Are you experiencing fatigue?

Breast cancer and its treatment often cause intense fatigue or tiredness and it can be one of the most common and distressing side effects. It can last anywhere from three to 12 months and even after active treatment (ie surgery, chemotherapy and/or radiotherapy) has finished. One third of breast cancer survivors still experience fatigue five years after finishing treatment (Berger et al., 2012).

What causes fatigue?

It is not clear what causes cancer related fatigue because it is rarely experienced in isolation of other symptoms. Experts are investigating a link between signalling proteins in the body, the immune system and the hypothalamic-pituitary-adrenal axis as the causes of cancer-related fatigue (Banasik, Williams, Haberman, Blank, and Bendel, 2011)

What does this mean? 

Chemicals in the body are produced in stressful situations; these are good for us in the short-term but if they carry on being produced, they may act together to cause fatigue.

Researchers believe contributing factors could also be:

  • Side effects of chemotherapy or radiotherapy
  • Coping with pain
  • Anaemia (lack of red blood cells)
  • Depression or anxiety, although depression is different to fatigue
  • Travelling for treatment
  • Sleeping difficulties

How can you manage your fatigue?

A normal reaction to feeling tired is to rest. However, research shows that fatigue is not relieved by rest and may worsen with rest (Berger et al., 2012). If you are experiencing cancer-related fatigue, the Cancer Council in Victoria have written a clear and comprehensive resource HERE

Some ways to help manage fatigue during treatment:

  • It is safe and effective to exercise as early as 6-8 weeks after surgery  (plastic surgeon and physio will advise after reconstructive surgery)
  • During treatment, exercise can help with controlling symptoms
  • Increasing sleep quality helps cancer-related fatigue – if you are not sleeping please call for advice or see your treating team
  • Incorporating some exercise, such as walking, especially early in the day, has been shown to greatly assist in reducing fatigue. It can also improve emotional well-being including your mood and sleep.
  • Eat a healthy diet
  • Feeling sad or anxious is normal but if these feelings don’t go away talk to a partner close friend or a health professional. Counselling can help.
  • Organise some practical help at home ie; help with childcare, housework or making meals
  • Build up to your usual level of daily activity rather than stepping straight back into old routines.
  • Allow your body time to recover after treatment. If you have not exercised for a while or have just finished treatment then you may need to build up slowly. The BCNA have produced a great booklet and exercise diary to help
  • Complementary therapies may help fatigue but there needs to be better research before this can be proven

Exercise significantly reduces cancer-related fatigue (Puetz & Herring, 2012).

How much exercise is recommended?

Research suggests that more is better than less but up to 150 minutes of moderate exercise or 30 minutes five times a week is recommended – unless you do more already.

It is important to find something you enjoy. Team sports and group activities are evidence based to help fatigue – and they’re more fun!

Exercises that you can try includes;

  • Walking or jogging
  • Swimming or water aerobics
  • Gym classes, such as aerobics or step classes
  • Yoga or Pilates (article on how Yoga can help)
  • Dragon boating 

Breast cancer survivors taking part in research felt supervised programs run by experienced and motivated health professionals giving individualised, structured, graduated programs with short and long term goal setting would be the greatest facilitators to exercise. Five years later women who took part in these programs were more confident about engaging in different types of exercise, more knowledgeable about how to exercise safely, more aware of the importance of exercise and integrated it into their lives.

We are lucky in WA to have access exercise programs such as Cancer Council’s Life Now program, Encore and the Vario Institute, which is among world leaders in research into cancer and exercise. For those who live in rural and remote areas or who are too busy to get to an exercise class, researchers are looking into the effectiveness of home-based exercise programs with telephone support.

View a list of recommended exercise programs in Western Australia HERE

Fatigue is not the same as depression but symptoms can overlap and counselling can help you to work through difficult emotional issues. Please call 9324 3703 and ask to talk to a breast care nurse. 

References: 

Banasik, J., Williams, H., Haberman, M., Blank, S. E., & Bendel, R. (2011). Effect of Iyengar yoga practice on fatigue and diurnal salivary cortisol concentration in breast cancer survivors. Journal of the American Academy of Nurse Practitioners, 23(3), 135-142.

Berger, A. M., Gerber, L. H., & Mayer, D. K. (2012). Cancer?related fatigue. Cancer, 118(S8), 2261-2269.