Fatigue And Breast Cancer Recurrence

Keeping Personal Health Records

You and your doctor should work together to develop a personalized follow-up care plan. Be sure to discuss any concerns you have about your future physical or emotional health. ASCO offers forms to help keep track of the cancer treatment you received and develop a survivorship care plan when treatment is completed. At the conclusion of active treatment, ask your doctor to provide you with a treatment summary and a survivorship care plan.

This is also a good time to talk with your doctor about who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the care of their family doctor, another health care professional, or a specialized survivorship clinic. This decision depends on several factors, including the type and stage of cancer, side effects, health insurance rules, and your personal preferences.If a doctor who was not directly involved in your cancer care will lead your follow-up care, be sure to share your cancer treatment summary and survivorship care plan forms with them and with all future health care providers. Details about your cancer treatment are very valuable to the health care professionals who will care for you throughout your lifetime.

The next section in this guide is Survivorship. It describes how to cope with challenges in everyday life after a cancer diagnosis. Use the menu to choose a different section to read in this guide.

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.

What Is A Breast Cancer Recurrence

Breast cancer recurrence means that the cancer was diagnosed when limited to the breast and/or armpit lymph nodes, then treated, and at some time later has come back.

This can occur in several ways:

• Local and/or regional recurrence: the breast cancer that was previously treated returns within the breast, chest wall or regional lymph nodes.
• New primary breast cancer: an unrelated new breast cancer occurs in one or the other breast. This actually isnt a local recurrence at allits a new cancer in the breast . This typically occurs many years after the original cancer and in an entirely different area of the breast. Its pathology is often different lobular instead of ductal, for example. Though they are often counted as recurrences in the statistics for breast conservation, they should be treated as completely new cancers, much as with new cancers in the opposite breast.
• Distant or systemic recurrence or metastasis is much more serious than local recurrence and is synonymous with stage 4 disease. For breast cancer patients, the most common areas of spread are the bone, liver, lungs and brain

Breast cancer recurrence occurs if:

• Cells from the original breast cancer diagnosis break away and hide nearby in the breast or spread elsewhere in the body

• Treatment, including surgery, chemotherapy, radiotherapy and/or hormone therapy have not gotten rid of all these cancer cells from the body.

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Fatigue Is The Most Important Symptom For Advanced Cancer Patients Who Have Had Chemotherapy

aCenter on Outcomes, Research, and Education , Evanston Northwestern Healthcare, Evanston, Illinois

bDepartment of Psychiatry and Behavioral Sciences, Northwestern University, Feinberg School of Medicine, Chicago, Illinois

cInstitute of Healthcare Studies, Northwestern University, Feinberg School of Medicine, Chicago, Illinois

What Are The Symptoms

The symptoms depend on where the cancer is and how large it is. The most common places for breast cancer to spread are within the breast or to the nearby chest wall or to the liver, lungs, or bones. Common symptoms include a lump in your breast or on your chest wall, bone pain, and shortness of breath.

Or you may not have any symptoms. Sometimes recurrent or metastatic breast cancer is found with an X-ray or a lab test.

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Recurrences Can Occur Far Beyond The 5

Unlike the common perception that people who have survived for five years are “cured,” we know that some breast cancers, particularly hormone receptor positive breast cancers, can recur many years and even decades later. In fact, estrogen receptor positive early breast cancers are more likely to recur five years to 10 years after diagnosis than in the first five years.

A 2017 study in JAMA looked at over 62,000 women with estrogen receptor positive breast cancer over a period of 20 years. The women all received endocrine therapy for five years and were free of cancer when they stopped their medication. Over the next 15 years a steady number of these women developed distant recurrences of their cancer.

There are algorithms that can be used to estimate the risk of recurrence of a breast cancer, but none of these take into account all of the nuances of an individual person.

Recurrences sometimes occur locally in the breast, or regionally in nearby lymph nodes, but far too often are distant recurrences recurrences that show up in distant regions of the body such as the bones, lungs, liver, brain, or other areas. Once a distant recurrence occurs, breast cancer is no longer considered “curable” and the median survival rate of stage 4 breast cancer is only three years with treatment.

How Is Breast Cancer Recurrence Managed Or Treated

Your treatment depends on the type of cancer recurrence, as well as past treatments. If cancer develops in a reconstructed breast, your surgeon may want to remove the breast implant or skin flap.

Treatments for local and regional breast cancer recurrence may include:

• Mastectomy: Your surgeon removes the affected breast and sometimes lymph nodes.
• Chemotherapy:Chemotherapy circulates in blood, killing cancer cells.
• Hormone therapy:Tamoxifen and other hormone therapies treat cancers that thrive on estrogen .
• Immunotherapy:Immunotherapy engages your bodys immune system to fight cancer.
• Radiation therapy: High-energy X-ray beams damage and destroy cancer cells.
• Targeted therapy: Treatments target specific cancer cell genes or proteins.

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Local Recurrence After Mastectomy

Even though the entire breast is removed in a mastectomy, breast cancer can still return to the chest area. If you notice any changes around the mastectomy scar, tell your health care provider.

The more lymph nodes with cancer at the time of the mastectomy, the higher the chances of breast cancer recurrence.

Local recurrence after a mastectomy is usually treated with surgery, and radiation therapy if radiation therapy wasnt part of the initial treatment.

Treatment may also include chemotherapy, hormone therapy and/or HER2-targeted therapy.

Four Steps To Avoid A Recurrence

Theres nothing you can do to guarantee that your cancer wont come back, but you can make some changes to help you feel your best after cancer treatment and keep your body stay strong.

Eat a balanced diet. Reach for a colorful mix of fruits and vegetables, good sources of fiber like beans and peas, and whole grains like whole wheat bread and brown rice every day. Avoid or limit drinks that are high in sugar and red or processed meat like beef, pork, hot dogs and sausages. You probably dont need to take vitamin or mineral supplements, unless your care team suggests them. In fact, taking more of certain vitamins or minerals than you need can have a negative effect on your cancer recovery, so be sure to discuss any supplements youre considering with your care team before taking them.

Exercise on most days of the week. Being active can improve your mood, boost self-esteem and reduce fatigue. Its even been shown to lower anxiety and depression and relieve nausea, pain and diarrhea.

Lean on a strong support system. Cancer might be all about the cellular changes in your body, but you know it certainly doesnt stop there. Taking care of your emotional health, whether it be cultivating a strong circle of friends and family as support or getting mental health services, can help you manage the stressors that cancer treatment and recovery can bring.

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Effect Of Depression And Anxiety On Mortality In Breast Cancer Patients

As shown in Supplementary Fig. , four studies yielded a pooled HR of 1.34 for the association between depression and anxiety and all-cause mortality based on fixed-effects model analyses. Low heterogeneity was observed, with I2=0.0% and P=0.755. Furthermore, two studies yielded a pooled HR of 1.45 for the association between depression and anxiety and breast cancer-specific mortality. Low heterogeneity was observed, with I2=49.3% and P=0.160.

British Columbia Specific Information

Breast cancer is the most common type of cancer in women in British Columbia. Breast cancer can occur in men as well, but it is not as common. Tests and treatments for breast cancer vary from person to person, and are based on individual circumstances. Certain factors such as your age, family history, or a previous breast cancer diagnosis may increase your risk of developing breast cancer. For information about your specific risk factors, speak with your health care provider.

A number of screening methods, including mammograms in women, can help find and diagnose breast cancer. The decision to have a mammogram or use any other screening method may be a difficult decision for some women. While screening for breast cancer is often recommended, it is not mandatory. Speak with your health care provider for information regarding how to get screened, the facts and myths about screening tests, how to maintain your breast health, and to get help making an informed decision.

For more information about breast cancer and breast cancer screening, visit:

• Government of Canada: Breast Cancer and Your Risk

If you have questions about breast cancer or medications, speak with your health care provider or call 8-1-1 to speak with a registered nurse or pharmacist. Our nurses are available anytime, every day of the year, and our pharmacists are available every night from 5:00 p.m. to 9:00 a.m.

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Fatigue And Cancer Recurrence

Hi all / Nurses,

I’ve got a question in relation to fatigue and its effect on cancer recurrence if anybody has any knowledge on the subject.

I was diagnosed with cancer of the small bowel in July 2015 and by diagnosis was T3N2M0 with the cancer cells moderately to poorly differentiated. 12 of the 29 lymph nodes removed were also cancerous and the surgeon described my cancer as being “high risk”. Due to one thing and another, including surgery to repair an incisional hernia I haven’t worked shifts since July 15. My shifts consist of two earlies, two lates and two nights and to be honest, as much as I love my job, the thought of doing those shifts and feeling as exhausted as I used to do fills me with dread!

Not only that, but I really can’t see how feeling so exhausted can be healthy, especially following a cancer diagnosis. Is there any studies or evidence that anybody is aware of that links fatigue with bowel cancer recurrence? I’m not particularly anticipating a battle with work as they’ve been fantastic with me, I’d just like to be aware of any evidence if it does exist prior to requesting to change roles.

Many Thanks,

Is Your Fatigue A Symptom Of Cancer

Could your fatigue be the first symptom of cancer? At one point or another, we have all experienced fatigue. For most of us, it is temporary, usually caused by stress or being overworked.

For some people, however, fatigue can become persistent, occurring daily. When fatigue becomes frequent, it is natural to be concerned about what may be causing it.

One of the first things many people think maybe the culprit for their fatigue is cancer. When might feeling tired be a sign of cancer and how often is it?

We often hear about cancer patients who are extremely fatigued, but a lot of cancer-related fatigue is caused by the side effects of cancer treatment, not always cancer itself. In other words, for people with many cancers, the fatigue begins after diagnosis.

While fatigue alone without other symptoms is uncommon in many cancers, for people with leukemias and lymphomas fatigue may well be the first symptom.

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Looking At Exercise Over Time

The findings come from the NCI-funded Diet, Exercise, Lifestyle, and Cancer Prognosis study, led by Christine Ambrosone, Ph.D., also of Roswell Park. The study was embedded in a large clinical trial, led by the NCI-funded SWOG Cancer Research Network, that compared different chemotherapy regimens for women with high-risk breast cancer.

The physical activity analysis by Dr. Cannioto and her colleagues included 1,340 patients from the SWOG trial who also enrolled in the DELCaP study. Participants completed questionnaires about the type, frequency, and duration of recreational physical activity they engaged in at four time points: during the month before diagnosis, during treatment, and at 1 and 2 years after study enrollment. Participants were followed for up to 15 years or until death, with a meanfollow-up time of 89 months .

Much, though not all, previous epidemiologic research describing the link between physical activity and cancer outcomes is based on physical activity data collected at only one time point, Dr. Cannioto said.

Using the questionnaire responses, the researchers determined whether participants had met the minimum 2018 Physical Activity Guidelines for Americans at each time point. The guidelines recommend that adults engage in at least 2.5 to 5 hours of moderate-intensity physical activity or 1.25 to 2.5 hours of vigorous-intensity aerobic physical activity per week.

What Causes Breast Cancer Recurrence

The goal of cancer treatments is to kill cancer cells. But, cancer cells are tricky. Treatments can reduce tumors so much that tests dont detect their presence. These weakened cells can remain in the body after treatment. Over time, the cells get stronger. They start to grow and multiply again.

Even surgery to remove a cancerous tumor isnt always 100% effective. Cancer cells can move into nearby tissue, lymph nodes or the bloodstream before surgery takes place.

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Why Does Breast Cancer Come Back After Treatment

Even with the best treatment, cancer can come back. If just a few cancer cells remain in your body after your initial treatment, those cells can spread through the blood or lymph system and grow. This may happen from a few months to many years after the first diagnosis.

If your breast cancer has come back, you may second-guess your previous treatment choices. But the fact is, there is no guarantee with any treatment. Now it is time to make new decisions and explore other treatment options.

Lifestyle Changes After Breast Cancer

Lifestyle Changes after Breast Cancer Treatment: Conversations on Survival. A group of breast cancer survivors openly discuss what lifestyle changes were continued or changed after treatment. The importance of living in the moment, maintaining a healthy lifestyle, and knowing what is really important in life are all discussed.

To help yourself better cope with the side effects of breast cancer treatment and to reduce your chances of breast cancer recurrence, try incorporating these healthy tips:

1) Take care of yourself emotionally

• Put your needs first sometimes
• Attend a support group or find a breast cancer survivor you can talk with
• Stay informed about new breast cancer research
• Consider psychotherapy and/or antidepressants if warranted if youre taking tamoxifen, check with your oncologist to ensure the prescribed antidepressant does not interfere with your endocrine treatment
• Communicate with your doctor about fears or concerns
• Volunteer or become a breast cancer advocate

2) Take care of yourself physically

• Exercise regularly
• Report any physical changes to either your oncologist or primary care provider
• Seek treatment for lymphedema if you experience signs

3) Eat healthy

Research has shown that a diet high in fat and calories increases circulating estrogen in the blood. Consuming a low fat and low calorie diet after breast cancer can improve your overall health and wellness. Here are some dietary suggestions:

4) Reduce stress

5) Limit alcohol

6) Exercise regularly

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How Long After Breast Cancer Treatment Do Recurrences Occur

The risk of recurrence for all breast cancers was highest in the first five years from the initial cancer diagnosis at 10.4%. This was highest between the first and second years after the initial diagnosis. During the first five years after the initial diagnosis, patients with oestrogen receptor positive breast cancer had lower rates of recurrence compared with those with ER negative disease. However, beyond five years, patients with ER positive disease had higher rates of recurrence.

The late recurrence or relapse of breast cancer refers to cancers that come back after five years, but may not return for 10 years, 20 years, or even more. For people who have estrogen receptor-positive tumours, the cancer is actually more likely to recur after five years than in the first five years.

In contrast to the common belief that surviving for five years after cancer treatment is equivalent to a cure, with hormone-sensitive breast tumours there is a steady rate of recurrence risk for at least 20 years after the original diagnosis, even with very small node-negative tumours.

An awareness of the risk of late recurrence is important for a number of reasons. People are often shocked to learn that their breast cancer has come back after say, 15 years, and loved ones who dont understand this risk are often less likely to be supportive as you cope with the fear of recurrence.

Bone Metastases

• Spine
• Pelvis
• The long bones of the arms and legs

Symptoms and Detection

Treatment

Liver Metastases