It is Exhausting

Hester Hill Schnipper, LICSW, OSW-C Program Manager, Oncology Social Work

JUNE 08, 2017

My last blog as about fear as a frequent companion of cancer. This is a second entry today as I will be travelling tomorrow and probably not able to sit at a computer. The subject here is fatigue, not the kind that is helped by a nap or a cup of herbal tea. Not even the kind that is a known side effect of most chemotherapies and probably persists a few days each cycle. I am thinking about the bone-deep, soul-crushing, heart-heavy fatigue that usually comes when cancer goes on and on and on.

I talk often with women who are living with newly diagnosed Stage IV/metastatic cancer. Very often, their oncologists suggest an "easy" treatment as the first treatment. Recognizing that some kind of anti-cancer therapy is going to be part of the rest of their lives, the thought seems to be to keep life as normal as possible for as long as possible--ergo, that means a treatment that does not have killer side effects and may not even cause hair loss or other obvious physical changes.

On the one hand, this makes a lot of sense. If someone can continue working or keeping up with her usual life for as long as possible, that's a plus. The flip side, however, is that this may then mean that the harder treatments, the drugs that do bring heavy duty side effects, come later at a time when the patient is feeling less resilient, more beaten down, more this kind of fatigued. Some people wonder why we don't start with the hardest stuff and use the more gentle weapons later on. Those are questions for your doctor, but it surely is a topic worthy of consideration.

And Susan Gubar brings it to us:

When Your Personal War on Cancer Is Exhausting
Living With Cancer

Because ovarian cancer initiated a stealthy assault before I discovered it, it seems the clear aggressor, and I the injured party. Yet as my physicians use their weapons to counterattack, collateral damages mount. Fatigue envelops me.
Sometimes the arsenal deployed against recurrent cancer feels like overkill. Often I wonder what will happen if and when the drug of the clinical trial in which I am enrolled fails to keep my cancer at bay. Will I have the resources to undergo surgery or chemotherapy again?
Paradoxically, rigorous medical protocols can steal some of the time they give us. A small quantity of life may be gained at the expense of a sometimes degraded quality of life. Enormous energy must be spent getting to the hospital, completing paperwork, waiting for vitals and blood work and the oncologist, preparing for scans or radiation, undergoing infusions or transfusions, lining up at the pharmacy, and tackling insurance red tape. Periodically, surgical procedures further weaken a patient sent home with a drug arsenal to offset gruesome side effects — the most prominent being pain, nausea and weakness.
Consider this scenario playing out over years — with no end date set for the tour of duty — and you will understand why besieged patients suffer treatment fatigue. Is treatment fatigue like combat fatigue? The enervation of chemotherapy and radiation — both derived from warfare technologies — demoralizes us as regimens multiply and at times it seems impossible to go on. Does treatment fatigue explain the gung-ho rhetoric that bombards cancer patients and that many of them deploy?

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Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.
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