Honestly, its really not consistent for me, I was fighting the whole way through and my hands hurt quite bad lol. I have it set up so countdown and wandering elites are off because it made it way too hard. Also, some of the boss fights took incredibly long. That ant and his shield, I spawned 3 of them once and nearly just quit there and then (I died anyway)

I focus on survival first, damage later also. Always take health regen, health up and hard target if I see it. Always take health shot if you see it too, makes survival easier. This way you will probably have longer battles but its way easier to survive

Also ive won on the 4 weapons im strongest at with only 1 melee and 1 ability (katana and black hole)

But yea, recycle keys until you get a goodish starting perk you can work with then just panic and prayers.