Women with cancer are more likely to experience cancer-related fatigue and depression than men, according to new research presented at the annual meeting of the American Cancer Research Association in Chicago on Tuesday.
Research shows that women are therefore less likely to engage in recreational physical exercise, and over time they aggravate their symptoms and reduce their quality of life.
The new discovery is based on previous research that found that women are more severe than men during cancer treatment. They also highlighted the “very realistic consequences” that women may have for women after remission.
"Cancer treatment is increasingly effective in keeping patients alive and turning cancer into a chronic disease," said Unger, who studies the quality of life of cancer patients. "It is understandable that patients do not want to live, they want to live well. So, this is really where this research helps point us in the next direction."
The study’s lead author Dr. Simo Du and the lead author of the internal medicine physician at NYC Health + Hospitals/Jacobi have noted that male cancer survivors in the clinic are more fatigued than women with more male cancer survivors, making it difficult to buy groceries, wear clothes, shower, and do other social or hygiene-related activities.
To better understand how this difference affects the quality of life of patients, DU and her colleagues analyzed responses from 1,555 adult cancer survivors from the National Health and Nutrition Survey from 2015-2016 and 2017-2020.
Participants answered questions about whether they felt desperate, faced with bad appetite, had trouble sleeping and had self-harm. They also completed a questionnaire about the types of sports they participated in.
Overall, these reactions can be extrapolated to 25 million survivors, including more than 20 different types of cancer, including those of the prostate, breast, skin, colon and cervix, the researchers said.
These findings have not been published in peer-reviewed journals.
The study found that female cancer survivors were 69% more likely to report cancer-related fatigue and 58% more likely to report depression than male survivors.
Although fatigue has been known to affect more than 80% of cancer patients, the study found that women are 1.5 times more likely than men.
Carolyn Gotay, a cancer researcher and professor of population and public health at the University of British Columbia, said cancer treatments affect the entire body because they can kill cancer cells and healthy cells. The effects could last for months to years, she said, which puts survivors in many health problems, ranging from deafness to infertility.
The National Cancer Institute says that fatigue and depression related to cancer may be caused by the cancer itself or other medical conditions it causes. Dealing with the emotional effects of this disease can also lead to these symptoms.
Although experts have some theories, it is still unclear why women bear the brunt.
Studies have shown that women have a stronger immune response to treatment, which can cause greater inflammation. Du said women also tend to remove medications slower than men, resulting in higher concentrations of medication in the system, which reduces symptoms. Differences in body size may also affect differences in the distribution and absorption of drugs and radiation in women's body.
Du said women are also more likely to develop cancers treated with hormone therapy that can greatly contribute to fatigue and depression. Some of these therapies, such as tamoxifen used to treat certain breast cancers, are taken five to ten years after remission to reduce the rate of cancer’s return, according to the American Cancer Society.
That is, women are more likely to report fatigue and depression even without a cancer diagnosis, so gender-related hormone differences may better explain why women experience more of these symptoms from the outset.
Du said gender norms may also play a role. She said women often assume more caretaker responsibilities, such as raising children and chores, which can increase stress and lead to fatigue and depression.
It is worth noting that research found that men are more likely to “let them die,” Du said. This finding reflects other data showing suicide rates, which are typically higher in men than in women. Du speculates that social norms, i.e., expectations that men should be able to provide for their families.
The study also found that among all cancer survivors, those who engage in moderate physical exercise, such as walking or cycling, had a 50% reduction in cancer-related fatigue risk. Du said those attending more intense events did not see any improvement in energy.
Meanwhile, both moderate and intense activity were associated with a two to five-fold reduction in the risk of depression, according to the study.
Overall, the results suggest that post-cancer treatment plans should prioritize exercise. A 2024 review of 113 randomized controlled trials came to similar conclusions and found that exercise, as well as cognitive behavioral therapy and mindfulness-based procedures, improved cancer-related fatigue during and after cancer treatment.
"We always prescribe medicines" to help cancer survivors cope with lingering symptoms, Du said. “But for cancer-related fatigue, exercise may actually be better than drug interventions.”
Even though still, exercise can be a bandage solution, just treating the symptoms, not the root cause, Uger said. Future research needs to investigate why women experience poorer side effects after cancer so that they can benefit from more effective treatment options.
Meanwhile, Gotay said she hopes the study helps normalize people’s ideas that it’s OK to feel bad after cancer survives, which can be difficult for many survivors to understand and accept.
"When people survive cancer and have fatigue or depression, they think they have problems because they are not grateful," Gotay said. "But they shouldn't feel lonely … or as if they weren't enough. It's part of the whole experience … we need to start giving them the tools they need to live as wealthy as possible."