ScienceDaily (Apr. 27, 2007) — A University of Nebraska Medical Center study has found that even before women with breast cancer undergo chemotherapy, they experience fatigue and disruptions in sleep and activity levels. Researchers say their findings suggest health professionals should address fatigue following breast cancer surgery.

Researchers say controlling fatigue after surgery — before starting chemotherapy — is important because fatigue typically increases during chemotherapy. Between 70 to 95 percent of breast cancer patients experience fatigue while undergoing chemotherapy.

The study was published in the current issue of the Journal of Pain and Symptom Management. Having studied 130 women with early stage breast cancer (stage I, II, IIIA), it the largest study to document the prevalence of fatigue associated with altered sleep and activity patterns before chemotherapy treatment. The data confirms what was reported in a previous smaller study funded by the National Institutes of Health.

“We found women are not going into chemotherapy in the best possible shape,” said Ann Berger, Ph.D., Niedfelt Professor of Nursing, UNMC College of Nursing, who has conducted several studies over the past 15 years related to fatigue in cancer patients. “It makes it that much more difficult to reduce the fatigue during treatment. If you start out with some fatigue, it will probably increase.”

“We as health professionals need to address potential fatigue and sleep issues sooner,” said Dr. Berger, principal investigator of the study. “If women are having sleep problems after surgery, we need to address this symptom before women begin chemotherapy. “What we’ve learned might explain why we’re having problems reducing fatigue in breast cancer patients during chemotherapy.”

The published study comes from initial results of a five-year, $1.5 million grant Dr. Berger and her team received in 2003. The purpose of the study, which was funded by the National Institute of Nursing Research, a division of the National Institutes of Health, was to determine the best ways to reduce fatigue during chemotherapy and to prevent chronic fatigue after treatment.

Researchers measured sleep and activity patterns during the 48 hours prior to the first chemotherapy treatment using wristwatch-sized activity monitors called actigraphs.

Fatigue, the most prevalent and distressing symptom for breast cancer patients receiving chemotherapy, has long been accepted by health professionals and patients alike as a side effect of treatment. Researchers say there are ways to intervene, and now they have found it may be important to intervene during the recovery period after breast cancer surgery.

Researchers say disrupted sleep, low daytime activity and/or reduced activity are likely to contribute to mild fatigue before chemotherapy and moderate to severe fatigue after chemo. They say fatigue should be addressed before and after surgery. Women typically begin chemotherapy three to four weeks after surgery.

Dr. Berger said because inactivity contributes to fatigue, she and colleagues say though women need to rest for several days after surgery, they should try to regain activity when they’re able. “We’ve been telling patients for years to rest and take it easy, but in some cases, we’re finding the patients who remain inactive are the one who report higher fatigue.”

Cancer-related fatigue can have a profound impact on an individual’s life, with significant physical, emotional, social, and economic consequences that may persist for months or years after completing treatment. Even after treatment ends, between 30 and 50 percent of patients say their fatigue remains at least six months or doesn’t ever go away.

Fatigue related to cancer treatment is described as a distressing, persistent, sense of tiredness or exhaustion that is not proportional to activity. The factors associated with fatigue are the presence and severity of anxiety, pain, lower sleep quality, physical inactivity, and poor performance status, leaving little desire to work or socialize.

Dr. Berger said the findings provide an important benchmark to begin looking for interventions to reduce cancer-related fatigue.

The study was undertaken to further establish values for sleep, wake, activity, rest, circadian rhythms and fatigue and how they interrelate in women before and during the first year after chemotherapy.

University Of Nebraska (2007, April 27). Fatigue Affects Breast Cancer Patients Even Before First Chemotherapy Treatment, According To Study. ScienceDaily. Retrieved December 4, 2007, from http://www.sciencedaily.com­ /releases/2007/04/070426135536.htm

Nervous System Changes

What they are and why they occur

Chemotherapy can cause damage to your nervous system. Many nervous system problems get better within a year of when you finish chemotherapy, but some may last the rest of your life. Symptoms may include:

• Tingling, burning, weakness, or numbness in your hands or feet
• Feeling colder than normal
• Pain when walking
• Weak, sore, tired, or achy muscles
• Being clumsy and losing your balance
• Trouble picking up objects or buttoning your clothes
• Shaking or trembling
• Hearing loss
• Stomach pain, such as constipation or heartburn
• Fatigue
• Confusion and memory problems
• Dizziness
• Depression

Ways to manage

• Let your doctor or nurse know right away if you notice any nervous system changes. It is important to treat these problems as soon as possible.
• Be careful when handling knives, scissors, and other sharp or dangerous objects.
• Avoid falling. Walk slowly, hold onto handrails when using the stairs, and put no-slip bath mats in your bathtub or shower. Make sure there are no area rugs or cords to trip over.
• Always wear sneakers, tennis shoes, or other footwear with rubber soles.
• Check the temperature of your bath water with a thermometer. This will keep you from getting burned by water that is too hot.
• Be extra careful to avoid burning or cutting yourself while cooking.
• Wear gloves when working in the garden, cooking, or washing dishes.
• Rest when you need to.
• Steady yourself when you walk by using a cane or other device.
• Talk to your doctor or nurse if you notice memory problems, feel confused, or are depressed.
• Ask your doctor for pain medicine if you need it.

Janice and Rodney Dietert display herbal and fungal medicinal sources that show promise for addressing developmental immunotoxicity (DIT) and DIT-associated diseases. On the tray are: sang-hwang mushroom, Panax ginseng, echinacea, shiitake mushroom and astragalus. (Credit: Image provided by Cornell University)

ScienceDaily (May 3, 2007) — A Cornell researcher and his wife have conducted the first comprehensive review of later-life diseases that develop in people who were exposed to environmental toxins or drugs either in the womb or as infants. They have found that most of the diseases have two things in common: They involve an imbalanced immune system and exaggerated inflammatory reactions (at the cellular level).

In an invited, peer-reviewed article on developmental immunotoxicity (DIT), published in a recent issue of Current Medicinal Chemistry, Rodney Dietert, professor of immunotoxicology at Cornell’s College of Veterinary Medicine, and Janice Dietert of Performance Plus Consulting in Lansing, N.Y., found that almost all the chronic diseases that are associated with DIT share the same type of immunological damage.

The diseases linked to DIT include asthma, allergy, suppressed responses to vaccines, increased susceptibility to infections, childhood neurobehavioral conditions, autoimmunity, cancer, cerebral palsy, atherosclerosis, hypertension and male sterility.

Toxins that are known to cause developmental immune problems in fetuses and neonates, according to the Dieterts, include herbicides, pesticides, alcohol, heavy metals, maternal smoking, antibiotics, diesel exhaust, drugs of abuse and PCBs.

Antidotes to DIT, the researchers note, could come from a variety of sources, including herbal and fungal chemicals — from mushrooms to clover — which appear to have promise.

Two immune processes — T helper (Th) cell balances and dendritic cell maturation — are both compromised in ways that disrupt the regulation of inflammatory cell function, which leads to exaggerated inflammatory responses.

“Most therapeutic approaches have looked at specific disease outcomes from DIT, rather than focusing on the underlying immune dysfunction that creates the increased disease risk,” said Rodney Dietert, who also presented his findings March 28 at the annual Society of Toxicology meeting in Charlotte, N.C. “Instead, we looked at the common immune dysfunction that is related to a host of diseases.”

Knowing the most common immune dysfunction patterns from DIT allows researchers to consider more seriously those “medicinals with the capacity to restore inflammatory cell regulation, promote dendritic cell maturation and restore desirable Th balance that would be the most likely candidates to combat the problems resulting from DIT.”

Focusing on studies of herbal and fungal chemicals, the Dieterts scoured the literature and found that some of the chemicals appear to be particularly promising when taken at appropriate doses. These include: Astragalus; Echinacea (purple coneflower); sang-hwang shiitake, reishi, maitake and snake butter mushrooms, black seed, Asian ginseng, milk vetch root, wild yam, Sophoro root and Greek clover (all of these also go by various other names).

In their paper, the Dieterts also list a multitude of substances that have been found to have “an uncertain impact” on DIT as well as several found to exacerbate immune dysfunction (including marijuana).

“We hope that these findings of persistent immune dysfunction from gestational exposure will provide encouragement for additional research. Furthermore, that researchers will look at these categories of medicines that have the possibility of correcting inflammatory and immune balance problems resulting from DIT rather than focusing solely on individual disease symptoms,” Rodney Dietert said.

He noted that until recently toxin-testing guidelines predicted only risk in adults, but that the Environmental Protection Agency has announced it will issue new guidelines to take into account the increased immune sensitivity of fetuses and young children.

Adapted from materials provided by Cornell University

What they are and why they occur

Chemotherapy can cause damage to your nervous system. Many nervous system problems get better within a year of when you finish chemotherapy, but some may last the rest of your life. Symptoms may include:

• Tingling, burning, weakness, or numbness in your hands or feet
• Feeling colder than normal
• Pain when walking
• Weak, sore, tired, or achy muscles
• Being clumsy and losing your balance
• Trouble picking up objects or buttoning your clothes
• Shaking or trembling
• Hearing loss
• Stomach pain, such as constipation or heartburn
• Fatigue
• Confusion and memory problems
• Dizziness
• Depression

Ways to manage

• Let your doctor or nurse know right away if you notice any nervous system changes. It is important to treat these problems as soon as possible.
• Be careful when handling knives, scissors, and other sharp or dangerous objects.
• Avoid falling. Walk slowly, hold onto handrails when using the stairs, and put no-slip bath mats in your bathtub or shower. Make sure there are no area rugs or cords to trip over.
• Always wear sneakers, tennis shoes, or other footwear with rubber soles.
• Check the temperature of your bath water with a thermometer. This will keep you from getting burned by water that is too hot.
• Be extra careful to avoid burning or cutting yourself while cooking.
• Wear gloves when working in the garden, cooking, or washing dishes.
• Rest when you need to.
• Steady yourself when you walk by using a cane or other device.
• Talk to your doctor or nurse if you notice memory problems, feel confused, or are depressed.
• Ask your doctor for pain medicine if you need it.