Talking With Your Health Care Team About Fatigue
Prepare for your visit by making a list of questions to ask. Consider adding these questions to your list:
- What is most likely causing my fatigue?
- What should I keep track of and share so we can develop a plan to help me feel better?
- What types of exercise do you recommend for me?
- How much rest should I have during the day? How much sleep should I get at night?
- What food and drinks are best for me?
- Are there treatments or medicines that could help me feel better?
If Youre Getting Radiation Therapy To The Breast
If you have radiation to the breast, it can affect your heart or lungs as well causing other side effects.
Short-term side effects
Radiation to the breast can cause:
- Skin irritation, dryness, and color changes
- Breast soreness
- Breast swelling from fluid build-up
To avoid irritating the skin around the breast, women should try to go without wearing a bra whenever they can. If this isnt possible, wear a soft cotton bra without underwires.
If your shoulders feel stiff, ask your cancer care team about exercises to keep your shoulder moving freely.
Breast soreness, color changes, and fluid build-up will most likely go away a month or 2 after you finish radiation therapy. If fluid build-up continues to be a problem, ask your cancer care team what steps you can take. See Lymphedema for more information.
Long-term changes to the breast
Radiation therapy may cause long-term changes in the breast. Your skin may be slightly darker, and pores may be larger and more noticeable. The skin may be more or less sensitive and feel thicker and firmer than it was before treatment. Sometimes the size of your breast changes it may become larger because of fluid build-up or smaller because of scar tissue. These side effects may last long after treatment.
After about a year, you shouldnt have any new changes. If you do see changes in breast size, shape, appearance, or texture after this time, tell your cancer care team about them right away.
Less common side effects in nearby areas
How To Cite This Article
- Matoso LBBMM, Boing L, Korpalski T, Dias M, Moratelli J, Fausto DY, Guimarães ACA. Relationship of fatigue with depressive symptoms and level of physical activity in women with breast cancer diagnosis. Rev Bras Cineantropom Desempenho Hum 2020, 22:e59189. DOI:
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Is Fatigue A Sign Of Cancer
Fatigue may develop as a symptom of blood cancers, such as leukemia, lymphoma and multiple myeloma, because these cancers start in the bone marrow, which produces red blood cells that carry oxygen throughout the body.
Its uncommon for fatigue to be the only symptom of undiagnosed cancer. A more concerning scenario develops when patients experience both fatigue and pain in one area thats getting progressively worse, along with unexplained weight loss and loss of appetite.
However, these symptoms may also be caused by an infection or another medical condition, such as anemia, depression, thyroid dysfunction, vitamin deficiency or sleep apnea, to name a few possibilities.
If a patient came to me complaining primarily of fatigue, my first thoughteven as an oncologistprobably wouldnt be cancer.
There may not be a simple answer behind whats causing your fatigue, and discovering the root cause often takes some digging, along with some trial and error with various therapeutic approaches.
What Else Can Cause Fatigue
Many other factors can make you feel tired and fatigued if you have cancer. Some of these include:
- not sleeping well at night or sleeping too much during the day
- treatment may be harder for you to cope with especially if you’re elderly
- your tiredness may make it harder for you to concentrate so everything seems more difficult making you feel even more tired
- travelling to and from the hospital for treatment
- having a lot of visitors when you are staying in hospital
- looking after children
- other health problems such as diabetes, problems with your lungs, heart problems and being overweight
You can ask your nurses to tell your visitors that they can only stay with you for a short time. Don’t feel bad if you have to do this. You need a lot of rest and your friends and family will understand.
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Treatment Of Fatigue In Breast Cancer Patients And Survivors
Clinical trials of treatment regimens for the alleviation and management of cancer-related fatigue have been limited compared with those focused on the alleviation of pain and suffering. Treatment of cancer-related fatigue can be complex because of the links observed between fatigue and various physical and psychological variables. Thus, a multidisciplinary approach to treatment and management of cancer-related fatigue is likely to be necessary for many cancer patients and survivors and treatments must be individualized based on underlying pathology.
To recap, in two large studies four and five years post-diagnosis or treatment of breast cancer, survivors fatigue was most strongly linked with depressive symptoms, pain and sleep disturbance and with worse physical health, less physical activity, and depressive symptoms. Depressed mood, cardiovascular problems, and cancer treatment modality were also linked with ongoing fatigue. Thus, several possible underlying factors have been implicated in cancer fatigue, many of which respond well to conventional treatments.
Early And Late Effects Of Radiation Therapy
- Early side effects happen during or shortly after treatment. These side effects tend to be short-term, mild, and treatable. Theyre usually gone within a few weeks after treatment ends. The most common early side effects are fatigue and skin changes. Other early side effects usually are related to the area being treated, such as hair loss and mouth problems when radiation treatment is given to this area.
- Late side effects can take months or even years to develop. They can occur in any normal tissue in the body that has received radiation. The risk of late side effects depends on the area treated as well as the radiation dose that was used. Careful treatment planning can help avoid serious long-term side effects. Its always best to talk to your radiation oncologist about the risk of long-term side effects.
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The Downside Of Mammograms
Mammography has been the medical industrys gold standard breast cancer screening tool for nearly four decades, and the procedure has been pushed on women with great zeal by physicians, public health programs, and cancer organizations. However, mounting scientific evidence indicates that mammography may not only be far less effective than we have been led to believe, but that it also has numerous drawbacks that are affecting women on a massive scale. Read on to learn about the major drawbacks of mammography, what the research recommends for breast cancer screening, and about promising breast cancer detection alternatives.
Are You Having Breast Cancer Pain
How often does breast cancer cause breast pain? If you have breast pain, what are the chances its cancer? What types of breast cancers are more likely to be painful? Since breast pain affects roughly half of all women at some point in our lives, these are important questions to be asking.
Learn about about how often breast cancer is painful , and whether pain may increase your risk of breast cancer in the future.
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Breast Discomfort And Pain
Women may feel discomfort and pain as the cancer grows and spreads in the breast. Cancer cells do not cause pain but as they grow they cause pressure or damage to surrounding tissue. A large tumor can grow into or invade the skin and cause painful sores or ulcers. It can also spread into the chest muscles and ribs causing obvious pain.
Anxiety And Depression Are The Most Common Psychological Causes Of Fatigue In People With Cancer
The emotional stress of cancer can cause physical problems, including fatigue. It’s common for you to have changes in moods and attitudes. You may feel anxiety and fear before and after a cancer diagnosis. These feelings may cause fatigue. The effect of the disease on your physical, mental, social, and financial well-being can increase emotional distress.
About 15% to 25% ofpeople with cancer get depressed, which may increase fatigue caused by physical factors. Patients who have depression before starting treatment are more likely to have depression during and after treatment. The following are signs of depression:
- Lack of energy and mental alertness.
- Loss of interest in life.
- Problems thinking.
- Feeling a loss of hope.
Patients who have a history of stressful experiences in childhood, such as abuse and neglect, may have increased fatigue. See the PDQ summaries on Adjustment to Cancer: Anxiety and Distress and Depression for more information.
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My Breast Looked A Little Pink
In the shower one day, I noticed a pale pinkness on my breast just below my nipple area, which looked more like a mild sunburn than a rash. I knew something was off. I had my ob-gyn take a look, and he said he wasnt concerned at all because it was barely noticeable. He suggested my bra fit too snugly, and I needed to go shopping for new bras. So I did just that.
Over time, that pink area hardened slightly and was sore to the touch. My ob-gyn again said he wasnt concerned. Eventually the pain increased behind my breast in my back. My ob-gyn said that breast cancer does not hurt, so I didnt need to worry about it. He ordered a mammogram to put my mind at ease. The mammogram and all other tests came back normal.
Weeks went by and my lower back began to hurt. Eventually, after my GP suggested I had arthritis and I went to physical therapy. I went to see a breast specialist. He told me I had mastitis and gave me antibiotics. That didnt help. Back at the breast surgeon, he sent a picture of my breast to the top surgeon who ordered a diagnostic mammogram, which includes a sonogram and a biopsy. I was diagnosed with Stage IV inflammatory breast cancer in my breast, bones, and liver.
Jennifer Cordts, stay-at-home mom, Dallas
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Feelings That Can Come Up During Radiation Therapy
Fatigue is common with radiation therapy and may affect your mood. As treatments continue, fatigue can increase. This fatigue is due to treatment itself, but it can also be related to having to go to radiation therapy appointments every day for several weeks. If you must travel far for treatment, you might feel more tired and drained than you normally would. Just the stress of daily travel and treatment can be exhausting.
Treatment-related fatigue feels very different from regular tiredness. It can come on quickly and exhaust you. Even after a good nights sleep, you may not feel rested.
Radiation therapy may cause changes in the shape, texture, and size of your breast or in the skin, and this can be distressing. Know that your and nurses can offer you treatments to help soothe skin irritation and prevent certain side effects. Treating them early may help you feel better physically and, in turn, emotionally.
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What About Tiredness That Becomes A Severe Burden
A final aspect of the cancer fatigue conversation comes up when those receiving treatment begin to experience dramatic changes in the severity and frequency of fatigue. When fatigue becomes persistent and interferes with your ability to perform basic daily function, tell your doctor. More importantly, if fatigue reaches an extreme point and causes confusion, dizziness, loss of balance, severe shortness of breath or leaves you bedridden for more than 24 hours, contact your care team immediately. While it is normal to sleep more than typical after a radiotherapy session, these symptoms greatly increase your risk of injury and could lead to the worsening of your overall health.
What To Look For
- You feel tired and it doesnt get better with rest or sleep, it keeps coming back, or it becomes severe.
- Youre more tired than usual during or after an activity.
- Youre feeling tired and its not related to an activity.
- Youre too tired to do the things you normally do.
- Your arms and legs feel heavy and hard to move.
- You have no energy.
- You spend more time in bed and/or sleep more. Or, you may have trouble sleeping.
- You stay in bed for more than 24 hours.
- You become confused or cant concentrate or focus your thoughts.
- Your tiredness disrupts your work, social life, or daily routine.
It may be hard for you to talk about it, but tell your cancer care team about your fatigue. Tell them how its affecting your life. Someone on your team should be able to help you if they know youre having this problem. Managing fatigue is part of good cancer care. Work with your cancer care team to find and treat the causes of your fatigue.
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If Youre Getting Radiation Therapy To The Head Or Neck
People who get radiation to the head and neck might have side effects such as:
- Soreness in the mouth or throat
- Dry mouth
- Jaw stiffness
How to care for your mouth during treatment
If you get radiation therapy to the head or neck, you need to take good care of your teeth, gums, mouth, and throat. Here are some tips that may help you manage mouth problems:
- Avoid spicy and rough foods, such as raw vegetables, dry crackers, and nuts.
- Dont eat or drink very hot or very cold foods or beverages.
- Dont smoke, chew tobacco, or drink alcohol these can make mouth sores worse.
- Stay away from sugary snacks.
- Ask your cancer care team to recommend a good mouthwash. The alcohol in some mouthwashes can dry and irritate mouth tissues.
- Rinse your mouth with warm salt and soda water every 1 to 2 hours as needed.
- Sip cool drinks often throughout the day.
- Eat sugar-free candy or chew gum to help keep your mouth moist.
- Moisten food with gravies and sauces to make it easier to eat.
- Ask your cancer care team about medicines to help treat mouth sores and control pain while eating.
If these measures are not enough, ask your cancer care team for advice. Mouth dryness may be a problem even after treatment is over. If so, talk to your team about what you can do.
How to care for your teeth during treatment
Radiation treatment to your head and neck can increase your chances of getting cavities. This is especially true if you have dry mouth as a result of treatment.
Fatigue Is The Most Common Side Effect Of Cancer Treatment
Cancer treatments such as chemotherapy, radiation therapy, hormone therapy, bone marrow transplantation, and immunotherapy can cause fatigue. Fatigue is also a common symptom of some types of cancer. People with cancer describe fatigue as feeling tired, weak,worn-out, heavy, slow, or that they have no energy or get-up-and-go. Fatigue in people with cancer may be called cancer fatigue, cancer-related fatigue, and cancer treatment-related fatigue.
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Summary And Future Directions
While research into the etiology, course, and treatment of cancer-related fatigue is relatively new, much progress has been made in recent years however, considerable opportunities remain. While some well-powered studies have examined risk factors for fatigue in breast cancer patients and survivors, most studies examining underlying mechanisms have involved small to very small sample sizes. While a few studies employing repeated-assessments have been conducted, most have been cross-sectional in design. Thus, more longitudinal studies that involve assessment of cancer patients pre-/post-completion of initial treatment and into survivorship are needed. While multiple factors have been observed to be linked with cancer-related fatigue, it has yet to be determined which factors predispose, precipitate or exacerbate/maintain the patients experience of fatigue. For example, longitudinal studies examining and comparing the effects of chemotherapy- and radiation-induced inflammation on functioning during survivorship are warranted. Also, additional studies employing statistical analytic techniques that can evaluate hypotheses about causal pathways are needed. These will require multiple assessments of established or promising biomarkers of fatigue. Such studies should also assess fatigue using multidimensional scales normed on and/or tailored to breast cancer patients.
Grade Of Breast Cancer
The grade describes the appearance of the cancer cells.
- Low grade the cells, although abnormal, appear to be growing slowly.
- Medium grade the cells look more abnormal than low-grade cells.
- High grade the cells look even more abnormal and are more likely to grow quickly.
Want to know more?
- Breast Cancer Now: Secondary breast cancer
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Why Does Radiation Therapy Cause Fatigue
Fatigue occurs during radiation therapy because the body is working hard to repair damage to healthy cells incurred during treatment. The degree of fatigue generally varies depending on the amount of tissue irradiated, as well as the location.
But radiation therapy may not be the sole culprit of fatigue: it can be a result of cancer itself or the mental stress associated with being a cancer patient. Certain medications, such as those to prevent and treat nausea, can also be responsible for fatigue. It’s impossible to pinpoint the exact cause because there are many factors in cancer treatment that can all be responsible.
Sickness In Advanced Cancer
Some people in the advanced stages of cancer may feel or be sick a lot. This type of sickness is very different to that of people having chemotherapy or radiotherapy.
It can severely affect your day to day life and make you very tired and depressed.
People with advanced cancer can feel and be sick for different reasons. These include:
- the cancer itself
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