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Pharmacy Links

AFTER CANCER: POSTCANCER FATIGUE. MORE QUESTIONS

12th March 2009

Do All Cancer Survivors Get Postcancer Fatigue?

No. Survivors who required limited treatment usually recover fairly quickly and completely. Although some fatigue following treatment is almost universal, if it resolves after correction of an identified cause of fatigue, it was not postcancer fatigue.

One woman complained, “I’m running on empty, and I can’t do what I need or want to do. It’s making me feel depressed.” An evaluation revealed iron deficiency anemia and low estrogen levels. She was placed on iron and estrogen replacement, and her fatigue and depression resolved completely over the subsequent month. She had anemia and reactive depression; she did not have postcancer fatigue.

Another woman with the same complaints and abnormalities (anemia and estrogen deficiency) was also treated with replacement iron and estrogen. After a few weeks she felt somewhat improved, but complained, “Now I’m running on an eighth of a tank all the time. I can get some stuff done, but if anything extra or stressful occurs, I can’t handle it.” After another year this, too, resolved. The medications took care of her anemia and estrogen deficiency, but not her postcancer fatigue.

How Long Does Postcancer Fatigue Last?

The same factors that affect the duration of fatigue in general would be expected to affect the duration of postcancer fatigue. Anecdotal evidence suggests that for many survivors, it is a temporary, if protracted, condition. As a rule, the more intense and prolonged your treatment, the longer its aftereffects. As the population of survivors grows and research progresses, solid answers will become available.

What Can I Do If I Have Postcancer Fatigue?

Recognize that this is a real medical condition. Avoid blaming yourself with such thoughts as “I’m not trying hard enough. I must like being sick. My attitude isn’t good enough.” Avoid negative thoughts such as “If I’d known recovery was going to be so tough, I wouldn’t have gone through the treatment. My doctors must have given me too much treatment; that’s why I feel so awful.” Postcancer fatigue is one of the aftereffects that requires patience and hopefulness.

The first step you need to take is getting evaluated for any treatable problem(s) that may be causing or exacerbating your malaise. Just as important, make sure that you are reevaluated periodically if your fatigue persists. Normal results obtained by an evaluation six or twelve months ago do not guarantee normal results now.

If your doctors have ruled out all other causes of fatigue, including recurrence, and conclude that you have postcancer fatigue, reassure yourself that nothing is being missed. Remind yourself that postcancer fatigue is real, is not due to any detectable (or treatable) problem, and is not just in your head. As long as you are reevaluated periodically, you can let go of the fear of recurrence or other medical problem between evaluations.

Find out what you can do to prevent any new medical problems or flare-ups of old ones. Conserve your physical and emotional energies. Doctors, nurses, social workers, psychologists, psychiatrists, and clergy can all help you find a balance between your energy needs and supplies. Adjusting to energy limitations may be a novelty for you, and it is not always obvious what the best way to pace yourself is.

Even when your fatigue is not due to emotional stress or problems, it can cause emotional and social stress. A healthy understanding of the problem and a healthy attitude toward it -will help you cope with the necessary changes. Like your other losses, the losses accompanying postcancer fatigue (loss of energy, ability to do things, companionship, etc.) can be dealt with better when you accept emotional and spiritual support.