Start With Small Steps
Id love totell you that fatigue will disappear as quickly as it came on. It doesnot. But it will dissipate with time.
Its alsonot the same for everyone and its hard to quantify, to judge how bad it is.Fatigue isnt like a blood test that offers measurable datapoints. But its real. Its a formidable challenge in the cancerfight, but youre not alone.
So just getgoing, and take baby steps. Walk or exercise for five minutes,seven minutes or 10 minutes, whatever you can do. Keep building a routine,perhaps going from once a day to twice a day. Judge how you feel today.Judge how you feel in a month. Keep going.
How Can We Help Relieve Or Prevent Fatigue
Only two interventions have been proven truly effective in large clinical trials to relieve or prevent fatigue: correction of anemia and exercise. One reason it has been difficult to evaluate new therapies is due to a lack of understanding of the exact cause of CRF, as well as the lack of an animal model in which to do preliminary studies. You can’t exactly ask a mouse to rate his fatigue! In addition to anemia and exercise, we will discuss some other ways to manage fatigue that have been shown to be helpful.
Anemia
Anemia is defined as a hemoglobin level below 12 g/dl, and symptoms include shortness of breath or difficulty breathing with exertion and fatigue. Anemia in a cancer patient can have many causes including bleeding, bone marrow involvement of disease, chemotherapy, radiation therapy, organ dysfunction , or nutritional deficiencies. Anemia is believed to be one factor contributing to fatigue, and its correction has alleviated fatigue in clinical trials. One way to correct anemia is through the use of blood transfusions in some cases, this may be the best method, particularly if the patient is bleeding or having symptoms. Despite many safeguards, blood transfusions are not without risk and can lead to the transmission of viruses, allergic reactions, and lung injury.
Exercise
Energy Conservation
Integrative Therapies
Medications
What The Patient Can Do
- Rest, but not too much. Plan your day so you have time to rest. Take short naps or rest breaks , rather than one long nap during the day. Too much rest can lower your energy level and make it harder to sleep at night.
- Certain drugs used to treat pain, nausea, or depression can make a person feel tired and sleepy. Talk with your cancer care team about this. Sometimes adjusting the doses or changing to a different drug can help.
- Talk to your health care team about any problems with your nutritional intake
- Regular moderate exercise especially walking is a good way to ease fatigue. Talk to your doctor about the right exercise plan for you.
- Ask your family or friends to help with the things you find tiring or too hard to do.
- Try to sleep 7 to 8 hours each night. Sleep experts tell us that having regular times to go to bed and get up helps us keep a healthy sleep routine.
- Each day, prioritize decide which things are most important to you and focus on those tasks. Then plan ahead. Spread activities throughout the day and take breaks. Do things slowly, so that you wont use too much energy at once
- Avoid caffeine
- Avoid exercising too late in the evening.
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Stomach Upset Loss Of Appetite And Weight Loss
Cancer can cause nausea, vomiting, diarrhea, and constipation. Anxiety and lack of sleep can also upset the digestive system.
It can be more difficult to eat a healthy diet as these symptoms occur, setting up a vicious cycle. As women avoid certain foods because of stomach upset, the digestive system may lack the fiber and nutrients it needs to function optimally.
Over time, women may lose their appetite and have difficulty taking in the calories they need. Not eating regularly may cause significant weight loss and nutritional imbalances.
How Cancer Treatment Causes Fatigue
Radiation therapy, chemotherapy, surgery, hormone therapy, immunotherapythese treatments and their common side effects challenge the body, and the body needs energy to recover.
When you start a new treatment, the body produces cytokines to help boost the immune response. When cells die, the body works to clean up those dying cells, causing inflammation. Its a desirable response in this case, but inflammationboth acute and chronicalso causes fatigue.
You can compare this fatigue to how you feel when your body fights the flu or another infection, like COVID-19. While your bodys working hard to fight the infection, you feel tired.
How and when you experience fatigue from cancer treatment may vary according to the treatment youre receiving and its side effects.
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‘i Felt A Pea On My Ribs’
I had done monthly self-breast exams since I was in my early 20s. I felt a tiny hard little bump the size of a small pea. I could only feel it because it was over my rib at the bottom of my left breast. In retrospect, my bra may have hurt a little in that area before I found the lump. I have had many lumps, bumps, and cysts biopsied, but this pea was definitely different. I scheduled my annual mammogram along with a biopsy. I received the breast cancer diagnosis within a week, just shy of my 55th birthday. Turns out, there was another in the other breast that didnt show up on a mammogram. I also discovered I was a BRCA 1 mutation carrier. I needed aggressive chemo followed by a double mastectomy. Had I not done the exam that evening, everything would be quite different.
Cynthia Bailey, MD, president and CEO of Advanced Skin Care and Dermatology, Inc., Sebastopol, California
Symptoms Of Angiosarcoma Of The Breast
Another rare form of breast cancer, angiosarcoma forms inside the lymph and blood vessels. Only a biopsy may definitively diagnose this type of cancer. Angiosarcoma can cause changes to the skin of your breast, such as the development of purple-colored nodules that resemble a bruise. These nodules, if bumped or scratched, may bleed. Over time, these discolored areas may expand, making your skin appear swollen in that area. You may or may not have breast lumps with angiosarcoma. If you also have lymphedema, which is swelling caused by a buildup of lymphatic fluid, angiosarcoma may occur in the affected arm. Cancer treatment sometimes damages the lymph vessels, which may lead to lymphedema.
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Metastatic Breast Cancer Symptoms
Metastatic breast cancer symptoms depend on the part of the body to which the cancer has spread and its stage. Sometimes, metastatic disease may not cause any symptoms.
- If the breast or chest wall is affected, symptoms may include pain, nipple discharge, or a lump or thickening in the breast or underarm.
- If the bones are affected, symptoms may include pain, fractures, constipation or decreased alertness due to high calcium levels.
- If tumors form in the lungs, symptoms may include shortness of breath or difficulty breathing, coughing, chest wall pain or extreme fatigue.
- If the liver is affected, symptoms may include nausea, extreme fatigue, increased abdominal girth, swelling of the feet and hands due to fluid collection and yellowing or itchy skin.
- If breast cancer spreads to the brain or spinal cord and forms tumors, symptoms may include pain, confusion, memory loss, headache, blurred or double vision, difficulty with speech, difficulty with movement or seizures.
‘it Felt Like There Was A Marble In My Breast’
I had fibrous breasts, so even on a good day, my breasts felt like a bag of frozen peas. I had been receiving Bright Pinks Breast Health reminder texts to check my breasts, so I was pretty familiar with how my breasts felt. However one day I felt a lump in my left breast near my nipple, which seemed to be the size of a marble or gumball. This lump felt different. It was hard, but had a bit of a give to it.
“From the moment I felt the lump, I knew I had breast cancer. I went in that day for an appointment with my gynecologist, who ordered a mammogram for later that afternoon. After that, I had a core needle biopsy, but the tests all came back negative. I never felt relieved or satisfied with that result.
“At a later breast check, I felt the lump had grown, so I insisted my gynecologist help me find a surgeon to remove the lump. It was removed and I was told it was stage 2, aggressive triple negative breast cancer. I also discovered I was BRCA-1 positive, meaning I had the breast cancer gene. I cant stress it enough, listen to your body!
Erin Scheithe, DC Education Ambassador for Bright Pink, Washington, D.C.
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Causes And Risk Factors Of Breast Cancer
The exact cause of breast cancer is still unknown. However, the risk factors that may increase the chance of getting breast cancer are well-studied.
In general, breast cancer tumors develop from the rapid growth and division of abnormal breast cells . Eventually, the cells accumulate and form a mass or a lump.
These abnormal breast cells may spread in the other parts of the breast, lymph nodes, or organs of the body.
The risk factors of breast cancer include:
- Metastasis to other organs or parts of the body
- Cardiac disease
Why Exercise = More Energy
Are youasking: How can exercise give me more energy? I can barely go to the grocerystore! I admit that it seems counterintuitive. But if you think about whatexercise does to the body, it might make more sense.
Exercise in any form brings oxygen to your muscles. This is true whether exercise is aerobic , resistive or yoga .
All theseexercise types also take away waste products. They bring fresh oxygen, freshnutrients! Circulation is truly the key to healthy tissues.
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Other Possible Causes Of Fatigue During Cancer Treatment
Vitamin D deficiency is common in the general population. Correcting this deficiency in otherwise healthy people has been shown to improve self-reported fatigue. If youre fatigued due to vitamin D deficiency going into treatment, cancer therapy may be less successful and result in more side effects like peripheral neuropathy .
For example, one study of breast cancer patients being treated with paclitaxel showed that pre-treating vitamin D deficiency reduced the incidence of peripheral neuropathy and also led to fewer treatment disruptions and better treatment outcomes.
Another study showed correcting vitamin D deficiency may ease gastrointestinal mucositis, a painful inflammation and ulceration of the digestive tract, in patients undergoing chemotherapy.
Consider getting your vitamin D levels checked periodically. In my practice, I often check it at least twice a year to get a better understanding of the patient’s vitamin D rhythms from summer to winter. I recommend levels of approximately 50-80 nanograms per milliliter .
When you check your levels is important, though. Levels tend to be higher during the summer, when people are spending more time in sunlight, and lowest at the end of winter. So, if you check it in the middle of the summer and your level is 30, thats low for the targeted endpoint of 50-80 ng/ml. But if its 30 at the end of winter, that means it likely was in the therapeutic range during winter, and your levels may be sufficient.
Make Deposits In Your Energy Bank
Fatigue is one of the main side effects of breast cancer treatment. Although you may want to carry on as usual, its important to know your limits and not to expect too much of yourself.
Think of your energy reserves as your energy bank. Whenever you do an activity you make a withdrawal. And when you rest you make a deposit.
Its important to balance withdrawals with deposits. If you keep doing too much whenever you feel like you have energy, youll run out completely and not have any left for the things that are important.
- Whether youre at work or at home, plan regular breaks and be careful not to push on or youll make your fatigue worse.
- Stress can have a negative effect on your energy levels, so try doing a stress-reducing activity such as listening to music or using a mindfulness app.
- If youre very low on energy, have a nap, but limit the number of naps you take and keep them to less than an hour so you still sleep at night.
- Try to do some regular moderate exercise like walking or swimming, and eat healthy meals or snacks whenever your appetite is good.
- Finally, try to get a good nights sleep.
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How Long Does Fatigue Or Weakness Last
Fatigue that is due to cancer and its treatment can last for weeks, months, or years. It often continues after treatment ends.
- For people who have surgery for cancer with no other treatment, fatigue often decreases or goes away over time as they recover from surgery.
- For people getting chemotherapy, targeted therapy, or immunotherapy in cycles, fatigue often gets worse at first and may get better until the next treatment, when the pattern starts again.
- For those getting radiation therapy, fatigue usually gets worse as the treatment goes on and often lessens within a few months after treatment is complete.
Fatigue can:
- Differ from one day to the next in how bad it is and how much it bothers you
- Be overwhelming and make it hard for you to feel well
- Make it hard for you to be with your friends and family
- Make it hard for you to do things you normally do, including going to work
- Make it harder for you to follow your cancer treatment plan.
What Causes Cancer Fatigue
Cancer and its treatment often cause fatigue, known as cancer-related fatigue. Between 80 percent to 100 percent of cancer patients report experiencing fatigue, according to the American Cancer Society.
If you havent been diagnosed with cancer and youre experiencing unexplained, persistent tiredness or lack of energy, you may be wondering if your fatigue could be a symptom of cancer.
While fatigue is a common symptom of cancer, cancer rarely causes fatigue alone. Fatigue is often multifactorial, meaning more than one contributing factor may be involved, and none of them may be cancer.
No matter its cause, fatigue is one of the toughest symptoms to deal with. When patients are struggling with fatigue in their daily life, they want to feel better, and theyre looking for someone to help them. As a medical oncologist at Cancer Treatment Centers of America® , I work every day to help patients enjoy a better quality of life while we fight their cancer.
In this article, Ill cover some common factors that may contribute to cancer-related fatigue. This article examines:
The main focus of this article is on patients whove already received a cancer diagnosis. But first, lets briefly explore fatigue as a symptom of undiagnosed cancer.
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When To Call Your Doctor
Although cancer-related fatigue is a common side effect of cancer and its treatments, you should mention any of your concerns to your doctor. There are times when fatigue may be a clue to an underlying medical problem. Other times, there may be things your doctor can do to help control fatigue.
Be sure to let your doctor or nurse know if you have:
- Shortness of breath
- Side effects from treatments
- Anxiety or nervousness
It Is Not Clear How Cancer Treatments Cause Fatigue
It is unclear how cancer treatments such as surgery, chemotherapy, and radiation therapy cause fatigue.
When cancer treatment begins, many patients are already tired from medical tests, surgery, and the emotional stress of coping with the cancer diagnosis. Fatigue may get worse during treatment.
Different cancer treatments have different effects on a patient’s energy level. The type and schedule of treatments can affect the amount of fatigue caused by cancer treatment. Some patients have more fatigue after cancer treatments than others do.
Fatigue related to surgery
Fatigue is often a side effect of surgery, but patients usually feel better with time. However, fatigue related to surgery can be worse when the surgery is combined with other cancer treatments.
Fatigue caused by chemotherapy
Patients treated with chemotherapy usually feel the most fatigue in the days right after each treatment. Then the fatigue decreases until the next treatment. Some studies have shown that patients have the most severe fatigue about mid-way through all the cycles of chemotherapy. Fatigue decreases after chemotherapy is finished, but patients may not feel back to normal until a month or more after the last treatment.
Fatigue during chemotherapy may be increased by the following:
- Pain.
- Lack of sleep caused by some anticancer drugs.
Fatigue caused by radiation therapy
Fatigue caused by hormone therapy
Fatigue caused by immunotherapy
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How We Treat Cancer At Ctca
We only treat cancer at CTCA. Our team of multidisciplinary cancer experts takes a personalized, patient-centered approach to treating cancer and its side effects.
In addition to using conventional cancer treatments to attack the cancer itself, we provide evidence-informed supportive care therapies to help patients tolerate treatment and reduce side effects, including:
- Nutritional support, which includes the option of meeting with a registered dietitian wholl develop a personalized plan for your nutritional needs
- Behavioral health care, which may include working with therapists to help with depression, anxiety and stress, and using techniques such as talk therapy, mindfulness and relaxation techniques
- Access to professionally led support groups for patients and their loved ones, both in-person and online, including our Cancer Fighters community, where you can connect with cancer survivors
- Naturopathic support, which includes consultations with our naturopathic providers who counsel patients on the use of natural, non-toxic techniques to support the healing process
Providers at CTCA work together under one roof, providing convenient access for patients.
If youd like to get a second opinion or talk to someone at CTCA about getting help for fatigue or other cancer-related side effects youre experiencing, or chat online with a member of our team.
