My chemotherapy schedule has become pretty routine at this point. I visit my doctor on Monday afternoons, 2 weeks on and 1 week off. During that time, I sit in a leather recliner getting random liquids pumped into my veins. The plus side of this is that it is an excellent time for me to get some work done. The nurses have become accustomed to my requests and will already have a desk set up next to my chair for my laptop and supplies. I do not know the exact names of everything I am receiving offhand, however I know one of the items is meant to help prevent any nausea and sickness I would otherwise get from the Oxaliplatin. While it prevents any nausea, I do get some side effects of nausea, like the sweats. Pretty much the chemotherapy renders me useless for the rest of the day. I am loopy and tend to just want to sleep. This week was a new level of exhaustion as I was pretty much out by 9pm. Notes from the doctor: Blood results look great, blood pressure was slightly lower than usual, and he does not suggest I drink breast milk to help combat cancer.
Today I feel pretty good. Not 100% but significantly better than before. Just in time for the most hectic week of the year. Let’s hope I’ve got what it takes. Below is Clover’s more educated take as to why I am loopy and tired after chemo.
You guys can blame me for the delay in this week’s post, because honestly I didn’t really have a good explanation for why Ryan felt “loopy and tired” other than … chemo sucks.
My inability to accept posting that succinct and unenlightened answer led me to research the possible mechanism(s) of post-chemotherapy fatigue. Fatigue is a common complaint attributable to cancer itself, however fatigue is also a very common side effect of chemotherapy, affecting 82-96% of patients receiving treatment(1). The fatigue experienced in cancer as well as during cancer therapy is different from that everyday tiredness experienced on a daily basis because this fatigue may not resolve with sleep or rest. Chemotherapy may cause fatigue through a myriad of ways, both as a direct side effect as well as through secondary means. For example, Ryan’s blood count is checked every other week for signs of anemia, which is a common adverse effect as well as a significant potential source of fatigue. Another secondary cause may be poor nutrition due to nausea, vomiting, or lack of appetite. One proposed mechanism for the direct effects of chemotherapy on fatigue is actually the same as the mechanism behind fatigue from cancer (2). In cancer, tumor cells are thought to release proinflammatory cytokines (basically, messenger cells that usher along immune responses) to promote an inflammatory response, which is somehow thought to promote tumor growth (I’m still not 100% clear on how exactly this occurs). Some chemotherapy drugs, including cisplatin (the ugly cousin drug of oxaliplatin) are thought to increase these cytokines as well, which have been associated with sleep changes as well as chronic fatigue. Don’t ask me how those exact same cytokines don’t then promote a tumor growth as well – this is some seriously circular stuff and I haven’t quite had enough sleep to slog through it. That question in itself may be a logical fallacy. However, I will say that cytokines aren’t really the good guys or bad guys here. They’re just the messengers. Don’t shoot the messenger. We have those guys gossiping about even when we just get a papercut (although papercuts truly are evil).
I guess my takeaway point from this somewhat confusing post is that there is still a lot that we don’t know about the mechanism of a process as nebulous as fatigue, not to mention cancer-related fatigue.
1 Iop A, et al. Fatigue in cancer patients receiving chemotherapy: an analysis of published studies. Annals of Oncology 2004;15(5):712-720.
2 Ray M, et al. Fatigue and sleep during cancer and chemotherapy: Translational rodent models. Comp Med 2008;58(3):234-245.