- Question from Page: Is it normal for fatigue to get worse instead of better?
- Answers —Lillian Nail, Ph.D., R.N.: This is a difficult question to answer because the answer is "it depends." So it depends on what is going on. For women getting chemotherapy it is not unusual that their fatigue worsens with each cycle of chemotherapy. And then gradually improves after chemotherapy is over. However, if something else in their life or their treatment regimen has changed, it may be that they experience a sleep problem as a result of a drug side effect. They may have experienced the physical deconditioning that we talked about before that makes them feel tired and makes it more difficult for them to do the activities that we all do as part of day-to-day life, or a person experiencing a problem with depression as a result of confronting a life threatening illness. Even when you have gone into remission and things are going very well, that's when depression might hit. Sometimes when people finish treatment is a point of important transition and since they might feel that they are no longer actively doing something about having had cancer that this is a time where they may feel emotionally vulnerable.
- Marisa Weiss, M.D., president and founder: For many women, the weight gain that comes with treatment, either as a result of inactivity, the steroids that are used to minimize some side effects, changes in your metabolism, as you shift into menopause quickly. This weight gain can be very discouraging and make it harder for you to want to get up and go and be active. In my practice, I find that the more weight that my patients gain, and the faster that that weight gain occurs, the less energy they seem to have.
- Russell Portenoy, M.D.: The implication of these comments is that unless a worsening fatigue fits a clear pattern, such as the worsening that occurs with repeated cycles of chemotherapy it should be assessed fully for the possibility of physiological or psychological factors that could worsen it.
- Marisa Weiss, M.D., president and founder: Recovering your energy and the resolution of fatigue tends to happen slowly with some days being good days and other days feeling like no days. You can expect that this time frame for recovery is going to be irregular.
- Lillian Nail, Ph.D., R.N.: And it's not steady progress. You hit a plateau and it seems like things aren't changing and suddenly you have a day with marked improvements.
- Marisa Weiss, M.D., president and founder: It is those glimpses of your "old self" that can really be most encouraging.
On Wednesday, March 21, 2001, our Ask-the-Expert Online Conference was called Ease Fatigue, Boost Energy. Lillian Nail, Ph.D., R.N., Russel Portenoy, M.D., and Marisa Weiss, M.D. answered your questions about ways to manage fatigue and increase energy levels.
The materials presented in these conferences do not necessarily reflect the views of breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.
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Lillian Nail, Ph.D., R.N., is the Dr. May Rawlinson Distinguished Professor and a senior scientist at the Oregon Health Sciences University School of Nursing in Portland.
Marisa Weiss, M.D. is a radiation oncologist specializing in breast cancer and the founder, president, and guiding force behind Breastcancer.org.
