAM Cancer for cancer-related fatigue (CrF). Please click on a CAM treatment below to view an assessment of its safety and efficacy based on the current research status. Please note that this is not a list of recommended treatments and does not suggest that the treatments are safe and effective.
Safety
Generally considered safe when administered by a qualified practitioner.
Few adverse events are reported in clinical trials and serious adverse effects appear to be rare.
Overall injury rates are comparable to other exercise types.
Efficacy
Breast cancer: There is moderate-quality evidence to show that yoga is better for fatigue (6 SRs) than no treatment.
Other cancers: Effects are unclear, with mixed results in RCTs (n=6) (low-certainty evidence).
Read the full version of the Yoga summary.
Safety
Generally considered safe when administered by a qualified practitioner.
As it is a moderate form of aerobic exercise, it may be beneficial for people to check with their health practitioner if they have a known heart condition, severe osteoporosis or musculoskeletal difficulties.
Efficacy
Two SRs, one high-quality SR of 5 RCTs and one SR of various study types, report reduced short-term cancer-related fatigue in breast, lung, head and neck, and prostate cancer (high-certainty evidence).
Read the full version of the Tai chi summary.
Safety
MBSR and MBCT are generally considered to be safe in supportive cancer care. However, no rigorous assessment of the safety of mindfulness-based approaches in cancer patients is available.
Efficacy
MBSR seems to reduce fatigue in women with breast cancer in the short- and medium-term (4 SRs including 1 Cochrane review, high-certainty evidence).
Children: Positive effects in children and adolescents with mixed types of cancer are limited by methodological flaws of the included studies.
Mindfulness apps were not shown to be effective in reducing fatigue (1 RCT).
Read the full version of the Mindfulness summary.
Safety
Generally considered safe with no safety issues on record.
Caution is advised for acutely distressed and/or emotionally fragile patients, particularly in patients with serious and life-threatening cancers.
Efficacy
Music intervention has a small to moderate effect but not during active cancer treatment: one Cochrane review (52 RCTs and quasi RCTs) found a small to moderate effect of music therapy/music medicine (high-certainty evidence) while one SR (25 RCTs) found no significant effects of music intervention for fatigue during active cancer treatment.
Read the full version of the Music therapy summary.
Safety
Generally considered safe with only minor adverse drug reactions reported.
Mainly gastrointestinal intolerances, headaches and sleep disorders have been reported. These are dose-dependent, infrequent and transient.
The risk of interactions is low.
Efficacy
The results of two studies (high-quality evidence) indicate that preparations made from the powder of the dried root of American ginseng (P. quinquefolius) reduce symptoms of fatigue.
The results of the five studies with Asian ginseng (P. ginseng) differed according to the treatment of the ginseng root:The results of two studies suggest that preparations made from the dried root do not alleviate symptoms of fatigue more than treatment with a placebo (high-quality evidence). The results of the other three studies using preparations from heat-treated roots indicate that these can reduce symptoms of fatigue (moderate-quality evidence).
Read the full version of the Ginseng spp summary.
Safety
Generally well tolerated and considered safe when good-quality products are used.
More safety research is needed particularly for possible herb-drug interactions.
Efficacy
Three RCTs suggest that administration IV infusion of PG2 (Astragalus polysaccharides), 250mg-500mg 3x/ week for up to 8 weeks during chemotherapy probably improves fatigue for people with advanced cancer (moderate certainty of evidence).
Read the full version of the Astragalus summary.
Safety
Generally considered safe when administered by a qualified practitioner.
As it is a moderate form of aerobic exercise, it may be beneficial for people to check with their health practitioner if they have a known heart condition, severe osteoporosis or musculoskeletal difficulties.
Efficacy
Several SRs (5 SRs published since 2016) report significantly reduced fatigue with qigong compared to controls. The evidence is however of low certainty as the included studies have methodological shortcomings and are very heterogenous.
Read the full version of the Qigong summary.
Safety
Generally considered safe when administered by a professional qualified practitioner.
Mild adverse effects, such as pain or bleeding at the site of acupuncture can be expected in about 10% of all cases.
Serious complications seem to be very rare.
Efficacy
Some positive evidence exists but overall the published data from 12 systematic reviews are either contradictory or too methodologically weak to allow firm conclusions (low-certainty evidence).
Reported differences in effect between true acupuncture and sham have been less convincing than the differences in effect between acupuncture and usual care.
For transcutaneous electrical acupoint stimulation and infrared laser moxibustion only preliminary evidence is available from one RCT, respectively (low-certainty evidence).
Read the full version of the acupuncture for fatigue summary.
Safety
Generally considered safe when administered by a qualified professional.
Contraindications include strong forceful massage in patients suffering from haemorrhagic disorders, low platelet counts, and blood thinning medication.
Efficacy
The evidence from 5 SRs is mixed with some reviews reporting positive results and others reporting no significant differences (low-certainty evidence).
Read the full version of the Massage (Classical/ Swedish) summary.
Safety
Generally safe and only associated with minimal adverse effect when used in appropriate dilutions.
Allergic reactions can occur with all oils. Should not be used undiluted.
Efficacy
Overall, the evidence from 2 recent SRs is conflicting with some included RCTs reporting positive and others negative results.
Read the full version of the aromatherapy summary.
Safety
Generally considered safe when administered by qualified professionals.
Contraindications include acute psychoses, severe personality disorders and an inability to be hypnotized.
Efficacy
There is evidence from 1 RCT of 200 breast cancer patients for significantly lower levels of fatigue at the end of radiotherapy and up to 6 months follow-up (low-certainty evidence).
Read the full version of the Hypnotherapy summary.
Safety
Biofeedback is generally considered safe and no adverse events have been reported in the included studies.
Some concern has been raised on the use of this intervention in individuals who have a history of psychiatric illness.
Efficacy
There is evidence from only one RCT (n=71) available which has shown encouraging results for neurofeedback (low-certainty evidence).
Read the full version of the Biofeedback summary.
Safety
CoQ10 is generally well tolerated when taken as a dietary supplement.
There are some safety concerns related to the CoQ10 supplementation: one observational study reported that the use of coenzyme Q10 (standalone or in combination with vitamins C, E) before and during chemotherapy was associated with a non-significantly increased hazard of breast cancer recurrence.
Efficacy
In breast cancer patients one RCT of CoQ10 reported no improvements of fatigue (high-certainty evidence) while one RCT of a combination product containing CoQ10 suggested some improvements (low-certainty evidence).
Read the full version of the Co-enzyme Q10 summary.
Safety
Generally considered safe when administered by a qualified practitioner.
Some concern has been raised about the use of relaxation therapy interventions among individuals who have a history of psychiatric disorders.
Efficacy
There are not enough data available: only one RCT (n=100) of low quality reports improvements in fatigue (low-certainty evidence).
Read the full version of the Progressive Muscle Relaxation summary.
Safety
Generally considered safe when administered by a qualified practitioner.
Efficacy
One CCT (n=72) reports significant improvements but has severe methodological shortcomings (low-quality evidence).
Read the full version of the Reflexology summary.
Safety
Generally considered safe when administered by a qualified practitioner, reiki has not been associated with any direct safety issues.
Efficacy
A pilot CCT (n=18) found significant reductions in fatigue for distant Reiki compared to usual care but this study has major limitations.
An earlier review identified studies reporting reduced fatigue but they concluded that “none of the included trials met a standard which produces reliable results” (very low-quality evidence).
Read the full version of the Reiki summary.
Safety
There are no serious direct risks associated with homeopathy.
Indirect risks if homeopathic preparations are used in place of conventional cancer treatment.
Efficacy
There is very preliminary evidence from a small observational study (low-quality evidence) that homeopathy added to conventional treatments might have a beneficial effect on fatigue and quality of life. This needs to be confirmed in further studies.
Read the full version of the homeopathy summary.
Safety
Generally considered safe when administered by a qualified practitioner, no serious safety concerns are known.
Efficacy
Evidence is unclear: low-quality evidence from one RCT for improvement of fatigue, 1 open-label case-control study reported no effects.
Read the full version of the Therapeutic touch summary.
Safety
Generally well tolerated at normal clinical doses.
Larger doses have been reported to cause some abdominal pain or gastrointestinal problems, including diarrhoea.
Caution: antifertility effects, might reduce platelet aggregation and could theoretically be an anticoagulant.
Efficacy
There is only one uncontrolled trial (n=51) available in patients with advanced solid tumours.
Some improvements in overall quality of life, social functioning and fatigue were reported but the evidence is too preliminary to allow any conclusions (very-low certainty of effect).
Read the full version of the Cat's claw (Uncaria spp) summary.
Safety
Generally well tolerated and has been safely used in clinical trials at doses from 250mg to 6g per day for up to six months.
Interactions with thyroid medications have been reported.
Efficacy
There is evidence from four RCTs involving >800 participants with that LC does not reduce moderate to severe CrF (n=3) or that acetyl-L-carnitine prevents from CrF occurring during taxane-based chemotherapy (n=1). (high-certainty evidence)
Read the full version of the L-Carnitine summary.