Hester Hill Schnipper, LICSW, OSW-C Program Manager Emeritus, Oncology, Social Work
MARCH 10, 2021
Fatigue is a common, almost universal, complaint among people going through cancer treatment. If you look at the list of possible side effects for any chemotherapy drug or other medication, fatigue is always at or near the top of the list. Fatigue also accompanies recovery from surgery and radiation. It can be especially troubling because it is so disruptive to our lives but seems less serious than some other side effects. Your doctor may react with alarm and helpful strategies if you describe persistent nausea and vomiting, constipation or serious headaches, but being tired probably won’t elicit the same concern. The conclusion seems to be that fatigue just goes with the territory, and we have to deal with it.
Cancer fatigue is a sense of physical, emotional and mental exhaustion.
Cancer fatigue is different from the tiredness we experience after several nights of poor sleep, jetlag or a lot of exercise. Cancer fatigue is a sense of physical, emotional and mental exhaustion. It can hit us suddenly and can be described as hitting a brick wall. All of a sudden, we need to just stop. Sometimes people can barely make it through the morning shower before hitting that wall while others can keep going until late afternoon. When it hits, it can seem as though nothing helps. A classic study compared the benefits of a cup of coffee, a half hour nap and a half hour walk when people were fatigued. The finding was that exercise, even mild, helped the most. But when I have described this report to my patients, they usually react with incredulity or humor. How can you possibly consider going out for a walk when all you want to do is lie on the couch?
A new study published in Cancer described different and distinct trajectories of fatigue among women diagnosed with and treated for breast cancer. The authors considered women from the time of diagnosis through treatment and into recovery and survivorship. Almost 300 women, with Stages 0 through IIIA breast cancer, were recruited at diagnosis and followed through surgery, radiation and chemotherapy/hormonal therapy. Follow up continued for 18 months.
Five different experiences of cancer-related fatigue were identified: Stable Low, Stable High, Decreasing, Increasing and Reactive. It is not surprising that there was not a single reaction among women going through breast cancer. Everyone is different, as we hear over and over, and we respond differently to medical interventions. Some people, for example, recover quickly from surgery, while others have complications that result in a much longer recuperation. Chemotherapy regimens come with an expected list of side effects and reactions, but no two people have exactly the same experience. Doctors talk about a 15% or 20% swing among chemo cycles. This means that you might feel 15% or even 20% better or worse each time, but you are not likely to feel 75% worse. Most people do find chemo to be cumulative and have a harder time with successive cycles. It is important to note that the authors acknowledged the contribution of depression and anxiety to the experience and intensity of fatigue.
Ok, you may be thinking, someone is paying attention to this and even making subgroups and categories. But what can I do about it? How can I help myself feel better? Let's look back at the study mentioned earlier about exercise. Although it can seem counterintuitive, it helps to be physically active. No one is suggesting that you need to train for a marathon, but you will feel better if you have some gentle exercise daily; a walk around the neighborhood or even to the mailbox can help. You might want to consult with a physical therapist or a personal trainer who is informed about working with cancer patients.
It may also help to speak with a counselor to try to reframe your thoughts and develop some useful coping strategies. BIDMC's oncology social workers can help or refer you to someone in the community. Various mind-body treatments may also be helpful. Consider meditation, yoga, acupuncture, massage or music therapy. There is no magic diet that is going to restore all your energy, but it is important to try to eat healthily and to make sure you are getting enough protein. There is some evidence that some dietary supplements, like ginseng, may help with cancer-related fatigue. The caveat here is to speak with your doctor before ingesting anything that might interfere with active treatment. There are some prescription medications that can help with energy and alertness, and you can speak with your doctor about possibly trying one.
Most importantly, remind yourself that you will feel better once treatment has ended and some time has passed. Working gradually and faithfully to restore your body and your spirit will help you regain the best possible health.