Women who survive cancer are more likely to experience cancer-related fatigue and depression than men, according to new research presented Tuesday at the American Association for Cancer Research’s annual meeting in Chicago.
As a result, women are less likely to engage in recreational physical activity, which over time exacerbates their symptoms and lowers their quality of life, the research suggests.
The new findings build on previous research that found women develop more severe side effects during cancer treatment than men. They also underscore the “very real consequences” that cancer treatment can have for women after they’ve entered remission, said Joseph Unger, a biostatician and cancer researcher with the Fred Hutch Cancer Center in Seattle who was not involved in the study.
“Cancer treatments are becoming more effective at keeping patients alive and turning cancer into more of a chronic disease,” said Unger, who studies cancer patients’ quality of life. “Understandably, patients don’t want to just live, they want to live well. So, that’s really where this research helps to point us in the next direction.”
Dr. Simo Du, lead author of the study and internal medicine resident physician at NYC Health + Hospitals/Jacobi, had noticed that many more female than male cancer survivors in her clinic were complaining of fatigue that made it hard to shop for groceries, get dressed, shower and do other social or hygiene-related activities.
To better understand how this disparity affected patients’ quality of life, Du and her colleagues analyzed responses from 1,555 adult cancer survivors that were included in the 2015-2016 and 2017-2020 cohorts of the National Health and Nutrition Examination Survey.
Participants answered questions about whether they feel hopeless, deal with poor appetite, experience trouble sleeping and have thoughts of self-harm. They also completed questionnaires about the type of physical activities they participate in.
Overall, the researchers said, the responses could be extrapolated to 25 million survivors with over 20 different types of cancer across the U.S., including those of the prostate, breast, skin, colon and cervix.
The findings have not yet been published in a peer-reviewed journal.
Why women have worse quality of life after cancer
The study found that, compared with male survivors, female cancer survivors were 69% more likely to report cancer-related fatigue and 58% more likely to report depression.
While fatigue is already known to affect more than 80% of people with cancer, the study found that women were 1.5 times more likely than men to experience it.
Cancer treatments affect the entire body, as they can kill both cancerous and healthy cells, said Carolyn Gotay, cancer researcher and professor emeritus of population and public health at the University of British Columbia in Vancouver who was not involved in the study. These effects can persist for months to years after treatment is done, she said, leaving survivors with a host of health issues from deafness to infertility.
Cancer-related fatigue and depression can be caused by cancer itself or the other medical conditions it causes, according to the National Cancer Institute. The emotional impact of dealing with the disease can also cause these symptoms.
Why women bear the brunt of these effects remains unclear, although experts have some theories.
Research shows that women have stronger immune responses to treatments, which causes greater inflammation. Women also tend to clear drugs from their bodies more slowly than men, Du said, leading to higher concentrations of medications in their system and thus worse symptoms. It’s possible, too, that differences in body size affect how drugs and radiation are distributed and absorbed in women’s bodies.
Women are also more likely to develop cancers that are treated with hormone therapies that can contribute greatly to fatigue and depression, Du said. Some of these therapies, like tamoxifen that’s used to treat some breast cancers, are taken for five to 10 years after remission to lower the chances the cancer returns, according to the American Cancer Society.
That said, women are more likely to report fatigue and depression even without a cancer diagnosis, Gotay said, so it’s possible that sex-related hormone differences might better explain why women experience more of these symptoms from the start.
Du said that it’s also possible social gender norms play a role. Women typically have more caretaker responsibilities like tending to children and chores that can increase stress and contribute to fatigue and depression, she said.
Notably, the study found that men were more likely to have thoughts “that they would be better off dead,” Du said. This finding mirrors other data that shows suicide rates are generally higher in men than in women. Du speculated that social norms, namely expectations that men should be able to provide for their families, could be to blame.
How exercise can help
The study also found that, among all cancer survivors, those who did moderate physical activity such as walking or cycling had a 50% lower risk of cancer-related fatigue. Those who participated in more vigorous activity didn’t see any improvements in their energy, Du said.
Meanwhile, both moderate and vigorous activity was associated with a two- to five-fold decrease in depression risk, according to the research.
Overall, the results suggest that post-cancer therapy programs should prioritize exercise. A 2024 review of 113 randomized controlled trials came to similar conclusions, and found that exercise, along with cognitive behavioral therapy and mindfulness-based programs, improved cancer-related fatigue both during and after cancer treatment.
“We always prescribe medications” to help cancer survivors cope with lingering symptoms, Du said. “But for cancer-related fatigue, exercise may actually work better than pharmaceutical interventions.”
Even still, exercise may be a bandage solution, Unger said, treating just the symptom and not the root cause. Future research needs to investigate why women experience worse side effects after cancer so they can benefit from more effective treatment options.
In the meantime, Gotay said she hopes the study helps normalize the idea that it’s OK to not feel OK after surviving cancer, which can be tough for many survivors to understand and accept.
“When people survive cancer and have fatigue or depression, they think that something is wrong with them because they’re not grateful,” Gotay said. “But they shouldn’t feel alone … or as though they’re deficient. It’s a part of the whole experience … and we need to start giving them the tools they need to make their lives as rich as possible.”
