Fatigue From Radiation Therapy For Breast Cancer

Radiation Therapy And Risk Of A Second Cancer

In rare cases, radiation therapy to the breast can cause a second cancer.

The most common cancers linked to radiation therapy are sarcomas . For women who are long-term smokers, radiation therapy may also increase the risk of lung cancer .

The risk of a second cancer is small. If your radiation oncologist recommends radiation therapy, the benefits of radiation therapy outweigh this risk.

How Are Side Effects Of Radiation Therapy Diagnosed And Treated

• Your healthcare provider will ask you about your symptoms and decide if they are side effects of radiation therapy. Radiation therapy may prevent the bone marrow from making red blood cells, white blood cells, and platelets. This may cause low blood counts. Low blood counts are diagnosed with a blood test.
• Treatment depends on what area of the body is affected. You may be given medicine to treat nausea, vomiting, indigestion, or diarrhea. You may also be given medicine to treat problems in the mouth, or pain in the area that receives radiation. Lotions, ointments, or creams may be given to treat skin problems caused by radiation therapy.

Chemotherapy And Cognitive Impairment

After chemotherapy, objective cognitive difficulties are usually mild-to-moderate and are often transient. Cognitive decline shortly after chemotherapy was reported by some breast cancer patients, followed by partial recovery one year after treatment completion . Patients treated with anthracycline-containing chemotherapy regimens are more at risk to present decline of verbal memory performances compared to those not treated with anthracyclines . However, reduced cognitive performance and white matter alterations observed on imaging were found to recover in a group of breast cancer survivors 34 years after chemotherapy .

Nevertheless, some breast cancer survivors had worse performances on cognitive tests compared to healthy controls for up to 20 years after the end of adjuvant chemotherapy , including fine motor function deficits . Furthermore, an imaging study showed that time since cancer treatment was inversely associated with lower global and focal white matter integrity . Decreased responsiveness of brain regions related to memory encoding and executive functioning was also observed 10 years after chemotherapy in breast cancer survivors . In addition, a dose-dependent effect of adjuvant chemotherapy was also suggested on grey matter volume one decade after treatment .

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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
• Exhaustion
• Reduced energy

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.

Cytokines Fatigue And Cutaneous Erythema In Early Stage Breast Cancer Patients Receiving Adjuvant Radiation Therapy

Vitaliana De Sanctis et al.

1Department of Translational Medicine, Institute of Radiation Oncology, Sapienza University, SantAndrea Hospital, Via di Grottarossa 1035-1039, 00189 Rome, Italy

2Department of Clinical and Molecular Medicine, Cellular Diagnostic Unit, Sapienza University, SantAndrea Hospital, Via di Grottarossa 1035, 00189 Rome, Italy

3Statistics, Probability and Applied Statistics, Sapienza University, Piazzale Aldo Moro 5, 00185 Rome, Italy

4Department of Translational Medicine, Breast Surgery, Sapienza University, SantAndrea Hospital, Via di Grottarossa 1035, 00189 Rome, Italy

5Department of Clinical and Molecular Medicine, Medical Oncology, Sapienza University and IDI-IRCCS, SantAndrea Hospital, Via di Grottarossa 1035, 00189 Rome, Italy

6UOD Psyco-oncology, SantAndrea Hospital, Via di Grottarossa 1035, 00189 Rome, Italy

Academic Editor:

Abstract

1. Introduction

Therefore, factors responsible for fatigue during RT remain still unknown. Among potential causes, the local activation of substances such as systemic inflammatory markers and proinflammatory cytokines has been hypothesized . The most frequent acute adverse effect during RT in breast cancer patients is breast skin erythema that has not been evaluated for eventual correlation with fatigue onset .

2. Materials and Methods

2.1. Statistical Methods

3. Results

4. Discussion

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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

Exercise Has A Positive Effect On Fatigue During And After Cancer Treatment

Exercise may help people with cancer feel better and have more energy during and after treatment. The effect of exercise on fatigue in people with cancer is being studied. One study reported that breast cancersurvivors who took part in enjoyable physical activity had less fatigue and pain and were better able to take part in daily activities. In clinical trials, some people with cancer reported the following benefits from exercise:

• More physical energy.
• More enjoyment with life.
• A greater sense of well-being.

Moderate activity for 3 to 5 hours a week may help cancer fatigue. You are more likely to follow an exercise plan if you choose a type of exercise that you enjoy. Your healthcare team can help you plan the best time and place for exercise and how often to exercise. You may need to start with light activity for short periods of time and build up to more exercise little by little. Studies have shown that exercise can be safely done during and after cancer treatment.

Mind and body exercises such as qigong, tai chi, and yoga may help relieve fatigue. These exercises combine activities like movement, stretching, balance, and controlled breathing with spiritual activity such as meditation.

Cognitive behavior therapy

• Stress from coping with cancer.
• Fear that the cancer may come back.
• Feeling hopeless about fatigue.
• Lack of social support.
• A pattern of sleep and activity that changes from day to day.

Other ways to manage fatigue

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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:

• Lack of sleep caused by some anticancer drugs.

Fatigue caused by radiation therapy

Fatigue caused by hormone therapy

Fatigue caused by immunotherapy

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.

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What Are The Side Effects Of Radiation Therapy

The side effects of radiation therapy depend on the area of the body that receives radiation. Early side effects happen shortly after you receive radiation therapy. Late side effects can happen months to years after you receive radiation therapy. Late side effects of radiation therapy may be permanent. Early and late side effects may include any of the following:

• Fatigue or loss of energy
• Pain in the area of the body that is being treated
• Skin changes such as a sunburn or red skin
• Hair loss in the area receiving radiation
• Nausea, vomiting, diarrhea, or indigestion
• Sores, pain, or dryness in your mouth
• Difficulty urinating
• Sexual dysfunction

Impact Of Cognitive Impairment

Cognitive dysfunction may substantially impact quality of life and social function. An example of such negative impact is the ability of return to work after cancer treatment. Indeed, five years post-diagnosis, in addition to fatigue and psychological problems, cognitive disorders are related with difficulties in returning to work in breast cancer survivors . Furthermore, cognitive complaints were shown to be associated with poorer work ability, work performance, and work productivity . Stressing the relevance of this concern from a patients perspectives, some reports have shown that breast cancer survivors with CRCI express the need of appropriate support to maintain their quality of life and be facilitated to return to work .

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What Causes Excessive Tiredness

Itâs tricky because a number of things can bring on fatigue when youre going through prostate cancer treatment.

For example, itâs common to feel quite worn down due to:

• not having enough sleep or rest

• eating poorly and not getting the right amount of exercise

• stress, anxiety or depression

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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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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.

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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Nutrition Needs Change And Cause Or Increase Fatigue

For many patients, the effects of cancer and cancer treatments make it hard to eat well. The body’s energy comes from food. Fatigue may occur if the body does not take in enough food to give the body the energy it needs. In people with cancer, three major factors may affect nutrition:

• A change in the way the body uses food. A patient may eat the same amount as before having cancer, but the body may not be able to absorb and use all the nutrients from the food. This is caused by the cancer or its treatment.
• An increase in the amount of energy needed by the body because of a growing tumor, infection, fever, or shortness of breath.
• A decrease in the amount of food eaten because of low appetite, nausea, vomiting, diarrhea, or a blocked bowel.

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Radiation Therapy For Breast Cancer

Radiation therapy uses high-energy rays or particles to destroy cancer cells. It is often used to treat breast cancer. Your healthcare team will consider your personal needs to plan the type and amount of radiation, and when and how it is given. You may also receive other treatments.

Radiation therapy is given for different reasons. You may have radiation therapy to:

• lower the risk of the cancer coming back, or recurring, after surgery
• shrink a tumour before surgery
• treat breast cancer that comes back, or recurs, in the area of a mastectomy
• relieve pain or control the symptoms of advanced breast cancer

Doctors use external beam radiation therapy to treat breast cancer. During external beam radiation therapy, a machine directs radiation through the skin to the tumour and some of the tissue around it.

Some women may not be able to have radiation therapy because they already had radiation therapy to the chest or breast. Doctors may not offer radiation therapy to women with lung problems, damaged heart muscles and certain connective tissue diseases.