Fatigue During Radiation Therapy For Breast Cancer

How Long Do Side Effects Last

Remember that the type of radiation side effects you might have depends on the prescribed dose and schedule. Most side effects go away within a few months of ending treatment. Some side effects may continue after treatment ends because it takes time for the healthy cells to recover from radiation.

Side effects might limit your ability to do some things. What you can do will depend on how you feel. Some patients are able to go to work or enjoy leisure activities while they get radiation therapy. Others find they need more rest than usual and cant do as much. If you have side effects that are bothersome and affecting your daily activities or health, the doctor may stop your treatments for a while, change the schedule, or change the type of treatment youre getting. Tell your cancer care team about any side affects you notice so they can help you with them.

Problems Moving Your Arm And Shoulder

Radiotherapy might make it harder to move your arm and shoulder. This can affect your activities and work. It usually improves when the treatment finishes. Your nurse or physiotherapist can give you exercises to help.

Its important to continue the arm exercise you were shown after your surgery. This will make it easier for you to lift your arm to the correct position during radiotherapy. It can also help stop your arm and shoulder from becoming stiff.

• Find out more about arm exercises after breast surgery

Why Does Radiation Therapy Cause Fatigue

Fatigue occurs during radiation therapy because the body is working hard to repair the damage caused to healthy cells during treatment. The degree of fatigue generally varies depending on the amount of tissue irradiated, as well as the location.

Radiation therapy may not be the sole culprit of fatigue. Fatigue also is a symptom of cancer itself and 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 not always possible to pinpoint the exact cause because there are many factors in cancer treatment.

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A Note About Sex And Gender

Sex and gender exist on spectrums. This article will use the terms, male, female, or both to refer to sex assigned at birth. .

Breast cancer fatigue can occur as a symptom of breast cancer or as a side effect of its treatment.

A 2019 study followed 332 women referred for a mammogram and compared levels of fatigue among women who received a cancer diagnosis compared with those who did not. Fatigue was greater for women who received a breast cancer diagnosis and was most severe during the first 6 months following the diagnosis.

Breast cancer fatigue can occur as a result of multiple factors, including:

• the disease itself
• the psychological impact of receiving a cancer diagnosis
• side effects due to cancer treatments

Below are some possible causes of breast cancer fatigue.

Why You’re So Tired After Radiation Therapy

Brandi Jones MSN-Ed, RN-BC is a board-certified registered nurse who owns Brandi Jones LLC, where she writes health and wellness blogs, articles, and education. She lives with her husband and springer spaniel and enjoys camping and tapping into her creativity in her downtime.

When you undergo radiation therapy to treat cancer, your healthcare provider may provide you with a list of possible side effects of treatment. Things like nausea, diarrhea, and hair loss usually catch a person’s attention first because they seem to be the worst.

However, fatigue is one of the most common side effects. A lack of energy and excessive tiredness is common for cancer patients no matter their therapy, but those undergoing radiation therapy experience fatigue more frequently. It also worsens as treatment continues.

This article reviews symptoms of fatigue, why radiation causes it, tips to manage and cope with fatigue, and when to call your healthcare provider

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Breast Discomfort Or Swelling

You may have some tenderness in your breast on your affected side, especially at your nipple. You may also develop extra fluid in your breast that may cause sharp, stabbing sensations. Your breast or chest may feel heavy or swollen. Your shoulder on your affected side may also feel stiff.

These sensations can start within the first few days of your radiation therapy. They can go on for many months after you finish radiation therapy. Below are suggestions to help you reduce this discomfort.

• If you wear bras, you may want to choose soft, loose bras without an underwire. Sports bras or cotton bras are good choices. You may even find it more comfortable to not wear a bra at all.
• Take pain medications such as nonsteroidal anti-inflammatory drugs as needed. Some examples of NSAIDs are ibuprofen and naproxen . If you cant take an NSAID, you can take acetaminophen instead.

Easing Worries About Radiation Therapy

Its normal to worry about possible side effects of radiation therapy.

Talk with your health care provider about your concerns.

Your health care provider may be able to suggest a hospital social worker, patient navigator, psychologist or support group to help ease anxiety related to radiation therapy .

Learn more about support groups.

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Longitudinal Studies Of Rt

Several studies have evaluated for changes in fatigue in women with breats cancer during the course of RT.4,15,16 While the exact measurement times differed across these studies, in most cases fatigue severity ratings increased significantly from the beginning to the middle of RT and remained elevated from the middle to the end of RT. In the seven studies that evaluated for changes in fatigue in women with breast cancer following the completion of RT,1723 fatigue severity scores decreased to pretreatment levels within 4 to 8 weeks following the completion of treatment.

How Long Does Cancer Fatigue Last

Unfortunately, if you have cancer fatigue, there is no way to know how long it might last or how severe it might be. Fatigue from breast cancer and breast cancer treatment can last for weeks, months, or years and may continue after you finish treatment.

Its important to know that the effects of cancer fatigue can change from day to day. If youre receiving chemotherapy, targeted therapy, or immunotherapy in cycles, the fatigue is often worse at the beginning of the cycle and then eases until the next cycle starts. If youre receiving radiation therapy, fatigue usually gets worse as treatment goes on and then eases a few months after you finish treatment.

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How Long Will Tiredness From Radiation Therapy Persist

People usually see a reduction in tiredness after several weeks of receiving a final treatment. Some people may experience excessive tiredness after the first treatment. Others may gradually develop a sense of growing fatigue over a period of weeks. Of course, the tiredness resulting from radiation therapy alone varies in intensity and duration.

After receiving the final treatment, other factors come into play. The length of time the body takes to repair itself will affect time between final treatment and not feeling so tired. This gives rise to a belief that radiation therapy leads to permanent fatigue.

How To Lower Your Risk

You can do a number of things in addition to the precautions your healthcare provider takes to reduce your risk of long term complications related to radiation therapy.

• Dont smoke, as smoking increases the risk of lung cancer after chest radiation.
• Talk to your practitioner about any new respiratory symptoms that may suggest radiation pneumonitis.
• Ask about clinical trials designed to reduce the risk of late effects of radiation.
• If you will be having chest radiation, ask if respiratory gating is available.
• Ask your healthcare provider about physical therapy if your movements are restricted. Physical therapy cant rid your body of permanent scarring but can often improve flexibility and mobility.

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Comparison Of Pretest Scores Of Cancer

Pretest scores of cancer-related fatigue were compared to check whether the group differed in this at baseline. Mann-Whitney U-test was used to compare the two groups since the data were not following normality. Data presented in Table 3 show that there was no significant difference in the scores of cancer-related fatigue between the control group and the experimental group at the beginning of radiation therapy .

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Fatigue And Memory Problems May Be Related

During and after cancer treatment, you may find that you cannot pay attention for very long and have a hard time trying to think, remember, and understand. This is called attention fatigue. Sleephelps to relieve attention fatigue, but sleep may not be enough when the fatigue is related to cancer. Take part in restful activities and spend time outdoors to help relieve attention fatigue.

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?

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How Can I Manage My Fatigue

Even though your normal response to fatigue will be to rest, its important that you keep moving as much as possible. Research shows that spending long periods in bed or lying down can actually make fatigue worse.

Tips to help manage fatigue:

• Incorporate basic exercise, such as walking, into your day. Exercise, especially in the morning, has been shown to greatly assist in reducing fatigue.
• Eat a healthy diet.
• Keep hydrated by drinking plenty of water.
• Organise practical help at home, such as help with childcare, housework or making meals.
• Give your body time to recover after treatment. Try to work up to your usual level of daily activity rather than stepping straight back into old routines.
• Take time to rest throughout the day between activities, but limiting the length of naps so that you are still able to sleep at night. If you are facing sleepless nights during your breast cancer treatment, BCNA’s Sleepless nights: breast cancer and sleep fact sheet provides more tips and strategies that may be helpful.
• Discuss how you feel with a support group or counsellor. You can find a support group near you on the BCNA website or join BCNAs online network to connect with others affected by breast cancer.

You can also discuss your fatigue with your medical treatment team. They may be able to suggest approaches to help reduce or manage fatigue.

Causes And Risk Factors

Radiation therapy works by damaging DNA in cells. This damage isnt isolated to cancer cells, though normal cells can be damaged as well. While radiation therapy has improved significantly such that less damage occurs to healthy cells than in the past, some healthy tissues are inevitably exposed.

Several variables can increase or decrease your risk of developing long-term side effects of radiotherapy. Some of these are:

• Your age at the time of radiation
• The dose of radiation you receive
• The number of treatment sessions
• The type of cancer treated
• The area of the body that receives radiation
• Other cancer treatments, such as chemotherapy
• Other health conditions, such as heart disease or diabetes

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Inflammation And Immune Response

The individualâs inflammatory response is a main mechanism that is proposed to contribute to the experience of RIF. An increased serum level of IL-6sR was significantly associated with fatigue symptoms in women with stage 0-IIA breast cancer receiving 40 Gy of RT for 15 sessions . Increased serum concentrations of IL6 were significantly associated with fatigue symptoms in individuals with unresectable non-small-cell lung cancer receiving curative conventional external beam RT with concurrent chemotherapy . RIF was significantly associated with serum sTNF-R1and IL-6 levels after controlling for numerous covariates in locally advanced colorectal and esophageal cancer receiving concurrent chemoradiation therapy . Homozygous alleles of IL-6 were associated with higher levels of evening and morning fatigue symptoms among cancer patients before, during, and those actively receiving RT .

Microglial and glial cells in the central nervous system also produce cytokines especially in response to stressful conditions caused by RT . The inflammatory cytokines from these cells are thought to communicate with CNS structures causing fatigue by altering neurotransmission in the CNS through the afferent vagus nerve root . For example, the neurons of the preoptic nucleus that synthesize IL-1β have processes that have ramifications for other CNS structures, including the limbic system and the brainstem causing modulation of the neural response leading to significant fatigue .

If Youre Getting Radiation Therapy To The Brain

People with brain tumors often get stereotactic radiosurgery if the cancer is in only one or a few sites in the brain. Side effects depend on where the radiation is aimed. Some side effects might show up quickly, but others might not show up until 1 to 2 years after treatment. Talk with your radiation oncologist about what to watch for and when to call your doctor.

If the cancer is in many areas, sometimes the whole brain is treated with radiation. The side effects of whole brain radiation therapy may not be noticeable until a few weeks after treatment begins.

Radiation to the brain can cause these short-term side effects:

• Trouble with memory and speech

Some of these side effects can happen because radiation has caused the brain to swell. Medicines are usually given to prevent brain swelling, but its important to let your cancer care team know about headaches or any other symptoms. Treatment can affect each person differently, and you may not have these particular side effects.

Radiation to the brain can also have side effects that show up later usually from 6 months to many years after treatment ends. These delayed effects can include serious problems such as memory loss, stroke-like symptoms, and poor brain function. You may also have an increased risk of having another tumor in the area, although this is not common.

Talk with your cancer care team about what to expect from your specific treatment plan.

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Prevalence Of Cancer Related Fatigue

About 50%90% of cancer patients worldwide experience cancer-related fatigue.

The following symptoms begin after a week or so of the first radiation treatment:

• Feeling tired or lethargic throughout the day

Walking from the parking lot to your office may take longer and it may be difficult to accomplish physical tasks. Fatigue can be extremely frustrating because you aren’t quite sleepy, but you just don’t have enough energy to do much.

Fatigue does affect everyone differently. Some may experience mild fatigue, while others may suffer from severe chronic fatigue that affects their quality of life considerably. Your fatigue may increase over time as you undergo more radiation therapy treatments.

Swelling Of The Breast

Radiotherapy can make it more difficult for fluid to drain from the breast tissue. This can cause swelling of the breast or chest area. Doctors call this lymphoedema.

The swelling usually goes down a few weeks after the treatment ends. But tell your doctor or radiographers if it doesnt. They can arrange for you to see a lymphoedema specialist. You might have a type of massage called manual lymphatic drainage.

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Your Healthcare Team Will Continue To Look For Patterns Of Fatigue

A fatigue assessment is repeated to see if there is a pattern for when fatigue starts or becomes worse. The same method of measuring fatigue is used at each assessment. This helps show changes in fatigue over time. The healthcare team will check for other causes of fatigue that can be treated. See the Causes of Cancer Fatigue section.

Radioprotective Drugs For Reducing Side Effects

One way to reduce side effects is by using radioprotective drugs, but these are only used for certain types of radiation given to certain parts of the body. These drugs are given before radiation treatment to protect certain normal tissues in the treatment area. The one most commonly used today is amifostine. This drug may be used in people with head and neck cancer to reduce the mouth problems caused by radiation therapy.

Not all doctors agree on how these drugs should be used in radiation therapy. These drugs have their own side effects, too, so be sure you understand what to look for.

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