Fatigue and Radiation Therapy
One of the well-known side effects of radiation therapy (whether to the breast or another body part) is fatigue. For most women, there are two possible side effects from this treatment: fatigue and skin burning, and the intensity of each is highly variable. Fatigue and burning, if they happen, increase as the treatment progresses and sometimes become a big problem towards the end. In my experience, skin burning is more likely to be an issue for women who have had a mastectomy and are having chest wall radiation, women who are large breasted, or women who are being treated for inflammatory breast cancer where the skin is particularly targeted.
Fatigue is harder to predict. Certainly, women who have just completed chemotherapy and, therefore, begin radiation from a lower energy level may have more trouble. Women who commute long distances to treatment or have other logistical reasons for making it more difficult may, too, be more tired. While the reason for possible skin burning is obvious, it is harder to understand the mechanism that may result in fatigue. I have always wondered how much of it is due to needing to add one more thing to already busy schedules, daily trips to the hospital or radiation center, and the general stress associated with cancer treatment. Women who continue to work through therapy often try to schedule daily radiation before or after work. While coming in at 7 AM in order to get to the office on time may seem like a good idea, I encourage women to think very carefully about this choice. It is almost always easier to schedule treatment towards the end of the day and then go home. Otherwise, you are adding time to your daily routines.
All of that is prelude to this article about fatigue and radiation therapy by Anand Drhuva, MD and colleages from Cancer Nursing. Their conclusion, after reviewing a number of studies, is that it is impossible to predict who will be most fatigued. Here is the abstract and then a link if you want to read more:
From Cancer Nursing
Trajectories of Fatigue in Patients with Breast Cancer before, During,
and after Radiation Therapy
Anand Dhruva, MD; Marylin Dodd, PhD, RN; Steven M. Paul, PhD; Bruce A. Cooper, PhD; Kathryn Lee, PhD, RN; Claudia West,
MS, RN; Bradley E. Aouizerat, PhD; Patrick S. Swift, MD; William Wara, MD; Christine Miaskowski, PhD, RN, FAAN
Posted: 05/17/2010; Cancer Nurs. 2010;33(3):201-212. © 2010 Lippincott Williams & Wilkins
Abstract and Introduction
Background: Fatigue is a significant problem associated with radiation therapy (RT).
Objective: This study examined how evening and morning fatigue changed from the time of simulation to 4 months after the completion of RT and investigated whether specific demographic and disease characteristics and baseline severity of symptoms predicted the initial levels of fatigue and characteristics of the trajectories of fatigue.
Methods: Seventy-three women with breast cancer completed questionnaires that assessed sleep disturbance,depression, anxiety, and pain prior to the initiation of RT and the Lee Fatigue Scale, over 6 months. Descriptive statistics and hierarchical linear modeling were used for data analysis.
Results: Large amounts of interindividual variability were found in the trajectories of fatigue. Evening fatigue at baseline was negatively influenced by having children at home and depression. The trajectory of evening fatigue was worse for women who were employed. Morning fatigue at baseline was influenced by younger age, lower body mass index, and the degree of sleep disturbance and trait anxiety. Trajectories of morning fatigue were worse for patients with a higher disease stage and more medical comorbidities.
Conclusion: Interindividual and diurnal variability in fatigue found in women with breast cancer is similar to that found in men with prostate cancer. However, the predictors of interindividual variability in fatigue between these 2 cohorts were different.
Implications for Practice: Diurnal variability and different predictors for morning and evening fatigue suggest different underlying mechanisms. The various predictors of fatigue need to be considered in the design of future intervention studies.