Proposed Mechanisms Of Rif
Recent evidence suggests that RIF may be related to mitochondrial dysfunction . Downregulation of mitochondrial markers involved in cell death that are responsible for maintaining mitochondrial membrane integrity and regulating apoptosis may influence the worsening of fatigue symptoms during RT . Further evidence also suggests that genes that are related to regulation of the production of reactive oxygen species and release of cytochrome c may be involved in the worsening of fatigue symptoms during RT . It is specifically proposed that RIF could be due to attenuated physiological and cellular energy caused by a reduction in the capacity of mitochondria to utilize oxygen and synthesize adenosine triphosphate . These self-preservation physiological processes, such as apoptosis and autophagy, are activated in response to RT and may play significant roles in the worsening of fatigue symptoms during RIF. Other experts believe that impairment in these physiological processes to counter the toxic effects of RT, as well as bystander tissue damage from RT, may lead to the persistence and chronicity of symptoms through an altered immune response .
Other factors have been proposed in the literature to cause RIF including genetic factors, anemia, pro-inflammatory cytokine production, hypothalamicâpituitaryâadrenal axis dysfunction, and neuromuscular abnormality . We will discuss three of these major mechanisms.
How Can Exercise Help Reduce Cancer Fatigue
You may feel ill from your cancer or treatment, which may lead to less physical activity. Decreased levels of physical activity can lead to tiredness and lack of energy. Scientists have found that even healthy athletes forced to spend extended periods in bed or sitting in chairs develop feelings of anxiety, depression, weakness, fatigue and nausea. Regular, moderate exercise can decrease the feeling of fatigue and help you feel energetic. Even during cancer therapy, it’s often possible to continue to exercise. Be sure to check with your healthcare provider before starting an exercise program.
Exercise has many health benefits. Regular exercise can:
- Increase your appetite.
Tips For Managing Your Fatigue
- 1. Tell your GP or nurse how youre feeling. Your fatigue may have a treatable cause, for example anaemia, which can be treated with iron supplements. 2. Try using a fatigue diary. This involves recording your level of fatigue every day from 1 to 10 . This can help you think about how your treatment affects your energy levels so you can plan your day and mak
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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.
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.
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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
Take Charge Of Your Stress
Managing stress can play an important role in fighting fatigue. Here are some suggestions that may help.
- 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 toward easing stress.
- Help others understand and support you. Family and friends can be helpful if they can put themselves in your shoes and understand what fatigue means to you. Cancer support groups can be a source of strength, too. Other people with the disease may understand what youre going through.
- Relaxation techniques like deep breathing or visualization can lower stress, too. Or just do low-key things that are fun for you: read, listen to music, or knit, for example.
Let your doctor know if your stress seems out of control. They can help you feel better.
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How Can I Conserve Energy When I Have Cancer Fatigue
Plan and organize your work
- Change storage of items to reduce trips or reaching.
- Delegate when needed.
- Combine motions and activities and simplify details.
Schedule rest
- Balance periods of rest and work.
- Rest before you feel tired.
- Frequent, short rests are beneficial.
Pace yourself
- Do not hold your breath.
- Wear comfortable clothes to allow for free and easy breathing.
Identify anything in your environment that may contribute to cancer fatigue
- Avoid extreme temperature.
- Eliminate smoke or noxious fumes.
- Avoid long, hot showers or baths.
Prioritize
- Use your energy on important tasks.
Box 1 Suggestions For Screening Of Chronic Fatigue In Adult Cancer Survivors The Overview Is Based On International Guidelines And The Norwegian Directorate Of Health’s Recommendations
Assessment of fatigue level
General history of fatigue: onset, pattern, duration, change over time, factors that exacerbate/improve the symptoms, pattern of activity throughout the day and week
Other factors:
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psychological factors, particularly high anxiety level and catastrophising sleep, pain, medication, abuse of alcohol or narcotics
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somatic comorbidity
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cancer treatment can predispose for comorbidity, for example cardiomyopathy after cardiotoxic chemotherapy or hypothyreosis following radiotherapy targeting the lower neck
A general physical examination should be undertaken to detect somatic conditions as an underlying cause. Recurrence of the cancer should be considered if a patient who has been in good shape develops fatigue
Additional examinations must be considered individually:
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Relevant blood tests are: haematological profile, hormone tests , electrolytes, liver/gallbladder function
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Radiological examinations should be performed if clinical signs of somatic disease
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Referral to other medical specialists must be based on findings and clinical evaluation. Referral to the following may be needed:
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Cardiologist after completion of cardiotoxic treatment
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Neuropsychologist in cases of memory and/or concentration difficulties, particularly in younger patients
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Psychologist/psychiatrist if signs of mental disorders
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Pain management team
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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
Certain Drugs Are Being Studied For Cancer Fatigue
The following drugs are being studied for cancer fatigue:
- Psychostimulants are drugs that improve mood and help decrease fatigue and depression. Psychostimulant drugs may help some patients have more energy, a better mood, and help them think and concentrate. The use of psychostimulants for treating fatigue is still being studied. The FDA has not approved psychostimulants for the treatment of fatigue.
- Bupropion is an antidepressant that is being studied to treat fatigue in patients with or without depression.
- Steroids are being studied in patients with advanced cancer. Dexamethasone is a steroid that reduces inflammation, but has unwanted side effects. In one clinical trial, patients who received dexamethasone reported less fatigue than the group that received a placebo.
Talk to your doctor about the risks and benefits of these drugs.
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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.
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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What Are The Different Types Of Radiation Treatments
Radiation therapy uses concentrated doses of radiation to kill cancer cells and reduce the size of tumors. Depending on the type of cancer present in the body, one of two types of radiation therapy may be used.
External beam radiation therapy uses a large machine to send radiation into the specific area containing cancer. The radiation machine never touches the body, but it does move around to deliver radiation into precise parts of the body. External beam radiation is the most common type of treatment for many cancers.
Internal radiation therapy, on the other hand, uses a solid or liquid radiation source to physically deliver radiation inside the body. If a solid source of radiation is used, it only targets a specific part of the body for localized treatment, especially for cancers of the head, neck, breast, cervix, prostate, and eye. If a liquid source of radiation is used, its considered a systemic therapy that travels through the blood into tissues throughout the entire body.
Radiation therapy is often used in conjunction with other treatments or surgeries to target cancer in the most strategic way possible. Its often used to make surgery easier by shrinking the size of the tumor beforehand. Radiation therapy is even used during surgery to go straight into cancer cells without passing through the skin.
How Long Side Effects May Last
Radiation therapy can cause side effects during and just after treatment. These are called short-term or acute effects. It can also cause long-term or late effects months or years down the track. Most side effects go away after treatment. But sometimes radiation therapy can cause long term or late effects months or years down the track.
During treatment, tell your radiation therapy team about any side effects, as side effects can usually be controlled with the right care and medicine.
Learn more about:
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Tiredness After Brain Radiotherapy
People having radiotherapy for brain tumours often feel tired. This can be worse if you’re also taking steroids. The tiredness often reaches its maximum 1 to 2 weeks after the end of treatment.
A small number of people are asleep for a lot of the day after a long course of radiotherapy to the brain. This called somnolence syndrome.
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External Beam Therapy Peter Hoskin
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Efficacy of exercise interventions in modulating cancer-related fatigue among adult cancer survivors: a meta-analysisJ C Brown and othersCancer Epidemiology, Biomarkers and Prevention, 2011
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Devita, Hellman and Rosenberg’s Cancer Principles and Practice of Oncology VT Devita, TS Lawrence and SA RosenbergWolters Kluwer Health, 2019
If Youre Getting Radiation Therapy To The Chest
Radiation treatment to the chest may cause side effects such as:
Radiation can also cause other problems in the heart or lungs.
Heart complications
Getting radiation to the middle portion of the chest can raise your risk of heart disease. This risk increases with higher radiation doses and larger treatment areas in this part of your body. Radiation can also cause hardening of the arteries , heart valve damage, or irregular heartbeats.
Radiation pneumonitis
Radiation pneumonitis is inflammation of the lungs that can be caused by radiation treatment to the chest . It may occur about 3 to 6 months after getting radiation therapy. Its more likely if you have other lung diseases, like emphysema . Common symptoms of radiation pneumonitis include:
- Shortness of breath that usually gets worse with exercise
- Chest pain, which is often worse when taking in a deep breath
Sometimes there are no symptoms, and radiation pneumonitis is found on a chest x-ray.
Symptoms often go away on their own, but if treatment is needed, it is based on trying to decrease the inflammation. Steroids, like prednisone, are usually used. With treatment, most people recover without any lasting effects. But if it persists, it can lead to pulmonary fibrosis . When this happens, the lungs can no longer fully inflate and take in air.
Be sure you understand what to look for, and tell your cancer care team if you notice any of these side effects.
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Kidney And Bladder Effects
Certain chemotherapy medications, such as cisplatin, can cause damage to the kidneys and bladder. This can result in a decreased ability of your kidneys to filter your blood. Damage to the bladder can also occur and may be temporary or permanent. Symptoms of bladder irritation may include pain or urgency with urination, or blood in your urine.
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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What Is The Right Kind Of Exercise For Cancer Fatigue
It’s important for you to exercise your whole body every day, or at least every other day. A good exercise plan starts slowly, allowing your body time to adjust. Any kind of exercise is acceptable, including walking, riding a stationary bike, yoga or swimming , and strength training. Whatever kind of exercise you do should be at a moderate intensity so you can say to yourself “I am working somewhat hard.” Avoid exercise that makes you feel sore, stiff or exhausted.
What Happens If You Sleep Too Much
Too much sleep can result in more fatigue and restless nighttime sleeping. Rest when you need it. If you begin to feel tired, stop and take a few moments to rest to recharge your batteries. Resting can mean taking a short power nap or just sitting in a relaxing place and taking time out for yourself.
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