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Sleeping with the enemy: treatment of fatigue in individuals with cancer.

The Oncologist 2002;7:96-99 www.TheOncologist.com INTRODUCTION For people with cancer, like me, cancer is the C word. What I have discovered is that cancer does not travel alone, but is accompanied by its insidious colleague, namely fatigue, which, for me, is the F word. This profane side effect adds additional disabling restrictions to my struggle against cancer. An important warning for many, but a life-limiting condition for others and me with cancer, how can fatigue both defend our well-being and disable our desires? What parts of our body control our sense of fatigue? Can we achieve control over its working parts? How many times have I heard that a particular therapeutic agent or combination of agents will have side effects, perhaps nausea, bowel irritation, anemia causing tiredness, and of course, fatigue? I have been generally informed that some degree of fatigue is inevitable and needs to be endured. I was told by my oncologist and radiation therapists that my energy resources will be limited, I will neither feel like nor be able to work, will not seek social interactions and activities with my family and friends as I had before my diagnosis, and that treating any underlying purely physiological source of the problem, epoetin alfa (Epogen®; Amgen; Thousand Oaks, CA) for anemia, for example, while important, will not fully restore my energy resources to precancer levels. Further, I was told I needed to accept fatigue’s presence for the duration of my battle against cancer. I was admonished to passively accept its intrusive and disabling affects, as though passive acceptance of any part of having cancer could be acceptable. While I often learned to adapt to certain physical and other restrictions resulting from my diagnosis, I needed to not permit cancer to curtail all vestiges of my potential resilience. There may not be medical weapons that will sufficiently defend the integrity of my bodily organs, but perhaps there are untried resources to better mobilize my emotional energies so I can again vigorously pursue my life’s goals.