No magic pill can cure your fatigue, but there are some medical treatments that may help. If your doctor doesn't respond well to your concern about these problems, find one who will. You must assert yourself if you know you've reached your limit and need help. The best doctor is one who appreciates the problem, is willing to listen to your complaints carefully, who knows enough about the problem to do an evaluation, and who is willing to treat the problem as part of cancer care. Be specific when you talk about your fatigue, such as, "I get short of breath when I walk the five stairs to my office."
There are many medicines that can help, depending on the cause of your fatigue:
- Low immune cell counts improve with time off from breast cancer treatment, rest, and good nutrition. Special medications called growth factors, such as Neupogen (chemical name: filgrastim), can stimulate the production of new immune cells to build your supply back up to normal.
- Infections can be treated with the appropriate antibiotics and extra fluids that contain minerals you lose from excess sweating.
- Anemia resulting from iron deficiency can be treated with iron. Procrit (chemical name: epoetin alfa), Epogen (chemical name: epoetin alfa), and Aranesp (chemical name: darbepoetin alfa) work if the problem is low red blood cell counts because of chemotherapy and chronic illness. Blood transfusions can immediately increase your blood counts and your energy levels.
- Low platelet (clotting cells) counts, which also can contribute to bleeding, can be treated with a growth factor called Neumega (chemical name: oprelvekin) and, if necessary, platelet transfusion.
- An underactive thyroid can be treated with thyroid hormone replacement, called Synthroid (chemical name: levothyroxine).
- Depression can be treated with therapy (counselor, social worker, psychologist, psychiatrist), antidepressant medications, or both.
- In some cases, fatigue that isn't helped by other medicines or lifestyle changes may respond to stimulant medicines. You may want to ask your doctor about some of these options: caffeine, Ritalin (chemical name: methyphenidate), Dexadrine (chemical name: dextroamphetamine), or Provigil (chemical name: modafinal). Work closely with your doctor to find the best medicine for your situation.
Expert QuoteTo the person experiencing it, the fatigue that accompanies anemia or the fatigue that is from other causes can feel the same. So the person who experiences fatigue doesn't know for sure whether she has anemia or some other problem. That's why it's important to have an adequate assessment if the fatigue is significant. There is now evidence that makes us believe that even relatively mild anemia can be associated with fatigue in some women. And it may be worthwhile to have a relatively mild anemia treated in an effort to determine whether the fatigue lifts.
Kutluk Oktay, M.D.