Cancer News

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Fatigue from chemotherapy can range from a mild to extreme feeling of being tired. Many people describe fatigue as feeling weak, weary, worn out, heavy, or slow. Resting does not always help.

Many people say they feel fatigue during chemotherapy and even for weeks or months after treatment is over. Fatigue can be caused by the type of chemotherapy, the effort of making frequent visits to the doctor, or feelings such as stress, anxiety, and depression. If you receive radiation therapy along with chemotherapy, your fatigue may be more severe.

Fatigue can also be caused by

• Anemia
• Pain
• Medications
• Appetite changes
• Trouble sleeping
• Lack of activity
• Trouble breathing
• Infection
• Doing too much at one time
• Other medical problems

Fatigue can happen all at once or little by little. People feel fatigue in different ways. You may feel more or less fatigue than someone else who gets the same type of chemotherapy.

Ways to manage

• Relax. You might want to try meditation, prayer, yoga, guided imagery, visualization, or other ways to relax and decrease stress.
• Eat and drink well. Often, this means 5 to 6 small meals and snacks rather than 3 large meals. Keep foods around that are easy to fix, such as canned soups, frozen meals, yogurt, and cottage cheese. Drink plenty of fluids each day–about 8 cups of water or juice.

Plan time to rest. You may feel better when you rest or take a short nap during the day. Many people say that it helps to rest for just 10 to 15 minutes rather than nap for a long time. If you nap, try to sleep for less than 1 hour. Keeping naps short will help you sleep better at night.

• Be active. Research shows that exercise can ease fatigue and help you sleep better at night. Try going for a 15-minute walk, doing yoga, or riding an exercise bike. Plan to be active when you have the most energy. Talk with your doctor or nurse about ways you can be active while getting chemotherapy.
• Try not to do too much. With fatigue, you may not have enough energy to do all the things you want to do. Choose the activities you want to do and let someone else help with the others. Try quiet activities, such as reading, knitting, or learning a new language on tape.

Sleep at least 8 hours each night. This may be more sleep than you needed before chemotherapy. You are likely to sleep better at night when you are active during the day. You may also find it helpful to relax before going to bed. For instance, you might read a book, work on a jigsaw puzzle, listen to music, or do other quiet hobbies.

• Plan a work schedule that works for you. Fatigue may affect the amount of energy you have for your job. You may feel well enough to work your full schedule. Or you may need to work less–maybe just a few hours a day or a few days each week. If your job allows, you may want to talk with your boss about ways to work from home. Or you may want to go on medical leave (stop working for a while) while getting chemotherapy.
• Let others help. Ask family members and friends to help when you feel fatigue. Perhaps they can help with household chores or drive you to and from doctor’s visits. They might also help by shopping for food and cooking meals for you to eat now or freeze for later.
• Learn from others who have cancer. People who have cancer can help by sharing ways that they manage fatigue. One way to meet others is by joining a support group–either in person or online. Talk with your doctor or nurse to learn more.

• Try not to do too much. With fatigue, you may not have enough energy to do all the things you want to do. Choose the activities you want to do and let someone else help with the others. Try quiet activities, such as reading, knitting, or learning a new language on tape.

• Keep a diary of how you feel each day. This will help you plan how to best use your time. Share your diary with your nurse. Let your doctor or nurse know if you notice changes in your energy level, whether you have lots of energy or are very tired.
• Talk with your doctor or nurse. Your doctor may prescribe medication that can help decrease fatigue, give you a sense of well-being, and increase your appetite. He or she may also suggest treatment if your fatigue is from anemia.

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Roman Bystrianyk, “Leafy green vegetables reduces cancer risk”, Health Sentinel, August 11, 2006,

Epidemiological studies have shown the protective effect of vegetables, particularly cruciferous vegetables, such as broccoli, are protective against colon cancer. In Asia the lower incidence of degenerative diseases, such as cancer and heart disease, are believed to be due to the high consumption of fruits and vegetables. Green vegetables are widely consumed in Asia and are a major source of antioxidant and antioxidant like compounds. In addition, these green vegetables contain compounds that aid in the body’s natural detoxification pathways to remove potential carcinogens.

A study in the World Journal of Gastroenterology, examines the antioxidant and the detoxification inducing ability of green leaf vegetables consumed in Asia.

Free radicals are generated in the body by many mechanisms including response to inflammation, normal metabolism, and exposure to radiation. At places in the body where there is inflammation the immune system dispatches white blood cells, called neutrophils, to fight infections. These neutrophils use hydrogen peroxide (H2O2) and hypochlorous acid (HOCl) to kill foreign invaders such as bacteria and fungus.

Although neutrophils use these chemical mechanisms quite effectively to protect the body the resultant chemicals also can cause damage to the body through oxidative stress. “HOCl and species derived from it can oxidize lipids, proteins, DNA, and carbohydrates.” In fact, the generation of these chemicals in the body is “implicated in a wide range of human diseases ranging from cancer and cardiovascular disease to chronic inflammation.”

Antioxidants help neutralize free radical damage to the body. However, as they neutralize these free radicals the antioxidant levels in the body are depleted. The depletion of antioxidants allows for other free radicals to cause more damage that can lead to disease because they “participate in the carcinogenesis by inducing genetic mutations.” Antioxidants have been shown to “reduce oxidant induced damage.”

In this study the authors examined the ability of a variety of vegetables frequently consumed in Asia, such as broccoli, Rorripa, Sio Pek, Pa Po, Pheuy leng, and Choi Sum to help protect the body from damage caused by free radicals. The authors also wanted to examine detoxification mechanisms of these vegetables that help protect the body in other ways.

The authors found that these cruciferous vegetables do in fact reduce genetic damage from free radicals by being a “potent source of antioxidants that may offer protection against oxidant induced damage in human beings.”

The authors also found that in addition to neutralizing free radicals that there is a secondary mechanism of protection against oxidative damage by stimulating the body’s own detoxification mechanisms. “The induction of phase 2 detoxification enzymes provides protection against electrophilic [electron-deficient molecules] and oxidant induced damage.”

Cruciferous vegetables contain phytochemicals known as glucosinolates that are converted in the body to bioactive substances called isothiocyanates or ITCs. “ITCs are potent inducers of phase II detoxification enzymes in mammals.”

ITCs act to prevent cancer at three different stages. First, ITCs prevent carcinogenic activation by stopping certain cancer promoting enzymes. Second, they help with phase II enzymes that result in the elimination of potential carcinogens from the body. Third, ITCs can induce apoptosis, or cell death of damaged cells. These ITC mechanisms are consistent with the results of many studies “which have suggested a reduced risk of cancer, particularly of the gastrointestinal tract, through the consumption of cruciferous vegetables.”

Examining the vegetables they authors found that the different vegetables had different effects on their ability to detoxify. Both broccoli and Rorripa were found to be the strongest in helping to form enzymes that help rid the body of carcinogenic chemicals.

The authors conclude, “Green leaf vegetables are potential sources of antioxidants and phase II detoxification enzyme inducers in the Asian diet. It is likely that consumption of such vegetables is a major source of beneficial phytochemical constituents that may protect against colonic damage.”

SOURCE: World Journal of Gastroenterology, December 2005

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