Monday, April 22, 2024

Chronic Fatigue After Cancer Treatment

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Whats Normal And Whats Not

Coping with fatigue after cancer treatment Ruth’s story

Fatigue related to cancer and cancer treatment is not at all uncommon. Most people get over fatigue within a few months to a year following treatment. But there are a lot of moving parts to your life, so your experience will be unique to you.

With each treatment, youll have an opportunity to talk things over with your oncology team. They can gauge whether your fatigue falls within a normal range. If not, they can look for a cause and offer treatment.

A 2014 research review suggested that a quarter to a third of cancer survivors have persistent fatigue, lasting up to 10 years post-diagnosis. The longer it goes on, the more it can affect daily routines.

If youre still experiencing fatigue 6 months after treatment, follow up with your oncologist or family doctor.

Stress Mental And Emotional Changes

Having cancer can cause stress, sleeping problems, moodiness, and depression. Stress by itself can cause emotional, mental, and physical fatigue.

Both cancer itself and stress can cause dysregulation of cortisol. Increased levels of cortisol put your body in a high-alert state. This burns a lot of energy and can lead to mental and emotional changes and sleeping problems which all lead to fatigue.

Coping With Hair Loss

Hair loss can be upsetting. Talk to your care team if youre finding it difficult to cope with losing your hair.

They understand how distressing it can be and can support you and discuss your options with you.

For example, you may decide you want to wear a wig. Synthetic wigs are available free of charge on the NHS for some people, but youll usually have to pay for a wig made from real hair.

Other options include headwear, such as a headscarf.

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Fear Of Cancer Coming Back

After treatment, many people might be afraid that their cancer will come back . You may become concerned about new symptoms youre having and wonder if theyre related to breast cancer.

Its important to talk with your healthcare provider about any new symptoms you notice. Many of these issues are normal parts of healing and your body returning to a new normal after breast cancer treatment. Your healthcare team is always available to discuss your concerns or fears with you.

You can call or send messages to your doctor or nurse through MyMSK . It may also be helpful to talk with a social worker, therapist, or chaplain. You can also join a support group. For more information, read MSK Support Services.

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How Is Fatigue Treated

How to Live With Chronic Fatigue in Seniors

Some treatments can help with fatigue, depending on whats causing it.

  • Blood transfusion. If youre fatigued because you have a low red blood cell count , having an infusion of blood can make you feel better.
  • Nutritional advice. If youre not eating well, a dietitian may be able to give you some advice to help you get the nutrients and calories you need from your diet to keep your energy and strength up. They can also give you any supplements you might need. For example, iron or vitamin B12.
  • Hormone or steroid treatment. Some types of surgery and certain immunotherapy and hormone therapy drugs can affect your hormone levels, which can leave you feeling tired. You may need hormone supplements or steroids to improve your fatigue.
  • Counselling. Feeling anxious or depressed can sap your energy. Talking to a counsellor can help you to feel better. Find out more about counselling and how to get free counselling.
  • Complementary therapies. Some complementary therapies may help relieve fatigue, depending on whats causing it. For example, gentle massage, yoga or mindfulness. Check with your medical team first, to make sure the therapy youre thinking about is safe for you. Read more about complementary therapies.

Exercise and fatigue

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If Youre Getting Radiation Therapy To The Chest

Radiation treatment to the chest may cause side effects such as:

  • Sore throat

Radiation can also cause other problems in the heart or lungs.

Heart complications

Getting radiation to the middle portion of the chest can raise your risk of heart disease. This risk increases with higher radiation doses and larger treatment areas in this part of your body. Radiation can also cause hardening of the arteries , heart valve damage, or irregular heartbeats.

Radiation pneumonitis

Radiation pneumonitis is inflammation of the lungs that can be caused by radiation treatment to the chest . It may occur about 3 to 6 months after getting radiation therapy. Its more likely if you have other lung diseases, like emphysema . Common symptoms of radiation pneumonitis include:

  • Shortness of breath that usually gets worse with exercise
  • Chest pain, which is often worse when taking in a deep breath
  • Cough
  • Weakness

Sometimes there are no symptoms, and radiation pneumonitis is found on a chest x-ray.

Symptoms often go away on their own, but if treatment is needed, it is based on trying to decrease the inflammation. Steroids, like prednisone, are usually used. With treatment, most people recover without any lasting effects. But if it persists, it can lead to pulmonary fibrosis . When this happens, the lungs can no longer fully inflate and take in air.

Be sure you understand what to look for, and tell your cancer care team if you notice any of these side effects.

  • Anemia is a common cause of fatigue.
  • Describing And Managing Weakness

    Weakness is decreased strength. If this is caused by surgery in a certain part of the body or loss of a body part, the weakness might be helped by physical therapy or occupational therapy. If weakness is caused by having an infection or having changes in blood levels, such as low blood counts, low electrolytes, or changes in hormones, treatment to help with the specific problem can help decrease weakness.

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    Reduced Deactivation Of The Dmn

    A third pattern of connectivity emerged in three studies on brain tumors and breast cancer during treatment and before chemotherapy. They all reported a reduced capacity to inhibit DMN activation, which was correlated with measures of fatigue. Given the role of the DMN in disrupting attentional and engagement processes , failure to suppress DMN regions during tasks should be related to decreased attention and/or motivation toward the task. Nevertheless, within the DMN, hyperactivation was also observed on resting-state fMRI . Chemotherapy can induce white matter disruption and a reduction in gray matter density in several brain regions, including the DMN . Specifically, the precuneus, cingulate, lateral parietal cortex, medial frontal gyrus, cerebellum and hippocampus appear to be the structures most impacted by cancer treatments. Since the DMN is thought to be involved in contemplation, remembering, and rumination, the authors suggested that enhanced connectivity between the DMN and the frontal gyrus may be related to more cogitation and partially responsible for mental fatigue.

    This failure to suppress default mode activity during tasks has been linked to decreased activity in task-related regions leading to attentional lapses and decreases in performance . This disengagement of brain regions associated with mental effort favoring of brain regions linked to resting activity might be intended to conserve mental resources for the maintenance of engagement in the task .

    Intracellular Immunity: Nuclear Factor Kappa Beta

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    Besides activating the RNase L system, IFN also activates another intracellular double-stranded RNA-detecting system, namely protein kinase R . PKR will, once activated, stimulate nuclear factor kappa beta , a group of transcriptional regulators which modulate cellular responses to environmental stimuli and cytokines. NF-B is the major upstream, intracellular mechanism which regulates inflammatory and oxidative stress mediators. NF-B would, for instance, trigger inducible nitric oxide synthetase expression. Inducible nitric oxide synthetase generates increased production of nitric oxide by monocytes/macrophages .

    CFS patients. NF-B, as well as inducible nitric oxide synthetase and NO have been shown to be increased in CFS . The production of NF-B is significantly correlated to the severity of illness and symptoms, such as fatigue and pain. These correlations suggest that the symptoms of CFS, such as fatigue, pain, muscular tension and depressive symptoms reflect a genuine inflammatory response in those patients .

    The produced NO, in turn, has an immunological function: it is cytotoxic by inhibiting the mitochondrial electron transport and the DNA synthesis and by influencing iron metabolism . Excessive or persistent NO production as reported in CFS , is, however, detrimental for physiological functions, as explained in earlier studies on intracellular immune dysfunctions in CFS .

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    What You Can Do About Cancer

    • be aware of your own warning signs of fatigue, for example, a loss of appetite, low mood, difficulty concentrating
    • help others to understand and let them support you
    • talk to family/whnau and friends, and dont be afraid to ask for help
    • pace yourself, think about your energy levels and balance activity and rest
    • if you need time to rest during the day, dont be afraid to say no to visitors
    • have lots of nutritious snacks and meals
    • regular moderate exercise can help with tiredness and a lack of energy

    How Can I Combat Cancer Fatigue

    The best way to combat fatigue is to treat the underlying cause. Unfortunately, the exact cause may be unknown, or there may be multiple causes. There are treatments to reduce certain causes of cancer fatigue, such as anemia or hypothyroidism. Other causes must be managed on an individual basis.

    The following are tips you can use to combat cancer fatigue:

    • Conserve energy.
    • Manage your stress.

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    About Tiredness And Cancer Drugs

    Doctors use many types of drugs to treat cancer. But some cancer drugs can make you feel very tired and low on energy. This is also called cancer fatigue.

    You might find that your tiredness goes on for most of the time. And that resting does not help you to feel better. As a result, it affects your quality of life on many levels as you cant do your usual activities.

    Cancer tiredness is the most common side effect of cancer treatment. It affects between 25 and 99 out of every 100 people . Some people taking cancer drugs say that severe tiredness is the most disruptive side effect of all.

    Cancer drugs that can cause tiredness are:

    • chemotherapy

    Tiredness often happens as a group of symptoms, for example:

    • pain
    • difficulty sleeping
    • muscle weakness

    Tiredness can cause any of the symptoms below, but they can also be due to other things. Let your doctor know if you have any of these signs:

    • lacking energy and not feeling like doing much and wanting to stay in bed all day
    • feeling anxious or depressed
    • being breathless after doing small tasks, such as having a shower or making your bed
    • finding it hard to concentrate, even if watching TV or talking to a friend
    • being unable to think clearly or make decisions easily
    • loss of interest in doing things you usually enjoy
    • loss of interest in sex
    • negative feelings about yourself and other people

    How Long Does Fatigue Or Weakness Last

    How Can Chronic Fatigue Syndrome Impact the Ability to Care for Oneself ...

    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.

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    Course Of Cf And Factors Associated With Pf

    Ninety-seven of the women had CF at T2, including 57 individuals who also had CF at T1. The latter women were classified as having PF. Twenty-five women were diagnosed with resolving fatigue- i.e CF only at T1, while 40 subjects were incident cases with CF only at T2. At both assessment points women with PF had significantly higher total fatigue scores than those with chronic fatigue at either T1 or T2 . As expected, the total fatigue scores at the two assessment points were significantly correlated .

    Mean total fatigue scores at T1 and T2 grouped by fatigue status. T1: first assessment point . T2: second assessment point . NF: never fatigued. CF: chronic fatigued. PF: persistent fatigued

    In the univariate analyses previous treatment for mental problems, HADS caseness, BMI30, treatment-area related discomfort, increasing hsCRP and leukocyte count evaluated at T1 were significant predictors for PF, while educational and marital status reached borderline significance . Contrary to the findings on CF, respiratory symptoms were not associated with PF. Neither were hemoglobin-level, an elevated TSH or a diagnosis of hypothyroidism related to PF.

    How Is Cancer Fatigue Managed Or Treated

    The first step in treating fatigue is knowing the problem exists. Many people don’t bother to mention fatigue to their doctors because they believe it is normal. It’s vital that you discuss this and all symptoms or side effects with your healthcare provider. Then, efforts can be directed at determining the cause of the problem and prescribing appropriate treatment. Your particular cancer treatment regimen, with its known side effects, may provide clues for your doctor or health care professional. A simple blood test, for example, can determine if you are anemic.

    There is no single medication available to treat fatigue. However, there are medications available that can treat some of the underlying causes.

    When youre struggling, you may want to see a palliative care specialist. These experts help people with cancer manage symptoms like pain, nausea and depression.

    Your provider or palliative care team may recommend these actions to ease fatigue:

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    Ways To Manage Fatigue

    Tell your health care team if you feel extremely tired and are not able to do your normal activities or are very tired even after resting or sleeping. Keeping track of your levels of energy throughout the day will help your doctor to assess your fatigue. Write down how fatigue affects your daily activities and what makes the fatigue better or worse.

    You may be advised to take these and other steps to feel better:

    NCIâs Fatigue PDQ® summary has more information on how fatigue is assessed and treated. View the patient or health professional version.

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    What Caregivers Can Do

    Fatigue During and After Cancer Treatment
    • Help schedule friends and family members to prepare meals, clean the house, do yard work, or run errands for the patient. You can use websites that help organize these things, or ask a family member to look into this for you.
    • Try not to push the patient to do more than they are able to.
    • Help the patient set up a routine for activities during the day.

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    How Can I Conserve Energy When I Have Cancer Fatigue

    Plan and organize your work

    • Change storage of items to reduce trips or reaching.
    • Delegate when needed.
    • Combine motions and activities and simplify details.

    Schedule rest

    • Balance periods of rest and work.
    • Rest before you feel tired.
    • Frequent, short rests are beneficial.

    Pace yourself

    • Do not hold your breath.
    • Wear comfortable clothes to allow for free and easy breathing.

    Identify anything in your environment that may contribute to cancer fatigue

    • Avoid extreme temperature.
    • Eliminate smoke or noxious fumes.
    • Avoid long, hot showers or baths.


    • Use your energy on important tasks.

    Managing Work If You Have Fatigue

    You may find that you cant continue working due to fatigue, or that you have to reduce the amount of time you spend at work.

    It can help to talk to your employer or personnel/human resources department and let them know that you may need some time off.

    Dont feel that you have to work if youre too tired. If you do want to carry on working, you may be able to find ways of making your work less tiring for a while.

    Anyone with cancer is protected by the Equality Act 2010, which prevents employers from victimising or discriminating against people with a disability. The act also states that employers are expected to make reasonable adjustments to support employees in the workplace. You may want to make suggestions for adjustments that could help to support you. Things that your employer can do to help include:

    • changing your hours so that you can travel to and from work at less busy times
    • asking colleagues to be supportive and to help with some of your work
    • finding you a parking place near to your place of work
    • letting you take short breaks to lie down and rest
    • allowing you to work from home
    • finding you lighter work if your job involves physical exertion or heavy lifting

    If youre self-employed, it can help to talk to the Department of Work and Pensions about benefits that you may be entitled to claim.

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    Webinar: Fatigue After Cancer Treatment

    Cancer related fatigue is commonly reported by cancer survivors with the experience of fatigue ranging from feelings of tiredness to exhaustion. Fatigue often results in a substantial impact on a cancer survivors physical, emotional and/or psychological functioning. We explore why some people recover quickly while others do not.

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