by Dr. C.H. Weaver M.D. updated 2/2021

Cancer-treatment fatigue is more than just being tired. It is an overwhelming sense of tiredness that is not always relieved by rest. It can be mild, causing a person to have less energy to do the things he or she wants to do; or it can be severe, affecting many areas of a person’s life and resulting in the inability to do basic activities.

Fatigue is one of the most common side-effects of cancer treatment. It can impact many areas of normal living including one’s desire to eat and drink. Left unchecked, it can lead to severe consequences such as malnutrition and dehydration, which contribute to additional fatigue, thus creating a dangerous cycle.

It can affect many areas of normal living, including one’s desire to eat and drink. Left unchecked, it can lead to severe consequences such as malnutrition and dehydration, which contribute to additional fatigue, thus creating a dangerous cycle.

How Fatigue Affects Nutrition

Fatigue can significantly affect one’s desire to eat as well as one’s energy to prepare basic meals and snacks. Even walking to the kitchen can feel like running a marathon. This lack of energy is often overwhelming, causing patients to go many hours or even full days with only a few bites of food. This pattern leads to malnutrition and dehydration, both of which lead to more fatigue.

Eating for Energy

Many patients are in search of foods that will give them energy to overcome the fatigue. Unfortunately, there are no such foods. Even caffeine can reduce long-term energy levels and impair sleep, leading to additional fatigue. Foods that are purported to be a good source of energy simply provide calories (energy for the metabolism) but don’t provide a cancer patient with the type of energy he or she seeks.

Some cancer patients turn to herbal supplements such as guarana, ma huang, or ginseng for an energy boost. These are known stimulants, but the stimulation provided by these supplements has not been proven safe or effective in cancer-treatment fatigue. In addition, because they have known side effects and may interact with medications, they are not recommended during cancer treatment.

Eating Despite Fatigue

The best advice for people with cancer treatment fatigue is to eat a balanced diet that includes protein foods such as meat, eggs, cheese, peas, and beans and to drink eight to 10 glasses of fluids per day. Preventing malnutrition and dehydration can help keep baseline energy levels up and provide the body with the fuel it needs to maintain basic activities, although this is easier said than done.

Here are some tips to make meeting your nutritional needs easier during this difficult time:

  • Ask for help. Friends and family members are usually happy to prepare meals or go to the grocery store.
  • Set a timer for 60-minute intervals. Eat a few bites and drink some fluids every time the timer goes off.
  • Eat a few bites every time a commercial comes on TV.
  • Keep a cooler or mini refrigerator in the room where you rest or next to your chair or bed. Keep it stocked with yogurt, pudding, cheese, milk, juice, or nutritional supplement drinks.
  • Keep non-perishable food items such as nuts, dried fruit, juice boxes, crackers, and peanut butter next to your chair or bed and nibble often.
  • Eat high-calorie, high-protein foods to maximize your nutritional intake.

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If you feel your fatigue is interfering with your ability to eat and drink, please discuss this with your healthcare team.

Megestrol Acetate, Marinol and Medical Marijuana Improve Appetite in Patients With Cancer-Associated Anorexia

According to the results of a recent study conducted by the North Central Cancer Treatment Group (NCCTG), both the hormonal agent Megestrol Acetate and the cannabinoid Marinol improved appetite in patients with cancer-associated anorexia.

Anorexia is the lack or loss of appetite, which results in the inability to eat and can lead to drastic weight loss. Anorexia can result from psychological, physical and a variety of other causes. Anorexia is a common problem in cancer patients and can compromise treatment and result in a poor prognosis for patients.

More than half of patients with advanced cancer suffer from anorexia. There are currently several ways to manage anorexia including nutritional support to increase caloric intake and the use of antiemetics to control nausea and vomiting associated with chemotherapy and radiation. In addition, orexigenic agents help to stimulate appetite and are often used to treat anorexia. There are several different types of orexigenic agents including cannabinoids, progesterones and corticosteroids.

Both Marinol and Megestrol Acetate are orexigenic agents. Marinol, an appetite stimulant, is part of a class of drugs collectively referred to as cannabinoids. Marinol is believed to stimulate appetite and directly block the cannabinoid-1 receptor in the brain that is responsible for chemotherapy-induced nausea and vomiting. Megestrol Acetate is a progesterone, or steroid hormone, that improves appetite in patients with advanced cancer.

This most recent study evaluated both Marinol and Megestrol Acetate for improving appetite in cancer patients with anorexia. The study involved 469 cancer patients with an ongoing problem of anorexia and/or weight loss. The study had three arms: one group took Megestrol Acetate, another group took Marinol and a final group took both.

The results indicated that 73% of patients taking Megestrol Acetate reported an improved appetite, compared with 47% in the Marinol group and 70% in the combination group. Megestrol Acetate did, however, cause severe side effects, with 18% of patients in the Megestrol Acetate group experiencing impotence, compared with 14% in the combination group and only 4% in the Marinol group. Furthermore, 18% of patients in the Megestrol Acetate group experienced fluid retention, compared with 13% in the combination group and 11% in the Marinol group.

The results of this study indicate that both Megestrol Acetate and Marinol stimulate appetite in patients with cancer-associated anorexia. Marinol has an additional advantage in that it is an antiemetic and is FDA-approved for the treatment of chemotherapy-induced nausea and vomiting. Clinical studies are ongoing to evaluate the effectiveness of both of these orexigenic agents and to establish optimal dosing for Marinol, as patients in this study received a low dose of Marinol.