What Can I Do If My Fatigue Seems out of Proportion to the Treatment I Received or Seems to Be Lasting Too Long?

When fatigue persists, it is common to worry, consciously or unconsciously, that you have cancer again. Remind yourself that many problems other than cancer cause fatigue. In most cases where tests indicate that you are in remission, there is a good explanation other than cancer. Sometimes, however, the fatigue seen in disease-free cancer survivors has no explanation.

Keep your doctor and nurse aware of how you feel, even if your tiredness was addressed before and all treatable causes were ruled out. Although you may feel exactly the same, the explanation may have changed.

One man who was in remission after completing a course of radiation complained of lassitude, feeling cold, getting winded easily, and poor concentration and memory. A complete workup indicated that his thyroid was definitely normal, but he was mildly malnourished. His doctors reassured him that he was experiencing a common aftereffect of radiation in addition to the effects of malnutrition. As the weeks went by, he stuck to a prescribed diet and regained his weight; yet he continued to feel the same. After four months without any improvement, his doctor rechecked his thyroid blood tests; lo and behold, they were low. He had developed hypothyroidism (low thyroid) after the first evaluation, and his symptoms resolved after he took a thyroid medicine for a few weeks. Although he felt the same immediately after completion of his radiation as four months later, the cause of his fatigue was different each time.

Another patient suffered debilitating fatigue following her bone marrow transplant. A complete evaluation showed that she was adjusting well to her situation and was not depressed. Her fatigue was attributed to mild anemia and the physical aftereffects of intensive chemotherapy and radiation therapy. She followed all the advice given to her about diet, exercise, and rest. Over the next year her fatigue became less debilitating but was disturbingly persistent. A reevaluation determined that she had developed significant depression, which was manifesting itself chiefly as fatigue, a not uncommon occurrence after bone marrow transplantation. She responded dramatically to medication and counseling and is now doing beautifully without any medication.

Have your doctor or nurse advise you on specific ways to improve your diet, sleep patterns, exercise schedule, work level, and stress level. Support groups and counselors (social workers, psychologists, etc.) can offer invaluable advice and support in these areas.

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