Is There Anything Else You Would Like To Tell The Patients
Yes: I would like to emphasize that the patient plays a big role in finding the best possible therapy for themselves. They should know how important it is that they really listen to them-selves and that the greatest treasure of knowledge lies with them! Only if they share their complaints and needs with the doctor, he/she can make the best possible therapeutic decision.
Prostate cancer nowadays is very well treatable for a long time. And it is no longer just a matter of prolonging life with modern therapies, quality of life can also be maintained.
About Frank Verholen
As an experienced physician, Dr. Frank Verholen also knows the daily routine in the clinic and can combine the great wealth of knowledge of medical practice with the pharmacological innovations, e.g. from Bayer. Frank Verholen studied medicine at the Ruhr University in Bo-chum and completed his doctorate there. He then worked for more than 10 years at the Uni-versity Hospitals of Geneva, where he acquired his knowledge for training as a specialist in internal medicine as well as a specialist in hematology. Dr. Verholen initially worked in various positions in the pharmaceutical industry in Switzerland and Germany, as well on a European level, before he took on the global medical responsibility at Bayer for radium-223 in 2016. For several years, he has headed the medical department for the urogenital division, including prostate cancer, in the Bayer Oncology Business Unit.
About Prostate Cancer at Bayer
How Long Will My Fatigue Last
How long fatigue lasts will vary from person to person. It may get better or worse over time. How long the fatigue lasts will depend on whats causing it.
Fatigue caused by your treatment may improve when you finish treatment. But some men have fatigue that lasts for many months, or sometimes years. And life-long treatment for prostate cancer can cause long-term fatigue. Keeping active during treatment might help your fatigue to improve more quickly.
How long the fatigue lasts will also depend on the type of treatment youve had.
Surgery
Some men who have surgery get fatigue for a few weeks afterwards, but it can last for longer.
Radiotherapy
If youre having radiotherapy to treat your cancer, you may have external beam radiotherapy, or a type of internal radiotherapy called brachytherapy. Both types of radiotherapy can cause similar levels of fatigue. Men on radiotherapy often find that their fatigue gets worse over time, and sometimes doesnt start until after their radiotherapy has finished. Fatigue usually starts to improve several weeks after treatment ends. But it could take up to a year for it get better.
If your cancer has spread from your prostate to other parts of your body , you may be offered a short course of radiotherapy for advanced prostate cancer to treat symptoms such as pain. Your fatigue may be worse for a week or two after your treatment finishes.
Hormone therapy
Chemotherapy
High-intensity focused ultrasound and cryotherapy
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.
- Don’t 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 can’t rid your body of permanent scarring but can often improve flexibility and mobility.
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Causes Of Cancer Fatigue
- Fatigue in people with cancer may have more than one cause.
- It is not clear how cancer treatments cause fatigue.
- Fatigue related to surgery
- Fatigue caused by radiation therapy
- Fatigue caused by hormone therapy
- Fatigue caused by immunotherapy
Can A Dietitian Help Me Fight Cancer Fatigue
Dietitians can provide suggestions to work around any symptoms that may be interfering with caloric intake. They can help you find ways to take in calories despite an early feeling of fullness, swallowing difficulty or taste changes. Dietitians can also suggest ways of maximizing calories and proteins in smaller amounts of food. They may suggest powdered milk, instant breakfast drinks and other commercial supplements or food additives.
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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.
Short Term Side Effects
Patients who receive any type of radiation therapy to treat their prostate cancer can have side effects. Short term side effects are ones that start during or shortly after your radiation treatment. Below is a list of possible short term side effects. Treatments can affect each patient differently, and you may not have these particular side effects. Talk with your care team about what you can expect from your treatment
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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.
Fatigue Can Decrease Your Quality Of Life
Cancer fatigue can affect all areas of your life by making you too tired to take part in daily activities, relationships, social events, and community activities. You might miss work or school, spend less time with family and friends, or spend more time sleeping. In some cases, physical fatigue leads to mental fatigue and mood changes. This can make it hard for you to pay attention, remember things, and think clearly. If you suffer from cancer fatigue, you may need to take leave from a job or stop working completely. Job loss can lead to money problems and the loss of health insurance. All these things can lessen your quality of life and self-esteem.
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Frequent Urination Burning With Urination And Difficulty Urinating
These are the most common complaints. Occasionally the urinary stream will weaken. Generally these symptoms are managed with medications to help the bladder function better or eliminate burning. Rarely, your doctor may order a urine test. Symptoms will resolve after the end of treatment. Contact your doctor if you see blood in your urine or if you are unable to urinate.
Radiation Therapy Side Effects
Radiation not only kills or slows the growth of cancer cells, it can also affect nearby healthy cells. Damage to healthy cells can cause side effects.
Many people who get radiation therapy have fatigue. Fatigue is feeling exhausted and worn out. It can happen all at once or come on slowly. People feel fatigue in different ways and you may feel more or less fatigue than someone else who is getting the same amount of radiation therapy to the same part of the body. See Fatigue and Cancer Treatment to learn more.
Other radiation therapy side effects you may have depend on the part of the body that is treated. To see which side effects you might expect, find the part of your body being treated in the following chart. Many of the side effects in the list link to more information in the Side Effects section. Discuss this chart with your doctor or nurse. Ask them about the side effects that you might expect.
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Individual And Mean Change In Evening And Morning Fatigue
The first HLM analyses examined how evening and morning levels of fatigue changed from the time of the simulation visit to four months after the completion of RT. Two models were estimated in which the function of time was linear and quadratic. For both evening fatigue and morning fatigue , the goodness-of-fit tests of the deviance between the linear and quadratic models indicated that a quadratic model fit the data significantly better than a linear model .
Evening Fatigue
The estimates of the quadratic change model are presented in Table 3 . Because the model had no covariates , the intercept represents the estimated amount of evening fatigue at the time of the simulation visit. The estimated linear rate of change in evening fatigue, for each additional week, was 0.078 and the estimated quadratic rate of change per week was 0.003 . It is important to remember that it is the weighted combination of the linear and quadratic terms that define each curve. Figure 1 displays the trajectory for evening fatigue from the time of the simulation visit to four months after the completion of RT. Evening fatigue increased over the course of RT and then declined after the completion of RT. It should be noted that the mean fatigue scores for the various groups depicted in all of the figures are estimated or predicted means based on the HLM analyses.
Trajectories of evening and morning fatigue over the 25 weeks of the study.
Can Stress Management Help With Cancer Fatigue
Managing stress can play an important role in combating fatigue. Here are some ways you can manage stress:
- Adjust your expectations. For example, if you have a list of 10 things you want to accomplish today, pare it down to two and leave the rest for other days. A sense of accomplishment goes a long way to reducing stress.
- Help others to understand and support you. Family and friends can be helpful if they can “put themselves in your shoes” and understand what cancer fatigue means for you. Cancer support groups can be a source of support as well. Other people with cancer truly understand what you are going through.
- Relaxation techniques including guided meditation, deep breathing or visualization can help reduce stress and minimize cancer fatigue.
- Divert your attention. Activities that divert your attention away from fatigue can also be helpful. Activities that require little physical energy but demand attention include knitting, reading or listening to music.
If your stress feels overwhelming, talk to your healthcare provider. They are there to help.
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Remove Devices From Your Skin
The manufacturer recommends taking these devices off your skin before your simulation or treatment:
- Continuous glucose monitor
If you use one of these, ask your radiation oncologist if you need to take it off. If you do, make sure to bring an extra device to put on after your simulation or treatment.
While your device is off, you may not be sure how to manage your glucose . Ask the healthcare provider who manages your diabetes care. Make sure to do this before your simulation or treatment appointment.
Radiation Therapy For Prostate Cancer
Radiation therapy uses high-energy rays or particles to kill cancer cells. Depending on the stage of the prostate cancer and other factors, radiation therapy might be used:
- As the first treatment for cancer that is still just in the prostate gland and is low grade. Cure rates for men with these types of cancers are about the same as those for men treated with radical prostatectomy.
- As part of the first treatment for cancers that have grown outside the prostate gland and into nearby tissues.
- If the cancer is not removed completely or comes back in the area of the prostate after surgery.
- If the cancer is advanced, to help keep the cancer under control for as long as possible and to help prevent or relieve symptoms.
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Not Sleeping Well Causes Fatigue
Some people with cancer are not able to get enough sleep. The following problems related to sleep may cause fatigue:
- Waking up during the night.
- Going to sleep at different times every night.
- Sleeping duringthe day and less at night.
- Being inactive during the day.
- The time of day that cancer treatment is given.
Poor sleep affects people in different ways. For example, the time of day that fatigue is worse may be different. Some people with cancer who have trouble sleeping may feel more fatigue in the morning. Others may have severe fatigue in both the morning and the evening. People with cancer who are inactive during the day, have restless sleep, or who have obesity may have higher levels of fatigue.
Even in people with cancer who have poor sleep, fixing sleep problems does not always improve fatigue. A lack of sleep may not be the cause of the fatigue. See the PDQ summary on Sleep Disorders for more information.
Chronic Fatigue In Adult Cancer Survivors
National Advisory Unit on Late Effects after Cancer Treatment
Oslo University Hospital
Kristin Valborg Reinertsen , specialist in oncology and senior consultant. She completed her PhD in 2011 on long-term effects after treatment for breast cancer.
The author has completed the ICMJE form and reports no conflicts of interest.
Regional Advisory Unit for Palliative Care
Oslo University Hospital
Jon Håvard Loge , specialist in psychiatry and in child and adolescent psychiatry. He heads the Regional Advisory Unit for Palliative Care, South-Eastern Norway Regional Health Authority. He is professor II at the Department of Behavioural Sciences in Medicine. He was head of the National Advisory Unit on Late Effects after Cancer Treatment from 2011 to 2014. He has worked with late effects after cancer treatment since the mid 1990s with particular focus on chronic fatigue in cancer survivors.
The author has completed the ICMJE form and reports no conflicts of interest.
Department of General Practice/Family Medicine
Institute of Health and Society
University of Oslo
Mette Brekke , specialist in general practice and professor. She also works as a GP at the Kurbadet group practice, Oslo.
The author has completed the ICMJE form and reports no conflicts of interest.
National Advisory Unit on Late Effects after Cancer Treatment
Oslo University Hospital
Cecilie E. Kiserud , PhD and senior consultant in oncology. She heads the National Advisory Unit on Late Effects after Cancer Treatment.
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Faq: Radiation Therapy For Prostate Cancer
Why would I choose radiation therapy?
Radiation therapy, including external beam radiation therapy and brachytherapy, is an alternative form of treatment for prostate cancer. EBRT may be used after other treatments, such as surgery, to manage cancer that has recurred or is at high risk of recurrence. Radiation therapy has an excellent record of success, providing long-term disease control and survival rates equivalent to other treatments, including surgery.
How should I expect to feel during radiation therapy?
Undergoing external beam radiation therapy is similar to having a routine X-ray. Radiation cannot be seen, smelled or felt. Generally, side effects don’t appear until the second or third week of treatment. Because radiation therapy is a local treatment, only the areas of the body where it is directed will experience side effects. Most patients will experience some or all of the following:
- Increase in the frequency of urination
- Urinary urgency
- Softer and smaller volume bowel movements
- Increased frequency of bowel movements
- Worsening of hemorrhoids or rectal irritation with occasional scant blood and fatigue
Many questions may arise during radiation therapy treatment. Your doctors will be available to answer questions throughout your treatment.
How should I expect to feel after radiation therapy?
When Is Radiation Therapy Used
There are some instances where the practitioners opt for radiotherapy for prostate cancer as opposed to other forms of treatment. Here are some of the situations in which radiation therapy may be used:
- As the first treatment of cancer, which is still confined to the prostate gland.
- It is used along with hormone therapy during the first treatment for prostate cancer that has extended the nearby tissues.
- After the reoccurrence of cancer in the area, it was before surgery.
- To keep cancer under control and relieve you from the symptoms for as long as possible if the cancer is advanced.
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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
