Research for Survivors

Fatigue remains in some survivors years after treatment ends

by Karen Syrjala, PhD, Co-Director, Survivorship Program

Fatigue is one of most prevalent symptoms reported by long-term cancer survivors. Long-term fatigue occurs in about 20-40% of survivors who have received either chemotherapy or radiation therapy. In survivors, fatigue is often described as lack of stamina or energy and muscle weakness. Studies have recently documented increased rates of this 'survivor fatigue' by comparing long-term cancer survivors versus others without a cancer history. One study compared cases and controls using the 1999-2002 population-based home interview survey from the Centers for Disease Control National Health and Nutrition Examination Survey (NHANES) database of 10,083 adults.¹ They reported that long-term adult survivors had a higher likelihood of physical limitations, 53% compared with 21% for controls without cancer. Another large study looked at 25,719 postmenopausal women with a median age of 72. When compared to women without a history of cancer, survivors reported only modest but significantly different rates of inability to do heavy housework (42% versus 31%), walk a half mile (26% versus 19%), or walk up and down stairs (9% versus 6%).² Over 10,000 survivors of childhood cancers also reported more physical limitations (20% of the survivors versus 12% of their siblings) and restricted participation in social or physical activities, work or school (3-8% of survivors).^3,4

The best proven treatment so far for fatigue is exercise. Exercise programs improve heart and lung fitness, fatigue and general well-being after cancer.^5,6 Some cancer survivors are inspired to increased their physical activity after diagnosis. In a study of breast cancer survivors who were a mean of 13 years after diagnosis, women reported generally high levels of function, but the best physical health was reported by those who increased their exercise levels after diagnosis.⁷ Thus the bottom line for those suffering fatigue is to increase activity levels to rebuild muscle and cardiovascular health and to improve overall physical and emotional well-being.

References
¹ Ness KK, Wall MM, Oakes JM, Robison LL, Gurney JG. Physical performance limitations and participation restrictions among cancer survivors: a population-based study. Annals of Epidemiology 2006; 16:197-205.
² Sweeney C, Schmitz KH, Lazovich D, Virnig BA, Wallace RB, Folsom AR. Functional limitations in elderly female cancer survivors. Journal of the National Cancer Institute 2006; 98:521-9.
³ Robison LL, Green DM, Hudson M, et al. Long-term outcomes of adult survivors of childhood cancer. Cancer 2005; 104:2557-64.
⁴ Ness KK, Mertens AC, Hudson MM, et al. Limitations on physical performance and daily activities among long-term survivors of childhood cancer. Annals of Internal Medicine 2005; 143:639-47.
⁵ Vllance JK, Courneya KS, Jones LW, Reiman T. Differences in quality of life between non-Hodgkin's lymphoma survivors meeting and not meeting public health exercise guidelines. Psycho-Oncology 2005; 14:979-91.
⁶ Shmitz KH, Holtzman J, Courneya KS, Masse LC, Duval S, Kane R. Controlled physical activity trials in cancer survivors: a systematic review and meta-analysis. Cancer Epidemiology, Biomarkers & Prevention 2005; 14:1588-95.
⁷ Kendall AR, Mahue-Giangreco M, Carpenter CL, Ganz PA, Bernstein L. Influence of exercise activity on quality of life in long-term breast cancer survivors. Quality of Life Research 2005; 14:361-71.