Understanding Fatigue

From time to time throughout the writing and posting of these blogs on anti-cancer treatments and their noxious side effects, reference has been made to the all-too-familiar symptoms of “fatigue”.  I need now to be a little more explicit as to what fatigue really amounts to within the context of a cancer diagnosis and illness. We are all so familiar with references to “fatigue” in the general sense, that it hardly seems necessary at first sight to add this further word.  After a hard day’s toil we talk about “being spent” which, so one might think, is surely the same thing as being fatigued.  Or we feel tired and exhausted following a day working in the garden or at the end of a cross-country run or training session or whatever.  What could be more normal?  Surely all that is needed is fluid, food, rest and time to recover.  After that we can and do expect to be “as good as new” again.

Now it has to be said that whilst the “waves of recovery” principle (which I intend to deal with in a near future blog) still holds good; understanding and treating fatigue in cancer patients is sometimes not that simple. Many – whether they experience surgery or not – may be subjected to lengthy periods of chemotherapy or radiotherapy (or both).  Consequently, some may go on to experience fatigue for seeming inordinately lengthy periods of time, well exceeding the cessation of treatment. Moreover, both acute and chronic fatigue in cancer patients, can amount to much more than mere physical exhaustion and tiredness.  Indeed, and for the purpose of this particular blog, I have attempted a definition of fatigue, based on what I have perceived in innumerable patients.  It runs as follows:

Fatigue in cancer patients amounts to a notable or significant and on-going (though variable) awareness of tiredness and malaise.  Typically, it is experienced as limb heaviness and weariness, energy loss, retarded thinking, impaired memory, reduced enthusiasm for life in general and may even inflict a ‘dumbing down’ effect on special interests, hobbies and pastimes. Fatigue may also exacerbate chronic and acute feelings of loneliness and isolation.

One patient of mine summed it all up in the following phrase.  “It is rather like driving a 3 litre motor car which has been fitted with a 11/2 litre engine”. Thus we can see that fatigue in cancer patients affects the whole person, physically, cognitively, mentally, emotionally and – yes – spiritually. Incidentally, psychometrically· valid and reliable measures, in the form of self-report ‘paper and pencil’ questionnaires and the like, are now available for its more accurate measurement and assessment.

Well what about possible pathways to relief? We have already seen in an earlier blog, how it is that the condition of the blood is inextricably linked to fatigue.  Indeed, it is well known that anaemia bears heavily on such aspects of quality of life.  Studies have shown that the treatment of anaemia with an appropriate drug, can certainly relieve some of its more distressing symptoms and bring a measure of relief. Quality night sleep is also an essential contributor to relief and recovery from fatigue. A sub-series of blogs concerning the relationship between and need for good quality night sleep (especially when suffering from a cancer illness) is also “on the stocks” for future postings.

One further contributory factor to relief and healing is possibly best introduced through the recounted experience of a man I once knew. Alan was in his late 50s and had recovered well from bowel cancer.  But now some 20 months on, he was suffering from chronic fatigue and giving up hope of ever working again.  Admittedly things had improved somewhat at the time of which I write.  He was becoming more ambulant and, at any rate, beginning to show limited interest in former hobbies/pastimes, etc.  Nevertheless, there was still a void, which so it seemed, nothing would ever return to fill.

Then, quite unexpectedly, a firm for which he had worked in days gone by approached him with a view to providing part-time general supervision and support for a group of young apprentices that had just entered the firm’s employ.  Alan undoubtedly had a way with young people and such an offer just happened to be ‘right up his street’. Some three weeks after commencing upon his new employment, Alan came to see me on a routine clinical visit. The change in him was little short of dramatic.  He appeared brighter, sharper and much, much happier. He told me that the firm had offered him a six-month contract with the possibility of a further indefinite extension based on results.

Toward the end of our discussion I asked him, “And what about the fatigue Alan… how are you coping with that?”  “Oh it’s still there” he replied “but more in the background and it comes to my mind far less often than it did”. Then he added, “My love of what I am doing… you know, its worthwhileness and all that, seems somehow to provide energy all of its own”. “Waves of recovery”, as we shall increasingly come to behold, can come in very different ‘shapes and sizes’ and not infrequently require just a little stimulation and encouragement, in the form of initiative! Nevertheless, fatigue can be very real and it must be recognized and dealt with for what it is.  On the other hand it can – if not completely, then in part – be overcome, bringing enhanced quality of life to all concerned.

  • · Psychometrics is the measurement of individual differences in psychological functions.
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