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Breast Cancer-Related Fatigue

By Rosalyn Carson-DeWitt

Updated June 10, 2008

(LifeWire) - Fatigue is often a problem for people with breast cancer, during and after treatment. Cancer-related fatigue is more than just being tired; it's an extreme sensation of exhaustion and weakness, and it lingers even with appropriate amounts of sleep. If you experience such fatigue, remember that you're not alone and that it's a legitimate (and legitimately frustrating) aspect of cancer. Although there's no way to measure fatigue by a blood test or X-ray, your symptoms are real, and you deserve support as you cope with them.

How Likely Am I to Experience Fatigue?

A 2006 review of studies in the European Journal of Cancer found that as many as 19 to 38% of cancer patients experience "disabling fatigue." Women receiving chemotherapy or chemo plus radiation therapy are more likely to experience fatigue than those who only undergo radiation.

Research also suggests that you're more likely to experience such fatigue if you also have other conditions, including uncontrolled pain, depression, anxiety, sleep problems or anemia.

What Causes Cancer-Related Fatigue?

Researchers have not identified all the factors involved in cancer-related fatigue. Both the disease itself and side effects of treatment appear to play a role.

Cancer cells can cause fatigue by leaching nutrients from your system, altering your hormone levels and producing substances called "cytokines" that contribute to fatigue.

Various forms of therapy -- chemo, radiation and biological therapy -- and the aftereffects of surgery all contribute to fatigue. Also, treatments that impair your appetite, produce nausea or vomiting or cause sore mouth or throat can make it difficult to get adequate nourishment. Even the medications used to address treatment side effects (for example, pain and antinausea drugs) can cause fatigue.

Finally, the emotional stress of cancer and its treatment can be exhausting and could result in depression, adding to your fatigue.

When Can I Expect Fatigue, and How Long Will it Last?

Knowing when you're most likely to experience cancer-related fatigue can help you plan ahead for extra support when it's needed. Fatigue can strike at any time, but researchers have identified certain periods when it seems most likely to peak:

  • Chemotherapy:
    • Sharp increase in symptoms within 48 to 72 hours of chemo, lasting about 3 weeks
    • Sometimes a second spike in fatigue on days 10 to 14 of certain chemotherapy schedules
  • Radiation:
    • Gradually increasing levels of fatigue to about 4 weeks, then remaining steady and gradually returning to normal levels after about 3 weeks to 3 months

Fatigue often lingers after treatment has been completed, up to 40% of patients report that fatigue still interferes with their lives three years or more after treatment.

Symptoms of Cancer-Related Fatigue

Studies show that people with cancer-related fatigue typically experience some intense fatigue -- even discomfort -- after any form of exertion, weakness, a heavy feeling in the arms and legs, a lessened desire or ability to perform necessary tasks or participate in normal activities, problems with concentration or short-term memory, increased need for sleep, difficulty sleeping (insomnia) or a feeling that sleep doesn't relieve fatigue or increase energy level and associated feelings of sadness, frustration or irritability.

Could Anything Else be Responsible?

There are other potential explanations for your fatigue. Your doctor will probably evaluate you for pain, emotional distress, sleep problems, anemia, poor nutrition, reduction in physical activity and coexisting conditions, such as involvement of the nerves, glands, heart, lungs, kidneys, liver or thyroid.

Treating these conditions may help address your fatigue.

What Can I Do About Fatigue?

Even with the related symptoms and unrelated conditions, you can take heart that cancer or chemo-related anemia is still often easily treated, which can improve fatigue immensely. Here are other actions you can take in addition to your doctor's intervention:

  • Learn to ask for help. This can be difficult. It's not easy to ask others to take over tasks you've always been able to handle but consider it a temporary phase you have to get through, and once you're on the other side, you can take over again.
  • Nap when you can. Even catnaps may help, but if you sleep too much during the day that it keeps you from sleeping at night, then you may need to readjust your sleep schedule.
  • Delegate household chores as much as possible.
  • Ask your doctor how much exercise is safe for you. Getting rest is important, but physical activity has proven benefits -- improving mood, conferring a general sense of well-being and countering fatigue.
  • Learn relaxation techniques to relieve stress -- for example, meditation, yoga or visualization techniques.
  • If stress or depression (or both) are interfering with your life, you may want to consider counseling with a psychotherapist, joining a support group for women with breast cancer or speaking with a religious advisor.
  • Keep up your nutrition:
    • Consult with a licensed nutritionist.
    • Ensure that your daily calorie level is sufficient. (To maintain current weight, the rule of thumb is 15 calories per day per pound of weight).
    • Get enough protein. (Your daily need is roughly equal to your body weight times 0.5 to 0.6 grams of protein per day).
    • Don't get dehydrated. You should drink about 64 ounces of liquids per day (not counting caffeinated beverages).
    • Eat plenty of fruit, vegetables and whole grains.

Sources:

Bardwell W.A. "Breast Cancer and Fatigue." Sleep Medicine Clinics. March 2008; 3(1): 61-71. (subscription)

Levy, M. "Cancer Fatigue: A Review for Psychiatrists." General Hospital Psychiatry. 2008; 30(3): 233-244. (subscription)

Mock V. "Fatigue." Clinical Oncology, Third ed. Philadelphia: Elsevier, 2004. 835-843.

Prue G., Rankin J., Allen J., et al. "Cancer-Related Fatigue: A Critical Appraisal." European Journal of Cancer. 2006: 42(7): 846-863. (subscription)

LifeWire, a part of The New York Times Company, provides original and syndicated online lifestyle content. Rosalyn Carson-DeWitt, MD, works as a medical writer, editor, and consultant in Durham, NC. She served as editor-in-chief for two multi-volume MacMillan encyclopedias:  The Encyclopedia of Drugs, Alcohol, and Addictive Behavior and Drugs, Alcohol and Tobacco: Learning About Addictive Behavior. She worked on the 18th edition of the Merck Manual of Diagnosis and Therapy, and has written thousands of print and online articles for healthcare providers and consumers.
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