Fatigue - 1265172


My father, age 69, non-smoker, was diagnosed with stage IIIA lung adenocarcinoma (PT1bN2M0) in Dec 2013. He had surgery followed by four rounds of chemo (cisplatin and Gemcitabine). During the treatment, he had severe side effects, mainly vomiting and loss of appetite , but was able to recover from that. A month after chemo, he started radiation therapy, but was not able to finish due to severe fatigue. Now it has been more than a month after his last treatment, he is still suffering from the fatigue. He sleeps in bed at least half of the time during the day, and feels very tired even sitting for an hour or so. He also does not eat much, and lost some weight. During the treatment, all examinations (CT, ultrasound, SPECT, PET) shows no sign of recurrence. His blood works are also fine, except CEA is above normal (about 14).

I am concerned about his fatigue. My question is what is the likely cause of this? Is this side effects of treatment, cancer cachexia or depression? How do we find the cause and proper treatment for his symptoms? For example, will oxygen therapy help?


Dr West
Posts: 4735

There are dozens of causes of fatigue, far too many to rule out based on a detailed discussion here. It is very, very common to have patients experience profound fatigue during cancer treatment, especially an aggressive plan that combines several modalities such as chemotherapy, radiation, and surgery.

The most fruitful way to assess fatigue in the weeks to months after aggressive cancer treatment is to hold treatment and see whether things improve over time. After multimodality therapy, a few weeks is often not enough to clear the fatigue.

At this point, it seems that further treatment is neither clearly needed nor feasible, so the approach of holding treatment and looking for improvement is appropriate. If it doesn't improve over the coming weeks to months, it makes sense to look for other explanations, whether relapsing cancer, thyroid problems, or some other cause.

Oxygen doesn't help unless someone has low blood oxygen levels when breathing room air. We often check their oxygen saturation with an oximeter, just a little probe that you can put on a fingertip or ear, to tell how much of the blood is oxygenated. If it's over about 88%, there isn't a likely value in adding supplemental oxygen.

Good luck.

-Dr. West

Posts: 10

Dr. West,

Thank you very much for your quick response. I really appreciate it!

Posts: 144

My question to Dr West is, what does extreme mean?

I had full time working sleep patters of basically 10 to 6. No naps. I have now had 5.5 years of treatment for Stage 4 NSCLC, and 2 without paid employment, plus 10 sessions of WBR, and one of SBRT, plus commencement on Clovis trial in March 14, I'm unsure whether ny fatigue level is normal or extreme.

It's all a viscous cycle, I don't eat (I'm living on high protein drinks), and down to 43 kg. lack of exercise due ti low energy. Freezing cold weather not encouraging, and I'm not allowed to drive.

I tend to wake at 6.30 when husband goes to work, and then doze, listening to radio until about 9. Get up, a few things done, take trial drugs and painkillers, and doze of the couch for about an hour. Same in afternoon, with nap, then bed at 9ish. Seems like an awfully of sleep to me.

Dr west, your thoughts, plus other peoples experiences please. I don't know whether it's normal, laziness or what.

Thanks and cheers to all. Despite everything I have 3 more holidays booked.


Posts: 2753

Hi Gail,

I don't know how important it is to define "extreme" or "profound" in this context, but I think we can rule out laziness - the fatigue you describe seems pretty typical. From your profile I see that you had WBR in February of this year, and it is not at all unusual to have significant fatigue just from that therapy (in addition to the cumulative effects of all the other treatments you've had) and require more rest. After my wife completed WBR, she resumed treatment and was quite fatigued for months thereafter. Like you, she slept longer at night and took naps to get through the day, but she was still active, similar to what you describe.

Forum moderator

Dr West
Posts: 4735

I'm truly sorry you're so fatigued.

Fatigue is actually graded as mild, moderate, or severe based on whether it is relieved by rest, significant enough to limit certain daily activities, or severe enough to limit activities of daily living related to self-care, such as bathing and feeding, getting dressed, etc.

I wouldn't expect CO-1686 to cause severe fatigue, but it's certainly possible. If there's a question about whether a symptom is caused by the treatment or the underlying disease, I'd generally favor holding the treatment and seeing whether the symptom improves or not. If it improves, you can probably conclude that the treatment caused it. If it doesn't improve, and esepcially if it worsens, I'd take that as evidence that the disease is causing the symptom.

Good luck.

-Dr. West


My husband experienced severe fatigue during the time of thoracotomy closely followed by chemo/rads. He slept all the time and remained fatigued. I read some lines I'd written during that time just yesterday and it said how exciting it was to come home and see D sitting on the back porch petting the dogs.
yuzhou05, it sounds like your father may be in a similar situation. Like Gail my husband still drinks an awful lot of protein drinks with extra calories, sometimes only them. Nutrition and hydration is important to get over this bump. Magace has been very helpful for D. As a matter of fact he just started taking it again last week when we realized he was living off ensure protein drinks.

Gail, you're not lazy. I hope you get some energy back before the next trip. Take care, You remain in my thoughts.


Posts: 10

Dear catdander,

Thank you for sharing your story. It is reassuring to know that we are not fighting alone. My Dad's condition has improved a little bit in the last month, but the recovery is slow. I am wondering how long does it take your husband to recover from the fatigue?