With advances in medicine making cancer a disease that many can live with, health-care providers face a new challenge: helping their patients avoid feeling dead tired.
Although long overlooked, and considered relatively trivial when the disease was an immediate death sentence, fatigue has become a new frontier in the treatment of cancer.
Patients say the feeling of wrung-out exhaustion is worse than the nausea and the hair-loss brought on by chemotherapy, and often equal in discomfort to the pain caused by cancer.
Practitioners say it can be the most vexing side-effect to treat.
"Once we start treatment, fatigue is the biggest complaint and the most difficult to manage," said Elaine Scheinblum, a nurse at the cancer center at St. Francis Hospital and Medical Center in Hartford, Conn.
Chemotherapy is the most frequent cause of fatigue, because it kills healthy red blood cells along with the cancer. Anemia can be treated with medication or blood transfusions.
But sometimes, the exhaustion has no measurable physical link. Some medications cause insomnia, which obviously can lead to daytime tiredness. Patients who are in pain or depressed also can have trouble sleeping.
Sometimes, however, the problem is just the opposite. Patients just do not feel like getting out of bed.
"Part of the thing that gets people down in the dumps is they can't do the things they want," said Dr. Elizabeth Whelan, a radiation oncologist at the Center for Cancer Care in Torrington, Conn., an affiliate of Charlotte Hungerford Hospital.
The center is experimenting with complementary therapies such as guided imagery, Reiki, massage and art therapy to help their patients feel better.
Michael Lyn Cappello said guided imagery has helped her find the energy to raise four school-aged children while battling aggressive breast cancer, which has spread to her liver. "I just close my eyes and try to relax my body and imagine I'm a healthy person.":
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