“As a resident physician at a city hospital, I see lots of cancer patients whose primary complaint isn’t pain, weight loss, or poor appetite — it’s fatigue,” says Simo Du, MD, a resident at NYC Health + Hospitals/Jacobi Medical Center and Albert Einstein College of Medicine in New York City, who led the team that analyzed the survey responses. “Interestingly, we observed that women disproportionately experience exhaustion and significant impairment in their daily lives.”
In examining the existing research, Dr. Du says she and her colleagues identified a “substantial” knowledge gap regarding sex disparities in cancer-related fatigue. They wanted to better understand why these disparities exist in order to devise targeted interventions.
“Cancer-related fatigue significantly impacts patients’ quality of life but remains underemphasized, especially regarding sex-based disparities,” Du says. “Increased awareness among clinicians for routine screening from diagnosis through treatment and survivorship is essential.”
Fatigue Hits Female Cancer Survivors Especially Hard
Du and her colleagues evaluated responses to the 2015 and 2022 National Health and Nutrition Examination Survey (NHANES), which includes sections on depression and anxiety.
The data included responses from 1,555 cancer survivors. Adjustments were made to the sampling model for age, race, socioeconomic status, and coexisting illnesses.
Key findings:
- Cancer-related fatigue affects about 80 percent of patients who receive chemotherapy or radiation, and depression affects 25 percent.
- Women are 69 percent more likely to experience cancer-related fatigue and 58 percent more likely to experience depression compared with men.
- Both male and female cancer survivors with fatigue were 86 percent more likely to cut back on physical activity; those with depression, 65 percent more likely.
- Higher fatigue and depression rates among women led to lower rates of physical activity but didn’t significantly impact work-related activity.
The reasons women are more likely to have higher rates of fatigue and depression may be associated with differences in drug absorption, immune responses, and responsibilities in their day-to-day lives, the researchers suggest.
Gendered work expectations, for instance, mean that women typically take on greater caregiving responsibilities at home compared with men, even during and after cancer treatment.
This may help explain why women tend to experience a greater “cancer burden,” says Scherezade Mama, DrPH, assistant professor in the department of health disparities research at the University of Texas MD Anderson Cancer Center in Houston, who was not involved in the survey.
Exercise Is Beneficial for Cancer Patients and Survivors
Cancer-related fatigue and depression often lead to less physical activity, which can lead to poorer quality of life, the survey revealed.
Physical activity is crucial throughout the “cancer care continuum,” Dr. Mama says. “We definitely recommend physical activity to prevent and reduce risk initially, but then also during active treatment, we have physical activity recommendations. And then through the recovery and survivorship phases.”
Mama says cancer survivors have often told her that following a regular exercise routine gives them a sense of “controlling their cancer journey” at a time when many things, such as response to treatment, are outside their control.
What Kind of Exercise Is Best During and After Cancer Treatment?
“Both aerobic and resistance exercise have numerous positive effects on cancer treatment–related symptoms, including fatigue and depression, but also other things like physical functioning, anxiety, and sleep, which may also contribute to fatigue and overall quality of life,” she explains.
The type of exercise doesn’t necessarily matter. She recommends finding an activity you enjoy and are likely to stick with. “Every little bit counts,” Mama notes.
Du and Mama both suggest cancer patients ask their clinicians for referrals to experts such as physical therapists and certified fitness trainers, who can offer individualized exercise recommendations.