Chemotherapy Related Fatigue

by Dianne Armitage

When initially faced with the prospect of undergoing chemotherapy, most breast cancer patients are apprehensive about the possibility of nausea, vomiting, and hair loss. A few who have had friends that have undergone similar treatments, may actually be prepared for other possible side effects, but the overwhelming fatigue many women experience is often a side effect for which they are both ill-prepared and hard pressed to deal with.

Quite commonly, the medications you receive during chemotherapy can reduce your bone marrow's production of red blood cells, immune cells, and platelets. This may damage or diminish existing cellular functions. Low blood counts often contribute to fatigue, so it’s important to ask your doctor to evaluate you to determine the cause, and if low counts are the culprit, determine the appropriate treatment.

It is not uncommon for cancer patients to feel depressed before, during, and after treatment, which can also lead to feelings of fatigue. Again, you will want to talk candidly with your doctors about what you are experiencing in order for them to be able to evaluate what is at the root of your problem.

Because your immune cells protect your body from infection, injury, even cancer, low immune cell counts make you more vulnerable to fever and infections. If you run a high fever, sweating can cause you to lose a significant amount of water and minerals, causing you to become dehydrated. Any combination of these factors can contribute to fatigue.

In pre-menopausal women, chemotherapy often causes early onset menopause, since even abrupt and substantial hormonal changes can also contribute to fatigue.

A study from the University of Nebraska Medical Center, cited in Science Daily in April of 2007, has found that even before women with breast cancer undergo chemotherapy, they experience fatigue and disruptions in sleep and activity levels, which suggests that health professionals should actually begin addressing fatigue following breast cancer surgery.

Cancer-related fatigue often has a profound impact on an individual’s life bringing with it significant physical, emotional, social, and economic consequences that may continue for months – even years – after completing treatment. Between 30 and 50 percent of patients surveyed say their fatigue remains for at least six months after treatment, and many say it never completely leaves.

Fatigue can be difficult to pin down, but it is much more than just being tired. It’s normal for people to get tired from running errands, managing their children’s daily activities, working around the house or yard, or taking a fitness class. Even something as seemingly mellow as yoga can make you tired. When you are tired at the end of the day from normal activities, once you get enough sleep, you feel refreshed. Fatigue is an ongoing lack of energy, a type of weakness or inertia that you feel throughout your whole body. It quite often manifests in a loss of interest in people and the things you normally like to do. At its most simple, fatigue is physical exhaustion combined with low spirits.

Patients discussing cancer-related fatigue describe it as distressing and persistent. They express a sense of tiredness and exhaustion that is in no way proportional to their activity level. Factors associated with fatigue are the presence and severity of anxiety, pain, lower sleep quality, physical inactivity, and poor performance status. This quite often translates to little desire to either work or socialize.

"Cancer-related fatigue often has a profound impact on an individual’s life bringing with it significant physical, emotional, social, and economic consequences that may continue for months – even years – after completing treatment."

As we mentioned, you will want to have a candid dialogue with your oncologist to make sure that your fatigue is not simply the result of low blood counts or depression. There are several medications on the market that can help to alleviate this problem.

There are other ways to help fight fatigue, and some of them are as close as your pantry. Eating right and trying to make sure you are getting all the nutrients you need is a great place to begin. Your body is fighting cancer full time during chemotherapy, so it needs every resource you can possibly provide in order to do its job. A diet filled with fruits, vegetables, and whole grains most certainly lend your body a great helping hand.

Protein is particularly important when fighting fatigue. But how do you know if you are getting enough? How many calories should you be getting every day? As a rule of thumb:

• Vitamins and minerals are also very important to your overall health and energy. Ideally, we would get them from the foods we eat, but when the body is stressed or ill, supplements may be called for. It is important, however, to talk to your doctor about which supplements to take while you are undergoing treatment, because some may actually interfere with the effectiveness of your treatments.

• Water is essential in helping you to stay hydrated and in fighting fatigue. If you have side effects such as vomiting and diarrhea, you need to drink more liquids than normal. In addition to water, good beverage choices include fruit juice, milk, and low sodium broths. Because caffeine can dehydrate you, it’s a good idea to avoid coffee, tea, and soft drinks (or at the very least, cut down on your consumption!)

Eating for Beating Fatigue

Bulk it up! During those times when you have the energy and stamina to cook, try making large batches of nutritious foods. Casseroles and one-dish meals that include lots of veggies and whole grains are a good choice, and can easily be frozen in single-serving containers. On those days when you are just too pooped to pop, you’ll already have these handy meals you can heat and eat.

Scarf it up! Make a point of eating your largest meal when you are feeling your best. If you find that you are weary by the end of the day, then remember to eat more at breakfast and lunch.

Nibble to feel fit as a fiddle! Eating several nutritious snacks throughout the day will not only boost your calorie and protein intake, but can help to stave off fatigue. Baggies filled with cheese, dried fruit, baby carrots, or cut-up veggies are easy to keep handy, and make great snacks. Yogurt is another great option. If you feel well enough to eat a big meal during the day – great – if not, at least you’ve given your body some good fuel!

Emergency stash ready in a flash! Energy bars or nutritional supplement drinks are good ways to stay on track when you don’t feel well enough for a regular meal. These should be used only when you are feeling like dealing with a real plate of food is just too much – because they tend to be high in sugar.

Resourceful ways to get those protein grams

Lean meats, fish, poultry, dairy products, nuts, dried beans, peas, lentils, and a moderate amount of soy are all excellent sources of protein. Here are just a few simple ways you can pump up your protein intake:

• Cheese makes a great addition to everything from sandwiches and casseroles, to good old standards like pasta, rice, and noodles. You can garnish soups with grated cheese. Even some fish dishes can benefit from this tasty protein. If you are worried about the fat content, try dry cheeses like parmesan or asiago.
• When you are making pasta sauce, casseroles, chili, soups and other sauces, add a little meat to the mix. Another great protein pick-me-up is creating a stir-fry full of healthy vegetables and meat. When it makes sense, use milk rather than water for cooking.
• Hard boiled eggs are a protein filled treat you can cook ahead and keep in the frig. You can also add chopped hard-boiled eggs to salads and sandwiches to bolster the protein content of a meal. Nuts, seeds, and wheat germ add texture and taste to casserole dishes, breads, cookies, cakes, muffins, pancakes – even cereal.
• A variety of beans and legumes can make a ho-hum dish tasty and protein rich.
• Peanut butter can save the day, so don’t hesitate to add it to sandwiches, toast, crackers, and baked goods. Sliced apple with a dab of peanut butter is a great snack. And what’s not to love about raw celery spread with this childhood favorite?
• Yogurt makes a great dip for fruit and veggie slices. If you’ve got your hand in the cookie jar, try putting a dollop of yogurt on your cookie to add a bit of protein to an otherwise carbo-filled treat.
• If you aren’t troubled by mouth sores from the chemo, you may want to try mixing cottage cheese with salsa for a zesty dip that’s filled with protein.

"Changes in your daily life and in the expectations you set for yourself and others can also play an important role in handling and combating fatigue."

Many patients find that keeping a sort of running written dialogue or diary helps them to identify when they feel most tired, and what may be contributing to their fatigue. By tracking this for a while, you can better determine when you are going to have energy, and when you are likely to be wiped out. Then you can begin to plan your activities (and activity level) to coordinate with what you’ve discovered about your highs and lows.

This isn’t the time to try to solve the problems of the world. If your job, family, or money are concerns, do what you can to improve the situation, but give yourself permission to work out these problems once you are done with treatment. Don’t be afraid to ask for help if you need it. If the house needs cleaning, or a meal needs cooking and you just can’t muster the energy – this is the perfect time to reach out to family and friends for a bit of extra support.

And speaking of support, this may be exactly the right time to join a support group. Sharing your feelings with other people in similar situations can help to ease the burden of your fatigue. It may also give you some valuable insights into how others are dealing with this problem. If you don’t know of a local support group, ask your healthcare provider to suggest one.

This is a great time to teach yourself all about priorities. You don’t have to be the cheerleader or social secretary for other people right now. It’s okay to let some stuff slide (it will still be there when your treatments are done!) Do what feels good and what is important to you and let the rest go. Time spent with family and friends doing things you enjoy is time well spent.

When you feel well enough it’s important to get your body moving, even if it’s just a walk around the block. Studies have shown that exercise is beneficial to both your mental and physical health during and after treatment.

If there is any “take home” message here its that fatigue is frequently a very real part of the cancer experience. More and more studies are legitimizing this fact, so your health care professionals are much better equipped to help you regain your strength and enthusiasm – but you have to communicate what is going on!

This communication is also vital in helping them better understand the scope of the problem, since many breast cancer survivors report feeling tired long after their treatments are finished. If enough of us speak up, perhaps we’ll live to see the day that chemo-related fatigue gets kicked to the curb! (And we’ll have the energy to jump up and down with joy!)

This article was last reviewed August 2011.