Tired because of cancer treatment? Join the crowd.

Fatigue was one of the most distressing symptoms that my patients complained of. Many of us feel tired some of the time, but usually a brief afternoon nap can handle the problem. Not so with cancer patients – especially those on chemotherapy. Their fatigue is bone deep and doesn’t get better with sleep. It pervades.

I remember a small article written by a young man who was a resident in surgery in Boston about his fatigue during chemotherapy for lymphoma. He described a fatigue that was so intense that even usual activity like going up stairs became challenging. He felt so bad that he thought that the lymphoma must have been progressing. Months later, he was free of cancer and slowly recovering.

Many times the fatigue doesn’t always go away. Near the end of my practice, a patient who I had treated with chemotherapy for Hodgkin disease many years before, called me. He wanted to know if there was something wrong with him because he still felt tired all of the time. I reassured him that this was, unfortunately, normal. Many people, who received treatment for Hodgkin disease or other lymphoma, experience fatigue many years after the treatment has ended.

Chemotherapy isn’t the only villain. Radiation therapy will cause fatigue, especially if a large part of the body is being radiated. Just having cancer is sometimes enough. Of course, if the cancer has spread, that almost guarantees that fatigue will develop.

What to do? The National Comprehensive Cancer Network, a coalition of the major cancer centers in the U.S. has published some recommendations at www.nccn.org. They first recommend that doctors ask about fatigue. My advice for patients is not to wait to be asked. Speak up.

Sometimes – maybe often, the problem is depression. Having cancer and being in treatment is not a happy event. But, antidepressants don’t help and the NCCN recommends avoiding them. Also, taking another drug along with chemotherapy is a recipe for trouble. Certainly it is important to face the problem and understand it. Cancer treatment is not a walk in the woods. Talking with someone may help with depression and of course taking it easy instead of fighting your fatigue is also good for your attitude.

This doesn’t mean becoming a couch potato, just knowing your limits. The NCCN recommends some exercise to keep fit. Most people feel less fatigued on an exercise program. Another aid for some is stimulants. Drugs like Ritalin or Dexedrine can help some people. A few years ago, a pediatrician with advanced lung cancer wrote an article on how much Ritalin helped him recover some semblance of a normal life. It doesn’t work for everyone, but worth a try.

The drug company Amgen has made a fortune selling erythropoietin, a drug that can boost red blood cell counts in anemic people. But there is little proof that this works. Before the time of erythropoietin, I would try blood transfusions if a patient receiving chemotherapy was anemic. I was never convinced it helped those with mild anemia. Although many cancer patients, especially those on chemotherapy have mild anemia, it doesn’t account for the fatigue. And, there are lots of fatigued patients with normal blood counts.

Final message. Fatigue is normal for cancer patients, especially those on chemotherapy. Talk to your doctor and perhaps a psychotherapist if you are depressed – or just for comfort. Exercise. Try Ritalin. And, don’t give up. If the cause is chemotherapy, the fatigue will get better although it might not disappear completely.