When we are told about the possible side-effects of treatment or possible symptoms of illness, "fatigue" is usually mentioned towards the bottom of the list and without great fanfare. Compared to pain or nausea, it sounds quite harmless. Most women don't find fatigue to be a major issue in their tretament. Sure, you may want to go to bed a bit earlier at night or take a nap during the afternoon, but it is not so bad. I do remember, years ago while I was receiving radiation therapy, a sensation like the energy switch had just been flicked, and I needed to sit down. Right that moment. However, some women do experience fatigue that is almost disabling, preventing them for carryng on with their normal routines and responsibilities.
This is an excerpt from an editorial by Bruera and Yennurajalingam, both from M. D. Anderson in Houston, that has just been published in the Journal of Clinical Oncology. I am adding a link at the end if you want to read more:
Fatigue is the most common, and one of the most devastating, symptoms in patients with cancer. It has been defined as "a distressing, persistent, subjective sense of tiredness or exhaustion related to cancer or cancer treatments that is not proportional to recent activity and interferes with usual functions."
Unfortunately, there are limited treatment options to alleviate this distressing symptom. This is partly because fatigue is a complex, multidimensional syndrome. In recent years, there has been a much better understanding of the multiple mechanisms contributing to the expression of fatigue by patients with cancer. Tumor byproducts and host cytokines, direct effects of radiation therapy and chemotherapy, cachexia, deconditioning, opioids and other drugs, hypogonadism, metabolic abnormalities, chronic infection, mood abnormalities such as anxiety and depression, cognitive changes, and severe anemia are all contributors to the intensity of fatigue in patients with cancer. In a given patient, it is quite likely that multiple mechanisms coexist at any given time and that the main contributors change as the disease progresses or as patients reach the completion of therapy.