Fatigue, which can occur while undergoing treatment for breast cancer, is one of the most common side effects of the disease and its treatment. Fatigue is different from exertion. Everyone strains, and a good night’s sleep usually restores energy. Fatigue is a daily lack of energy or general exertion, and even good sleep does not eliminate the symptoms. Fatigue can prevent a person from carrying out daily tasks properly and can affect quality of life. Sometimes fatigue is “acute,” meaning it lasts for a month or less, or it can be “chronic,” lasting more than 6 months. Often, fatigue symptoms appear suddenly and may persist after treatment is completed.
Here are some possible causes and some ways to help restore energy.
Why does cancer cause fatigue?
The disease itself is the culprit. Tumor cells steal energy and nutrients from normal cells and can cause strain that can’t be eliminated. Treatment can also cause fatigue.
- Chemotherapy. All chemotherapy drugs can cause fatigue. Some people have symptoms that last for a few days, and others have them that persist throughout treatment and even after treatment is completed.
- Radiotherapy can cause fatigue and symptoms that get progressively worse. It usually lasts for 3 to 4 weeks after treatment ends, but may last up to 3 months.
- Endocrine therapy deprives the body of estrogen and can cause fatigue that may last throughout treatment or even longer.
- Targeted therapies. Taking large amounts of these drugs can lead to prolonged fatigue.
- Targeted therapy.
- Combination therapy. Taking more than one cancer treatment at the same time or back-to-back can also increase the chance of feeling burned out.
- Surgery.
- Surgery. Everyone recovers at a different rate after surgery, and this can lead to some daily fatigue.
In addition, there is one other potential culprit.
- Cancer treatments can cause anemia, which prevents cells in the body from getting enough oxygen they need.
- Side effects of treatment, such as nausea, vomiting, mouth ulcers, taste changes, heartburn, or diarrhea, can reduce the amount of nutrients received and make people feel tired. Medications used to treat side effects such as nausea, pain, depression, anxiety, and epilepsy can also cause fatigue. Hormonal changes caused by medications also have this effect.
- If the thyroid is underactive, the metabolism may slow down, so the body doesn’t digest food fast enough to provide enough energy. This is a common symptom, but may also occur after radiation therapy to the lymph nodes in the neck is completed.
- Lack of exercise and inability to move around in older patients can lead to fatigue. Younger patients undergoing treatment sometimes overestimate themselves, leading to a lack of daily energy or general fatigue. Chronic, severe pain can make symptoms worse.
- There is often fatigue when trying to maintain normal habits and activities during treatment. Changing daily habits and activities can help preserve energy.
- Depression and fatigue usually go together, but it is impossible to determine which symptom comes first. One way to tell the difference is to try to understand your own depression and how it affects your life. Your doctor should be told if you feel depressed all the time, or if you felt depressed before your cancer diagnosis, or if you are wallowing in feelings of worthlessness.
What help can the doctor provide?
The first step is to try to determine the source of the fatigue. There can be more than one cause of fatigue.
The doctor can run tests to determine if there is anemia or hypothyroidism. If one of these symptoms is present, treatment is useful.
If the cause is thought to be cancer treatment, you can consult your doctor about ways to deal with fatigue or discuss other options.
How can I help myself?
Identify your own energy
Journal for 1 week, noting the number of days you feel most tired and the number of days you have the most energy. Record possible causes.
Understand the warning signs of fatigue
- Eye fatigue
- Leg fatigue
- Full-body strain
- Stiff shoulders
- Inability to concentrate
- Weakness or discomfort
- Boredom or lack of motivation
- Feeling tired even after waking up from a nap
- Irritability
- Tension, anxiety, or impatience
8 ways to preserve your energy
- Plan and organize your work ahead of time. Consolidate activities and simplify details. When possible, ask family or friends to help with tasks.
- Self-regulate. A steady pace is better than a hurried one.
- Balance rest and work time. Focus your energy on the tasks that matter. Take breaks before you feel tired, and frequent short breaks can help.
- Sit and stand alternately. Sit in a chair with a sturdy back, keeping your back straight and your shoulders back.
- Work without bending over as much as possible. Adjust work level. If you have to lift an object, bend your knees and use your leg muscles instead of your back muscles.
- Limit work that requires lifting overhead or increases muscle tone. Change the location of stored objects, reduce walking distance or lift hands upward. Divide large volumes into several smaller ones, carry them multiple times, or use a cart.
- Breathe evenly, or wear comfortable clothing that is easy to breathe.
- Avoid excessively hot or cold temperatures. Do not take overly hot showers or baths for long periods of time.
Maintain balanced nutrition
Fatigue from cancer can be exacerbated if you do not consume enough food or eat the wrong foods. A well-balanced diet can help improve symptoms and increase energy. Here are some ways to improve your diet.
- Eat enough calories. If you have cancer and your weight is stable, you need about 15 calories per 500 grams of body weight. If you lose weight, add 500 calories per day. For example, a patient weighing 68 kg needs 2250 calories a day to maintain weight.
- Eat enough protein. Protein rebuilds and repairs damaged cells. Good sources of protein include dairy products, meat, eggs, and legumes.
- Drink plenty of fluids. Help prevent fatigue from dehydration and help get calories. Drink fluids such as water, juices, milk, broths and shakes, and avoid coffee. Also, if you vomit or have diarrhea, you will need more fluids.
- Eat enough vitamins. If you’re not sure if you’re getting enough, ask your doctor if you should take a vitamin supplement. Multivitamin supplements contain many of the nutrients your body needs. However, vitamin supplements do not contain calories, so make sure you consume nutritious foods for calories.
- Consider consulting a dietitian. A dietitian can help with dietary issues that prevent you from getting the right nutrients, such as difficulty swallowing, taste changes, or rapid satiety, and can suggest ways to get more calories and protein in smaller amounts of food.
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Exercise
Cancer and its treatment can make people feel exhausted, lying in bed or sitting in a chair for long periods of time. But this inactivity can lead to anxiety, depression, weakness, and more fatigue.
Often, moderate exercise can ease these feelings and help keep you active and rich with more energy. Even during cancer treatment, you can keep moving. Here are some tips.
Managing stress
Managing stress is an important way to fight fatigue. Here are some suggestions that may help.
- Regulate your expectations. For example, if you expect to accomplish 10 things that day, cut it down to 2 and leave the remaining events for later. A sense of accomplishment can be a long-lasting stress reliever.
- Help others to understand and support you. It can be helpful if family and friends can put themselves in the patient’s shoes and understand what fatigue means to them. Cancer support groups can also help. Other patients with the disease can also understand how the patient feels.
- Relaxation methods such as deep breathing or looking away can also help reduce stress. Or do something fun and low-key, such as reading, listening to music, or knitting.
- If stress is unmanageable, tell your doctor, who can help improve symptoms.
When should I seek medical attention?
While fatigue from cancer is a common side effect of cancer and its treatment, it is still important to inform your doctor of your concerns. In many cases, fatigue may be an indication of underlying disease, and if not, your doctor may be able to help manage it.
Be sure to tell your doctor or nurse if you have any of the following symptoms:
- Shortness of breath
- Pain
- Side effects from treatment (such as tolerance, vomiting, diarrhea, or lack of appetite)
- Anxiety or nervousness
- Depression