Why Do Radiation Treatments Cause Fatigue

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.

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 your chances of getting each side effect.

Urinary And Bladder Changes

Radiation therapy to the pelvis can cause urinary and bladder problems by irritating the healthy cells of the bladder wall and urinary tract. These changes may start 35 weeks after radiation therapy begins. Most problems go away 28 weeks after treatment is over. You may experience:

• Burning or pain when you begin to urinate or after you urinate
• Trouble starting to urinate
• Bladder spasms, which are like painful muscle cramps

Ways to manage include:

• Drink lots of fluids. Aim for 68 cups of fluids each day, or enough that your urine is clear to light yellow in color.
• Avoid coffee, black tea, alcohol, spices and all tobacco products.
• Talk with your doctor or nurse if you think you have urinary or bladder problems. You may need to provide a urine sample to check for infection.
• Talk with your doctor or nurse if you have incontinence. He/she may refer you to a physical therapist to assess your problem. The therapist may recommend exercises to help you improve your bladder control.
• Your doctor may prescribe medications to help you urinate, reduce burning or pain, and ease bladder spasms.

Treatment Areas And Possible Side Effects

Healthy cells that are damaged during radiation treatment usually recover within a few months after treatment is over. But sometimes people may have side effects that do not improve. Other side effects may show up months or years after radiation therapy is over. These are called late effects. Whether you might have late effects, and what they might be, depends on the part of your body that was treated, other cancer treatments you’ve had, genetics, and other factors, such as smoking.Ask your doctor or nurse which late effects you should watch for. See the section on Late Effects to learn more.

• Posted:May 1, 2018

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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.

Is Fatigue A Sign Of Cancer

Fatigue may develop as a symptom of blood cancers, such as leukemia, lymphoma and multiple myeloma, because these cancers start in the bone marrow, which produces red blood cells that carry oxygen throughout the body.

Fatigue may also be a symptom of undiagnosed metastatic cancer . This is more common in cancers that arent typically caught early, such as lung cancer or ovarian cancer.

Its uncommon for fatigue to be the only symptom of undiagnosed cancer. A more concerning scenario develops when patients experience both fatigue and pain in one area thats getting progressively worse, along with unexplained weight loss and loss of appetite.

However, these symptoms may also be caused by an infection or another medical condition, such as anemia, depression, thyroid dysfunction, vitamin deficiency or sleep apnea, to name a few possibilities.

If a patient came to me complaining primarily of fatigue, my first thoughteven as an oncologistprobably wouldnt be cancer.

There may not be a simple answer behind whats causing your fatigue, and discovering the root cause often takes some digging, along with some trial and error with various therapeutic approaches.

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Communicating With Your Healthcare Provider About Fatigue

Many people underestimate fatigue and fail to discuss it with their practitioner. There can be underlying medical reasons for fatigue, such as anemia, that may need to be addressed. Unfortunately, there is no medication, prescription or OTC, that treats fatigue, but your healthcare provider may be able to determine what is contributing to fatigue and offer solutions specific to your situation.

How We Treat Cancer At Ctca

We only treat cancer at CTCA. Our team of multidisciplinary cancer experts takes a personalized, patient-centered approach to treating cancer and its side effects.

In addition to using conventional cancer treatments to attack the cancer itself, we provide evidence-informed supportive care therapies to help patients tolerate treatment and reduce side effects, including:

• Nutritional support, which includes the option of meeting with a registered dietitian wholl develop a personalized plan for your nutritional needs
• Behavioral health care, which may include working with therapists to help with depression, anxiety and stress, and using techniques such as talk therapy, mindfulness and relaxation techniques
• Access to professionally led support groups for patients and their loved ones, both in-person and online, including our Cancer Fighters community, where you can connect with cancer survivors
• Naturopathic support, which includes consultations with our naturopathic providers who counsel patients on the use of natural, non-toxic techniques to support the healing process

Providers at CTCA work together under one roof, providing convenient access for patients.

If youd like to get a second opinion or talk to someone at CTCA about getting help for fatigue or other cancer-related side effects youre experiencing, or chat online with a member of our team.

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How Is Cancer Fatigue Diagnosed

Your healthcare provider will assess your symptoms. You may be asked to complete a questionnaire or rate your fatigue level. Your provider may ask you to keep a journal to track your level of fatigue and factors that might contribute to fatigue.

Blood tests can check for anemia, signs of infection or other problems that cause fatigue.

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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How Can I Manage Skin Problems

You may notice that your skin in the treatment area begins to look reddened, irritated, sunburned or tanned. After a few weeks your skin may become very dry. Ask your doctor or nurse for advice on relieving itching or discomfort.

With some kinds of radiation therapy, treated skin may develop a “moist reaction,” especially in areas where there are skin folds. When this happens, the skin is wet and it may become very sore. It’s important to notify your doctor or nurse if your skin develops a moist reaction. You might find it helpful to seek care from an onco-dermatologist, a doctor who specializes in caring for skin problems cancer patients encounter.

Be very gentle with the skin in the treatment area. Avoid irritating treated skin, which can compromise the stratum corneum . When you wash, use only lukewarm water and mild soap. Don’t wear tight clothing over the treatment area. It’s important not to rub, scrub or scratch any sensitive spots. Also avoid putting anything that is very hot or very coldsuch as heating pads or ice packson your treated skin. Don’t use any powders, creams, perfumes, deodorants, body oils, ointments, lotions, or home remedies in the treatment area while you’re being treated or for several weeks afterward . Thats because many skin products can leave a coating on the skin that can interfere with radiation therapy or healing.

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.

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Other Possible Causes Of Fatigue During Cancer Treatment

Vitamin D deficiency is common in the general population. Correcting this deficiency in otherwise healthy people has been shown to improve self-reported fatigue. If youre fatigued due to vitamin D deficiency going into treatment, cancer therapy may be less successful and result in more side effects like peripheral neuropathy .

For example, one study of breast cancer patients being treated with paclitaxel showed that pre-treating vitamin D deficiency reduced the incidence of peripheral neuropathy and also led to fewer treatment disruptions and better treatment outcomes.

Another study showed correcting vitamin D deficiency may ease gastrointestinal mucositis, a painful inflammation and ulceration of the digestive tract, in patients undergoing chemotherapy.

Consider getting your vitamin D levels checked periodically. In my practice, I often check it at least twice a year to get a better understanding of the patient’s vitamin D rhythms from summer to winter. I recommend levels of approximately 50-80 nanograms per milliliter .

When you check your levels is important, though. Levels tend to be higher during the summer, when people are spending more time in sunlight, and lowest at the end of winter. So, if you check it in the middle of the summer and your level is 30, thats low for the targeted endpoint of 50-80 ng/ml. But if its 30 at the end of winter, that means it likely was in the therapeutic range during winter, and your levels may be sufficient.

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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Things To Be Aware Of

RT involves exposure to radioactive materials. People who have undergone RT may need to take precautions to protect others from radiation exposure.

External beam RT involves a source of radiation outside of the body, which means that the person is not radioactive during or after the treatment.

However, if a person has received internal RT, radioactive particles can leave the body through sweat, blood, urine, semen, saliva, and other fluids.

People receiving internal RT as an oral capsule or injected liquid called systemic RT may need to stay in the hospital for afterward, until their body no longer gives off radiation.

How Is Cancer Fatigue Managed Or Treated

The first step in treating fatigue is knowing the problem exists. Many people don’t bother to mention fatigue to their doctors because they believe it is normal. It’s vital that you discuss this and all symptoms or side effects with your healthcare provider. Then, efforts can be directed at determining the cause of the problem and prescribing appropriate treatment. Your particular cancer treatment regimen, with its known side effects, may provide clues for your doctor or health care professional. A simple blood test, for example, can determine if you are anemic.

There is no single medication available to treat fatigue. However, there are medications available that can treat some of the underlying causes.

When youre struggling, you may want to see a palliative care specialist. These experts help people with cancer manage symptoms like pain, nausea and depression.

Your provider or palliative care team may recommend these actions to ease fatigue:

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How Can I Prevent Hair Loss

Radiation therapy can cause hair lossalso known as alopeciabut only in the area being treated. For example, if you are receiving treatment to your hip, you will not lose the hair from your head. However, radiation to your head may cause you to lose some or all of the hair on your scalp. Many patients find that their hair grows back again after the treatments are finished, but accepting the loss of hairwhether from scalp, face, or bodycan be a hard adjustment. The amount of hair that grows back will depend on how much radiation you receive and the type of radiation treatment your doctor recommends. Other types of treatment, such as chemotherapy, also can affect how your hair grows back. For example, if your radiation therapy is for palliative care, your hair probably will grow back slowly. However, if the goal of your radiation therapy is to cure rather than to relieve the symptoms of your cancer, then your hair may not grow back, and if it does, it probably will have a very fine texture.

Can Sleep Be Improved To Reduce Cancer Fatigue

Sleep is an important part of wellness. Good sleep can improve your mental and physical health. Several factors contribute to how well you sleep, and there are things you can do to improve your sleep, including:

• Doing relaxation exercises, meditation or relaxation yoga before going to sleep.
• Avoiding long afternoon naps.
• Going to bed only when sleepy. Use your bedroom only for sleep and sexual activities.
• Setting a consistent time to lie down and get up.
• Avoiding caffeine and stimulating activities in the evening.
• Establishing a relaxing pre-sleep routine.

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How Can I Prevent Cancer Fatigue

You cant do much to prevent cancer-related fatigue. But these strategies may help minimize the problem:

• Adopt healthy sleep habits: To build better sleep habits, keep phones and TVs out of the bedroom, go to bed at the same time every night and sleep in a dark, quiet room.
• Ask for help: Let family and friends run errands, fix meals or help with housework or child care.
• Cut back on caffeine:Caffeine provides a temporary pick-me-up. But it can also keep you up at night.
• Drink plenty of fluids: Its important to stay hydrated and eat nutritious foods.
• Set priorities: Be realistic about what you can do. Save your energy for the things that matter most.
• Stay physically active: Go for a walk or try yoga or tai chi. Dont exercise too late in the evening. The activity may make it harder to fall asleep.
• Take 30-minute rest breaks: During the day, dont sleep longer than 30 minutes or you could have trouble falling asleep at night. Rest breaks can help if you have an upcoming event that requires a lot of energy.

A note from Cleveland Clinic

A chronic illness like cancer can bring many unwanted challenges. Cancer fatigue is one of them. It makes sense that fighting off cancer can tire out your body. Cancer treatments can also be physically and mentally exhausting. Still, you shouldnt hesitate to let your healthcare provider know how cancer fatigue is affecting your life. You can take steps to bring more energy back into your days.

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