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Long Term Fatigue After Cancer Treatment

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What Caregivers Can Do

Coping with fatigue after cancer treatment Ruth’s story
  • Help schedule friends and family members to prepare meals, clean the house, do yard work, or run errands for the patient. You can use websites that help organize these things, or ask a family member to look into this for you.
  • Try not to push the patient to do more than they are able to.
  • Help the patient set up a routine for activities during the day.

Describing And Managing Weakness

Weakness is decreased strength. If this is caused by surgery in a certain part of the body or loss of a body part, the weakness might be helped by physical therapy or occupational therapy. If weakness is caused by having an infection or having changes in blood levels, such as low blood counts, low electrolytes, or changes in hormones, treatment to help with the specific problem can help decrease weakness.

Endocrine Therapy And Cognitive Impairment

In addition to the impact of chemotherapy on cognition, endocrine therapies could also affect cognition. In a recent meta-analysis, endocrine therapy was associated with impaired performance on some neuropsychological tests, especially those which assessed verbal learning/memory domain . Difference of the impact on cognition of tamoxifen or aromatase inhibitors is still debated. However, cognitive impairment has been shown more frequently with non-steroid aromatase inhibitors . Up to 18 months after the start of treatment, breast cancer survivors who received anastrozole had lower executive function scores than healthy controls . In the same study, 1218 months after initiation of therapy, women being treated with anastrozole alone exhibited decrease in working memory and concentration. Verbal memory also appeared to be affected one year post-treatment , whereas no detrimental effect of endocrine therapy on cognition was shown 6 years after the start of treatment .

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How Long Does Cancer Fatigue Last

Everyones experience with cancer fatigue is unique. For some people, fatigue lasts a few weeks. Others may feel exhausted for years. You may feel better when your cancer treatments stop, but often fatigue lingers.

  • Bone marrow transplants can cause prolonged fatigue that lasts up to a year.
  • Radiation therapy fatigue often gets worse as treatments progress. Fatigue should lessen a few months after you stop treatment.
  • Surgery tends to cause temporary fatigue that goes away after you recover.
  • Systemic treatments can cause fatigue that comes and goes. These treatments include chemotherapy, immunotherapy and targeted therapy. You may be exhausted while taking the medications and feel better during the recovery phase . When treatment resumes, you feel exhausted again. You should have more energy when you finish the treatment.

Reduced Deactivation Of The Dmn

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A third pattern of connectivity emerged in three studies on brain tumors and breast cancer during treatment and before chemotherapy. They all reported a reduced capacity to inhibit DMN activation, which was correlated with measures of fatigue. Given the role of the DMN in disrupting attentional and engagement processes , failure to suppress DMN regions during tasks should be related to decreased attention and/or motivation toward the task. Nevertheless, within the DMN, hyperactivation was also observed on resting-state fMRI . Chemotherapy can induce white matter disruption and a reduction in gray matter density in several brain regions, including the DMN . Specifically, the precuneus, cingulate, lateral parietal cortex, medial frontal gyrus, cerebellum and hippocampus appear to be the structures most impacted by cancer treatments. Since the DMN is thought to be involved in contemplation, remembering, and rumination, the authors suggested that enhanced connectivity between the DMN and the frontal gyrus may be related to more cogitation and partially responsible for mental fatigue.

This failure to suppress default mode activity during tasks has been linked to decreased activity in task-related regions leading to attentional lapses and decreases in performance . This disengagement of brain regions associated with mental effort favoring of brain regions linked to resting activity might be intended to conserve mental resources for the maintenance of engagement in the task .

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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 .

Should I Change The Way I Eat To Combat Cancer Fatigue

Cancer fatigue may be worse if you’re not eating enough or if you are not eating the right foods. Maintaining good nutrition can help you feel better and have more energy. The following strategies can help you improve your nutritional intake.

  • Basic calorie needs. A person with cancer whose weight has been stable needs about 15 calories per pound of weight each day. For example, a person who weighs 150 pounds needs about 2,250 calories per day to maintain weight. You should add 500 calories per day if you have lost weight.
  • Protein rebuilds and repairs damaged body tissue. You need about 0.5-0.6 grams of protein per pound of body weight to rebuild and repair body tissue. For example, a 150-pound person needs 75 to 90 grams of protein per day. The best sources of protein include foods from the dairy group and meats .
  • Fluid needs. Unless your healthcare provider tells you otherwise, you should aim for about 64 ounces per day to prevent dehydration. Fluids include juice, milk, broth, milkshakes, Jello® and other beverages. Of course, water is fine, too. Its important to note that beverages containing caffeine do NOT count. And if you are losing fluid from excessive vomiting or diarrhea, you will need extra fluids.
  • Supplemental vitamins. Talk with your healthcare provider to find out if vitamin supplements are a good idea for you. Vitamin supplements don’t provide calories, which are essential for energy production. So vitamins cannot substitute for adequate food intake.

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What Causes Fatigue In People With Cancer

Causes of cancer-related fatigue are complex, wide-ranging and not yet fully understood. Lifestyle, including poor nutrition, lack of exercise and alcohol consumption can be factors. CRF is also affected by sleep disturbances, certain medicines and your mental health prior to a cancer diagnosis. Many causes of CRF are linked to the cancer itself or the treatment youre receiving for your cancer.

Causes of CRF linked to cancer include the following:

Risk Factors And Mechanisms Of Long

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Fatigue is a complex and multidimensional symptom. A number of studies have investigated and proposed a variety of risk factors and mechanisms of onset for long-term cancer-related fatigue .

2.3.1. Risk Factors of Cancer-Related Fatigue

2.3.2. Mechanisms of Cancer-Related Fatigue

Several mechanisms have been proposed to be linked with cancer-related fatigue. These include, among others, inflammation, hypothalamic pituitary adrenal dysfunction, five hydroxyl tryptophan dysregulation, alterations in the autonomic nervous system, alterations in adenosine triphosphate and muscle metabolism, changes in leukocyte subsets, reactivation of latent herpes viruses, anemia, and down-regulation of genes with response elements for the glucocorticoid receptor . The lack of longitudinal studies in this setting makes it difficult to interpret whether or not all of the cited biological changes are only driven by cancer and cancer treatment or might also be present before cancer diagnosis.

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Course Of Cf And Factors Associated With Pf

Ninety-seven of the women had CF at T2, including 57 individuals who also had CF at T1. The latter women were classified as having PF. Twenty-five women were diagnosed with resolving fatigue- i.e CF only at T1, while 40 subjects were incident cases with CF only at T2. At both assessment points women with PF had significantly higher total fatigue scores than those with chronic fatigue at either T1 or T2 . As expected, the total fatigue scores at the two assessment points were significantly correlated .

Mean total fatigue scores at T1 and T2 grouped by fatigue status. T1: first assessment point . T2: second assessment point . NF: never fatigued. CF: chronic fatigued. PF: persistent fatigued

In the univariate analyses previous treatment for mental problems, HADS caseness, BMI30, treatment-area related discomfort, increasing hsCRP and leukocyte count evaluated at T1 were significant predictors for PF, while educational and marital status reached borderline significance . Contrary to the findings on CF, respiratory symptoms were not associated with PF. Neither were hemoglobin-level, an elevated TSH or a diagnosis of hypothyroidism related to PF.

Late Effects Of Radiation Therapy

Radiation therapy is applied to the areas of the body that are affected by cancer. Aftereffects occur only in the area that was treated. In some cases, treatment may also include healthy tissue. This is to make certain that all of the cancer is treated.

Newer methods of radiation therapy help minimize damage to normal tissue. Treatment is directed to the same area each time. Yet, radiation rays sometimes scatter. Tissues and organs near the cancer site might receive small doses of radiation if this happens. Late effects of radiation could include:

  • Cataracts.
  • Slowed or halted bone growth in children.
  • Skin sensitivity to sun exposure.
  • Problems with memory or ability to learn.
  • Secondary cancers such as skin cancer.

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What The Patient Can Do

  • Rest, but not too much. Plan your day so you have time to rest. Take short naps or rest breaks , rather than one long nap during the day. Too much rest can lower your energy level and make it harder to sleep at night.
  • Certain drugs used to treat pain, nausea, or depression can make a person feel tired and sleepy. Talk with your cancer care team about this. Sometimes adjusting the doses or changing to a different drug can help.
  • Talk to your health care team about any problems with your nutritional intake
  • Regular moderate exercise especially walking is a good way to ease fatigue. Talk to your doctor about the right exercise plan for you.
  • Ask your family or friends to help with the things you find tiring or too hard to do.
  • Try to sleep 7 to 8 hours each night. Sleep experts tell us that having regular times to go to bed and get up helps us keep a healthy sleep routine.
  • Each day, prioritize decide which things are most important to you and focus on those tasks. Then plan ahead. Spread activities throughout the day and take breaks. Do things slowly, so that you wont use too much energy at once
  • Avoid caffeine
  • Avoid exercising too late in the evening.

Is It Possible To Prevent Long

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It is not always possible to prevent long-term side effects from chemotherapy. There is no way to tell precisely how therapy will affect any given individual.

Doctors may discuss the risk of long-term effects or permanent issues with a person to help them select the most suitable drugs and therapies.

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Late Effects Of Chemotherapy

Chemotherapy medicines interfere with the rapidly growing cells of the body. These cells can include those related to hair, skin, fingernails or the stomach lining. This is why chemotherapy can cause temporary side effects. These include mouth sores, upset stomach, hair loss or skin rashes. Side effects usually improve as the normal tissues repair themselves.

Not all chemotherapy medicines have the same late effects. A lot depends on the kind of medicines used. The dosage and whether chemotherapy was done with another type of treatment are also important. If an organ is damaged, a lot depends on whether it can repair itself. Before starting treatment, ask your health care provider about the possible after-effects of all the medications you will receive. Late effects of chemotherapy include:

  • Secondary cancers.

Managing Symptoms Of Cancer

There are things you can do to help manage the symptoms of fatigue.

Eating well and drinking lots of fluids can help increase your energy levels. Your doctor or nurse can give you advice on your diet.

Being physically active can also improve your energy levels and increase your appetite. Start slowly and increase the amount of activity you do over time. Try setting yourself small goals that you can achieve, such as walking to the front door. Some exercise, even a small amount, is better than no exercise at all. Its important to get advice from your doctor before you do any new physical activity. They may refer you to a physiotherapist for further advice.

You may find that you feel more stressed when you are having treatment. This can make you feel more tired. Try to make time to relax. There are relaxation techniques you can use to relieve tension and increase your energy. Complementary therapies may also help you cope with fatigue and help you to relax. Speak to your GP about using these therapies.

There arent any licensed drug treatments for fatigue, but they are being researched. Steroid drugs can be helpful for some people. Your cancer specialist can talk about this with you.

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Chronic Fatigue In Cancer Brain Connectivity And Reluctance To Engage In Physical Activity: A Mini

  • 1Research Centre on Cognition and Learning , University of Poitiers, Sport Sciences Faculty, Poitiers, France
  • 2Maison des Sciences de lHomme et de la Société , Université de Poitiers, Poitiers, France
  • 3M2S-EA7470, University of Rennes, Rennes, France
  • 4APCoSS – Institut de Formation en Education Physique et en Sport , UCO Angers, Angers, France
  • 5Institut Universitaire de France , Paris, France

How Does Nutrition Affect Energy Level

Patient-reported long-term physical symptoms after prostate cancer treatments

Cancer-related fatigue is often made worse if you are not eating or drinking enough or if you are not eating the right foods. Maintaining good nutrition can help you feel better and have more energy. Make an appointment with a dietitian. A registered dietitian provides suggestions to work around any eating problems that may be interfering with proper nutrition . A dietitian can also suggest ways to maximize calories and include proteins in smaller amounts of food .

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Interaction With Healthcare Service

Perceptions of fatigue were impacted by the reactions of healthcare professionals to CrF. Participants felt that they were not adequately forewarned that fatigue would persist after treatment. Many said that fatigue was never mentioned. One person noted that although fatigue was mentioned, nobody said 3 years down the line youre still going to be nodding off.

Participants thought that doctors were dismissive when they mentioned fatigue. One woman felt that her G.P. practically laughed when fatigue was mentioned. She believed that doctors were more into the treatment and you mention tiredness, they ignore you. It was swept under the carpet. Others agreed that healthcare providers were slow to engage in a conversation about fatigue. One man said I feel like Im telling her Im tired all the time. She thinks Im cuckoo. Another man described how his doctors carried out various tests when he complained about fatigue, but not one of them has even acknowledged that it might be because I had cancer.

Positive experiences with healthcare professionals were also mentioned. One man said he was lucky that Ive a very good GP and he does listen. We do talk about fatigue. Many cited family members who worked in a healthcare profession as a support in terms of information provision and reassurance, especially in light of perceived gaps in care elsewhere.

Ways To Manage Fatigue

Tell your health care team if you feel extremely tired and are not able to do your normal activities or are very tired even after resting or sleeping. Keeping track of your levels of energy throughout the day will help your doctor to assess your fatigue. Write down how fatigue affects your daily activities and what makes the fatigue better or worse.

You may be advised to take these and other steps to feel better:

NCI’s Fatigue PDQ® summary has more information on how fatigue is assessed and treated. View the patient or health professional version.

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How Can I Tell If I Have Cancer Fatigue

  • Think of your personal energy stores as a “bank.” Deposits and withdrawals have to be made over the course of the day or the week to ensure a balance between energy conservation, restoration and expenditure.
  • Keep a diary for one week to identify the time of day when you are either most fatigued or have the most energy. Note what you think may be contributing factors.
  • Be alert to the warning signs of impending cancer fatigue tired eyes, tired legs, whole-body tiredness, stiff shoulders, decreased energy or a lack of energy, inability to concentrate, weakness or malaise, boredom or lack of motivation, sleepiness, increased irritability, nervousness, anxiety or impatience.

Paul Senior Living With Prostate Cancer Brain Fog Is The Hardest

Cancer Rehabilitation

Ive been living with cancer, and cancer treatment, for over six years. Fatigue for me is not constant: it sometimes peaks, and then it weakens again. What affects me the most is the brain fog. Sometimes, I cannot pick up a book without it feeling like a strain I cant focus, cant concentrate. I also experience tiredness, sleep disturbances and anxiety.

My healthcare providers are aware of the problem of fatigue, but I think they find it rather more difficult to offer solutions. They listen to me and provide advice, but there is no easy solution. Im also not pushing this aspect too much. At my appointments, Im most anxious about the progress of my disease and most interested that my doctors get the treatment of my cancer as right as they can.

Fatigue has just become part of my life, part of me now. I deal with it myself, and with the help of nurses, friends and the Prostate Cancer UK online community. Peer support is invaluable, as they are extremely knowledgeable from their own experience.

I struggle with anxiety. I try to identify the source of anxiety and avoid it, and if I cannot avoid it, work through it by talking with my friends and with the help of mindfulness techniques. Mindfulness exercises help to calm my anxiety down, I feel better since using them.

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