Cancer News

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.

What it is and why it occurs

Red blood cells carry oxygen throughout your body. Anemia is when you have too few red blood cells to carry the oxygen your body needs. Your heart works harder when your body does not get enough oxygen. This can make it feel like your heart is pounding or beating very fast. Anemia can also make you feel short of breath, weak, dizzy, faint, or very tired.

Some types of chemotherapy cause anemia because they make it harder for bone marrow to produce new red blood cells.

Ways to manage

• Get plenty of rest. Try to sleep at least 8 hours each night. You might also want to take 1 to 2 short naps (1 hour or less) during the day.
• Limit your activities. This means doing only the activities that are most important to you. For example, you might go to work but not clean the house. Or you might order take-out food instead of cooking dinner.
• Accept help. When your family or friends offer to help, let them. They can help care for your children, pick up groceries, run errands, drive you to doctor’s visits, or do other chores you feel too tired to do.
• Eat a well-balanced diet. Choose a diet that contains all the calories and protein your body needs. Calories will help keep your weight up, and extra protein can help repair tissues that have been harmed by cancer treatment. Talk to your doctor, nurse, or dietitian about the diet that is right for you.

When you get up from lying down, sit for a minute before you stand. Stand up slowly. You may feel dizzy if you stand up too fast.

Your doctor or nurse will check your blood cell count throughout your chemotherapy. You may need a blood transfusion if your red blood cell count falls too low. Your doctor may also prescribe a medicine to boost (speed up) the growth of red blood cells or suggest that you take iron or other vitamins.

Call your doctor or nurse if:

• Your level of fatigue changes or you are not able to do your usual activities
• You feel dizzy or like you are going to faint
• You feel short of breath
• It feels like your heart is pounding or beating very fast

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