AFTER CANCER: POSTCANCER FATIGUE (PCF)

The oncology literature acknowledges the existence of a characteristic fatigue that occurs following treatment when remission is achieved. It is not explained completely by detectable abnormalities and persists despite the evaluation and correction of all identifiable causes of fatigue. Anyone involved in the care of cancer survivors knows that fatigue is universal during and immediately following aggressive treatment and is difficult to understand, explain, or fix. Patients who experience postcancer fatigue describe it as different from any fatigue they ever experienced under healthy circumstances; they often describe it as feeling similar to infectious mononucleosis.

Postcancer fatigue is a symptom that

• is due to the effects of prior cancer and/or cancer treatment •persists after all other known physical causes of fatigue have been ruled out or corrected

• persists after any depression, anxiety, or other emotional problem has been ruled out or resolved

•persists despite good-quality sleep, good nutrition, and abstinence from medicines that cause fatigue or sleepiness

• hinders the performance of activities of daily living (ADLs)

Postcancer fatigue affects daily life and requires significant adjustments in habits and schedules. If severe, it may prevent you from performing desired activities. Before your illness, when you felt wiped out, one or two good nights of sleep probably recharged your batteries and made you feel refreshed. With postcancer fatigue you may at times feel exhausted even after doing all the things that used to make you feel refreshed.

Before your illness you experienced a predictable pattern of progressive exhaustion after becoming sleep-deprived: you felt okay when you first got up, or after a cup or two of coffee, and then gradually got sleepy by late morning or early afternoon. Similarly, individuals with postcancer fatigue learn that their fatigue is worse under certain circumstances (before or after meals, before or after exercise, during and following family conflicts, before checkups, and so on) and that it worsens gradually. Diverse circumstances may exacerbate postcancer fatigue in different people.

Although some circumstances predictably make you feel worse, the pattern with postcancer fatigue is often variable, with days or weeks of more energy followed by days or weeks of extreme fatigue. In addition, people with this symptom often report episodic bouts of fatigue: they feel pretty good for a while, and then suddenly, while reading a book or working on a report, they are unexpectedly overwhelmed with debilitating fatigue. They may feel fine until halfway through lunch—and all at once become too tired to finish eating.

“Postcancer fatigue” is a term that can be applied only after all treatable causes of fatigue have been ruled out by your oncologist or internist, or have been corrected.

*68/32/5*

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