R-Chop Fatigue

Hi Ayesha,

I had 6 R-CHOP last year.

On the first five days of his treatment, your father gets a rather high dose of prednisone (the "P" in "CHOP"). This steroid works with the other chemotherapy drugs in several ways, among which - besides enhancing their tumor-cell-killing effects - alleviating pain and nausea, increasing appetite, and generally stimulating (to the point of causing insomnia).

Usually, on the second day after the last dose of prednisone, and because of the brutal drop in steroid dose (our bodies produce their own, but not quite so high!), the patient will "crash", i.e., feel very tired and sleepy. Then your father should gradually start recovering over the course of the following days.

In my experience, I would feel the best on Day 12 of each cycle, and maintain that state of relative "well-being" until the next dose of chemo.

Your father is only in the course of his second cycle at this point, but you should also be aware of the fact that the effects of treatment are cumulative, and that he will likely find himself feeling even less up to going in to the office as he advances through treatment.

As a conclusion, what you describe seems to me quite "normal" for someone going through R-CHOP, but of course, if any symptoms or side effects seem too much to bear, your father's doctors should be informed.

Hope this helps.

PBL

ashsaj,

Severe fatigue is a hallmark of combination chemos.  The weakness is more a product of the drugs than the disease itself.  As mentioned, this becomes more severe with more doses in most people.

I never had R-CHOP, receiving R-ABVD instead. They are similiar, except that CHOP has Prednisone but ABVD does not, and ABVD has Bleomycine, and CHOP does not.  This means that R-ABVD has NO STEROID.  This of course means that there is no "post-Prednisone crash" (a good thing), but that is because there is never any Prednisone energy boost, either.   Ergo, all reaction to R-ABVD is down: severe fatigue all the time, not some of the time.  My experiences was that the first week after infusion was a little worse than the second, but after about 3 infusions (1.5 months) I basically slept all the time, at least 15 hours per day, every day.  Some days more than that.  If someone had suggested that I work I would have laughed, if I had had the energy.

Some on R-ABVD have a bit easier time of it than I did, especially if they received fewer doses.  And other chemos (R-EPOCH, R-ICE) usually require inpatient stays.   My point is: extreme weakness is the norm.  Probably, it will intensify.  All pateints have differing experiences, and I hope his is as mild as possible.  I was 53 at diagnosis, and your description of him somehow reminded me a little of myself.

Focus on the fact that most patients on these drugs usually are cured and live well thereafter.  It is critical that he drink a lot of water, even if he won't eat.   In some cases, liquid nutrition like Ensure becomes necessary.

max

Hi Ashaj.  Glad your dad is doing better.  One thing that I found that I needed to do was "adjust my expectations."  When I thought things were going terribly, others were telling me how great I was doing!  They were right & I was wrong.  

The fatigue is probably going to be there throughout his chemo and longer.  It may get worse before it gets better. I am 4.5 months out from my R-EPOCH (= R-CHOP plus one more drug) and still nowhere near where I was before this all started.  While my course was worsened by bone-marrow failure in the beginning, I now realize that I am not unusual.  My physician advises patience and focusing on steady, incremental progress. Have you approached his doctor about ordering home physical therapy for him? This was a lifesaver for me and should be covered by Medicare/insurance if he qualifies. That and a walker, because having a walker meant that I was more inclined to get up and walk, can make a big difference.  Do not be disheartened.

Hello Team, 

I have nhl high grade and have had 5 rounds of R-chop. Due for my 6th and last in a few days time. First 4 rounds were a walk in the park. Apart from a little bit tired days 5,6 and 7, I handled the treatment really well. Fifth round? Well that's a different story. Generally fatigued most of the time with little bursts of energy enabling me to do some light work. From what I've read here, most people seem to struggle with rounds 5 and 6. I wish I could give a hug to all of you who are undergoing chemotherapy and to your support person as well. 

My experience with RCHOP was exactly the same as yours. First 4 rounds not too bad. In the fifth round I have extreme muscle weakness and am only able to do anything useful for 30 minutes or so. Then feel too tired. I guess the effects really are cumulative. Not looking forward to round 6 - Hopefully the last!