You’ll know that the tiredness you are experiencing -- or may have experienced -- not only is a side effect of your treatment, it also may be something that lingers long after treatment ends.
We call this cancer-related fatigue (CRF), and it is common both during and after treatment. Unfortunately, it is something that neither rest nor a good night's sleep can cure. Some breast cancer survivors often describe their fatigue as debilitating.
Generally, fatigue is a daily lack of energy; an unusual or excessive whole-body tiredness. It can be acute (lasting a month or less) or chronic (lasting from one month to six months or longer). It can prevent you from functioning normally and can significantly impact your quality of life.
Chemotherapy -- Any chemotherapy drug might cause fatigue. Patients frequently experience fatigue after several weeks of chemo, but this varies among patients. In some, fatigue lasts a few days, while others say the problem persists throughout the course of treatment and even after treatment is complete.
Radiation therapy-- Radiation therapy can cause cumulative fatigue (fatigue that increases over time). This can occur regardless of the treatment site. Fatigue usually lasts from three to four weeks after treatment stops, but can continue for up to two to three months.
Hormone therapy -- This can cause fatigue by depriving the body of estrogen. It can last throughout the course of treatment or longer.
Biological therapy -- Interferons and interleukins are cytokines, natural cell proteins that are normally released by white blood cells in response to infection. In high amounts, these cytokines can be toxic and lead to persistent fatigue.
Other factors that may contribute to fatigue include:
Decreased nutrition – This can be a result treatment’s side effects, such as nausea, vomiting, mouth sores, taste changes, heartburn or diarrhea.
Anemia -- This blood disorder occurs when there is not enough hemoglobin, a substance in red blood cells that enables the blood to transport oxygen through the body. Some cancer treatments can cause reduced blood-cell counts. Fatigue can occur when the blood cannot transport enough oxygen to the body.
An underactive thyroid gland -- This may slow down your metabolism so that the body does not burn food fast enough to provide adequate energy. This is a common condition in general, but may also happen after radiation therapy to the lymph nodes near the neck.
Medicines -- Those used to treat side effects such as nausea, pain, depression, anxiety and seizures can cause fatigue.
Stress– It can worsen feelings of fatigue. Stress can result from dealing with the disease and its unknowns, as well as from worrying about daily accomplishments or trying to meet the expectations of others. Fatigue often results when patients try to maintain their normal daily routines and activities during treatment. Modifying your activities can help conserve energy.
Depression– This often goes hand-in-hand with fatigue, but it may not be clear which one started first. One way to sort this out is to try to understand your feelings of depression and how they affect your life. If you are depressed all the time, were depressed before your cancer diagnosis or are preoccupied with feeling worthless and useless, you may need treatment for depression.
What Can You Do To Combat Fatigue?
Obviously, the most effective way to combat fatigue is to treat the underlying medical cause. Unfortunately, understanding the exact cause is a process of elimination. However, the most important thing is that fatigue is managed on an individual basis.
Evaluate your level of energy. 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 balance 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 your personal warning signs of fatigue, which can include 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; and nervousness, anxiety or impatience.
Conserve your energy
Delegate tasks when possible, combine activities and simplify details. Schedule rest time and balance periods of rest and work. Frequent short rests are beneficial. Rest before you become fatigued, and remember to pace yourself.
Be Mindful About Your Nutrition
Cancer-related fatigue often is made worse if you are not eating enough or if you are not eating the right foods. Maintaining good nutrition can help you feel better and have more energy. Here are some strategies to help improve your nutritional intake:
Meet your basic calorie needs. The estimated calorie needs for someone with cancer is 15 calories per pound of weight if your weight has been stable. Add 500 calories per day if you have lost weight. Example: A person who weighs 150 pounds needs about 2,250 calories per day to maintain his or her weight (or 2,750 calories if weight was lost during treatment).
Get plenty of protein. Protein rebuilds and repairs damaged (and normally aging) body tissue. The estimated protein needs are 0.5 to 0.6 grams of protein per pound of body weight. Example: A 150-pound person needs 75 grams to 90 grams of protein per day. The best sources of protein include foods from the dairy group (8 ounces milk = 8 grams protein) and meats, fish or poultry at 7 grams of protein per ounce.
Drink plenty of fluids. A minimum of 8 cups of fluid per day will prevent dehydration. (That's 64 ounces, 2 quarts or 1 half-gallon). Fluids can include juice, milk, broth, milkshakes, gelatin and other beverages. Of course, water is fine, too. Beverages containing caffeine do NOT count. Keep in mind that you'll need more fluids if you have treatment side effects such as vomiting or diarrhea.
Get enough vitamins. Take a vitamin supplement if you are not sure that you are getting enough nutrients. Try a multivitamin that provides at least 100 percent of the recommended daily allowances (RDA) for most nutrients. Note: Vitamin supplements do not provide calories, which are essential for energy production. So vitamins cannot be a substitute for adequate food intake.
Make an appointment with a dietitian or nutritionist. A registered dietitian/nutritionist can provide suggestions to work around any eating problems that are interfering with proper nutrition (such as an early feeling of fullness, swallowing difficulty or taste changes). A dietitian can also suggest ways to maximize calories and include proteins in smaller amounts of food using, for instance, powdered milk, instant breakfast drinks and other commercial supplements or food additives.
Decreased physical activity, which may be the result of illness or treatment, 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 these feelings, help you stay active and increase your energy. Even during cancer therapy, it is often possible to continue exercising. Here are some guidelines to keep in mind:
Check with your healthcare provider before beginning an exercise program.
Start an exercise program slowly, giving your body time to adjust.
Keep a regular exercise schedule. Exercise at least 20 to 30 minutes, three times a week.
The right kind of exercise never makes you feel sore, stiff or exhausted. If you experience soreness, stiffness, exhaustion, or you are out of breath as a result of your exercise, you are overdoing it.
Most exercises are safe as long as you exercise with caution and don't overdo it. The safest and most productive activities are swimming, brisk walking, indoor stationary cycling and low-impact aerobics (taught by a certified instructor). These activities carry little risk of injury and benefit your entire body.
Manage Your Stress
Managing stress can play an important role in combating fatigue. Here are some suggestions that may help:
Adjust your expectations. For example, if you have a list of 10 things that 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 reducing 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 groups can be a source of support, as well. Other people with cancer understand what you are going through.
Relax. Relaxation techniques such as audiotapes that teach deep breathing or visualization can help reduce stress.
Activities that divert your attention from fatigue can also be helpful. For example, knitting, reading or listening to music requires little physical energy but requires attention.
If your stress seems out of control, talk to a healthcare professional. They are there to help.