Fatigue, Depression Hit Harder on Women Cancer Survivors, Data Show

Women who survive cancer are 69% more likely to experience cancer-related fatigue and 58% more likely to suffer depression than men, according to an analysis of responses to a national health survey presented Tuesday at the American Association for Cancer Research (AACR) Annual Meeting in Chicago.¹

Simo Du, MD, MHS | Image credit: Albert Einstein Medical College

Simo Du, MD, MHS, a resident at NYC Health + Hospitals/Jacobi and Albert Einstein College of Medicine, led a team that evaluated responses to 2 cycles of the National Health and Nutrition Examination Survey (NHANES) between 2015 and 2022; the survey includes a section on depression and anxiety. The NHANES data included responses from 1555 cancer survivors who were representative of the survivor population in the US. The sampling model included adjustments for age, race, socioeconomic status and comorbidities.

Cancer-related fatigue affects up to 80% of patients who receive chemotherapy or radiation, while depression affects about 25% of patients, the data revealed. But fatigue can persist even after cancer treatment ends, and the fallout of higher rates of fatigue and depression among women may cause them to have lower rates of physical activities and quality of life in survivorship, Du and fellow researchers found.

“During my residency, I saw a lot of cancer patients both in the clinic and inpatient settings, and cancer-related fatigue was one of the most frequent complaints they brought up,” Du said ahead of presentation of her study, which is featured at a poster session and in an AACR press conference. “It impacts not just their daily activities but also their overall quality of life and mental health, making tasks like climbing stairs, doing groceries, or laundry overwhelming.”

It is known that both cancer progression and treatment affect women and men differently.² Women often experience higher rates of toxicity from treatment than men due to differences in the way drugs are absorbed in the body, leading to calls for dosing that is specific to gender and not just weight.³ Studies show that women’s bodies may be slower to clear high-dose therapies, and they may have stronger immune responses to today’s newer treatments.

Du and her colleagues wanted to understand not just the differences in physical response to treatment between men and women, but also how these differences affected quality of life.¹ Although women scored higher than men on most depression metrics, men scored higher on the question of “having thoughts that they would be better off dead.” Du believes this could mean male cancer survivors face higher risk of suicide than women.

In addition, Du said, women may be more likely to continue caregiving responsibilities, which could exacerbate fatigue. Treatments may be more likely to disrupt sleep in women, contributing to fatigue.⁴

Specific data points in the abstract include¹:

• Female cancer survivors reported a 58% higher likelihood of experiencing depression compared with male survivors (OR, 1.58; 95% CI, 1.10-2.26, P = .014).
• Female survivors were 69% more likely to experience cancer-related fatigue than male survivors (OR, 1.69, 95% CI, 1.24-2.31; P < .001).

Among all cancer survivors, those reporting cancer-related fatigue were 86% more likely to cut back on moderate exercise, such as brisk walking, bicycle riding, or yard work. Survivors experiencing depression were 65% more likely to reduce both moderate physical activity and more intense exercise, such as running or hiking.

Notably, the researchers found that neither depression nor cancer-related fatigue significantly impacted work-related activity (OR, 1.17; 95% CI, 0.79-1.73; P = .431).

Cancer survivorship has received increased attention over the past decade, as professional societies and the National Comprehensive Cancer Network have developed guidelines for care after initial diagnosis and treatment.⁵ Medicare’s alternative payment model in cancer care, the Enhancing Oncology Model, calls for the development of survivorship plans.⁶ But Hil Moss, MBA, a young breast cancer survivor, created OncoveryCare because she saw gaps in available models to meet patients’ needs in cancer survivorship.

“Our findings highlight the importance of providing special attention and tailored interventions such as exercise programs, support groups, and mind-body behavioral techniques for vulnerable groups to help effectively manage fatigue and improve participation in recreational activities as they are an essential aspect of quality of life,” Du said.

Future studies are planned that will evaluate how well interventions work in combatting fatigue and how inflammatory markers can help physicians trace fatigue by gender.

References

1. Du S, Memon R, Han S, Wang Y, Yusuf H, Mesias JA. Sex disparity in cancer-related fatigue, depression, and impact on quality of life among cancer survivors: insights from NHANES. Presented at: American Association for Cancer Research 2025 Annual Meeting; April 25-30, 2025; Chicago, IL. Abstract 4989.

2. Rakshith HT, Lohita S, Rebello AP, Goudanavar PS, Raghavendra Naveen N. Sex differences in drug effects and/or toxicity in oncology. Curr Res Pharmacol Drug Discov. 2023;4:100152. doi:10.1016/j.crphar.2022.100152

3. Wagner AD. Sex differences in cancer chemotherapy effects, and why we need to reconsider BSA-based dosing of chemotherapy. ESMO Open. 2020;5(5):e000770. doi:10.1136/esmoopen-2020-000770

4. Fiorentino L, Ancoli-Israel S. Insomnia and its treatment in women with breast cancer. Sleep Med Rev. 2006;10(6):419-429. doi:10.1016/j.smrv.2006.03.005

5. Sanft T, Day A, Ansbaugh S, et al. NCCN Guidelines Insights: survivorship, version 1.2023. J Natl Compr Canc Netw. 2023;21(8):792-803. doi:10.6004/jnccn.2023.0041

6. Update: Enhancing Oncology Model factsheet. CMS. June 27, 2023. Accessed April 29, 2025. https://www.cms.gov/newsroom/fact-sheets/update-enhancing-oncology-model-factsheet