In the Aftermath of Cancer, Fatigue Remains

Be kind, for everyone you meet is fighting a great battle.

-- Philo of Alexandria

"Doc, I am so tired all the time. I'm sleeping okay, but I drag myself through the day. I have no pep at all and my energy is just shot. How long will this last?"

Her employer would not allow her to sit down to do her job anymore. She was convinced that her family was growing frustrated with her lack of progress. She worried she should have been getting better by now.

She looked just fine on the outside. She had successfully undergone an intensive course of radiation and chemotherapy a year before. Many of the other effects of treatment had resolved; her diet had improved, her dryness seemed to be getting better, her weight was up, and the skin changes had resolved. Despite being cancer-free, she was tired most of the day.

Cancer fatigue takes a huge toll on patients, and it can persist for years. A recent study of long-term breast cancer survivors by Julienne Bower at UCLA (Bower JE, Ganz PA, Desmond KA, et al, "Fatigue in long-term breast cancer survivors: A longitudinal investigation," Cancer 2006; 106:751-758) found that 21 percent of the survivors reported "fatigue" in both the first five years and the second five years after treatment.

At least one-third of survivors were fatigued at some point during the project. The study identified associations between fatigue and depression, other health issues like high blood pressure, pain or diabetes, lower incomes, and initial treatment with combination chemotherapy and radiation.

Fatigue is not completely understood, but it is more common in cancer survivors than in the general population. Cancer treatment, psychosocial factors, residual physical effects, medical conditions, pain, and sleep changes all contribute to fatigue, but none fully explains why the symptoms develop and, more importantly, why they do not go away. There is no one single effective approach to treating these symptoms.

My patient's life had been altered first by the cancer, then by its treatment, and now by the fatigue. She felt alone. I tried to reassure her that she is in good company and that our team would always be available to her, offering support and encouragement. She longs for some relief.

Bruce H. Campbell, MD, FACS
Professor of Otolaryngology and Communication Sciences
Chief, Division of Head and Neck Oncology
Interim Director, The Medical College of Wisconsin Cancer Center

"Reflections" is a collection of essays by the health professionals of the Medical College of Wisconsin.