Fatigue (extreme tiredness)

Fatigue is extreme tiredness and exhaustion that doesn’t go away with rest or sleep and may affect you physically and emotionally. It is a very common side effect of breast cancer treatment and may persist weeks or months after treatment has finished.

People who suffer from fatigue have no energy at all and find it difficult to do simple every day tasks. For this reason it can affect the independence and quality of life of the individual. Everyone’s experience of cancer fatigue is different. It is important to know your current limits and not expect too much of yourself.

'I concentrated on small pleasures and didn’t put myself under pressure to do anything.'
Rose

Why does fatigue occur?

Most of the treatments used for breast cancer have side effects which can contribute to fatigue.

• Surgery – many people experience a temporary feeling of tiredness after surgery. This may be due to the stress placed on your body and the time required to heal.
• Chemotherapy – this treatment can cause iron deficiency anaemia and disturbed eating patterns. Both oxygen and food are required to provide energy, so low amounts of these can make you feel weak and tired.
• Radiotherapy – travelling back and forth to the hospital for treatment appointments can make you feel increasingly tired and this may continue for some time after radiotherapy has finished.
• Hormone (endocrine) treatments can bring about changes to the body’s metabolism (the chemical balance of the body) and this can lead to a number of side effects including fatigue.
• Targeted therapies block the growth and spread of cancer by interfering with the biology of the cells. Some of these drugs can also cause fatigue.
• The emotional effects of your diagnosis throughout your treatment, including depression, stress and poor sleep patterns may all contribute to fatigue.
• The side effects of any other medications used throughout your treatment such as anaesthetic drugs, pain relief, anti-sickness drugs, sleeping tablets and anti depressants can also make you feel very tired.

You may find the following tips helpful.

• Tell your doctor or nurse how you feel as there are ways in which the fatigue may be treated, for example iron supplements maybe prescribed for anaemia.
• Incorporate plenty of rest between your daily activities.
• Aim to take short amounts of activity or light exercise each day, such as walking.
• Use relaxation techniques to relieve tension and regain energy.
• Drink plenty of fluids. Make the most of the times when your appetite is good, choosing healthy high calorie foods for energy.
• Prepare for special occasions by resting beforehand.
• Accept offers from help from others where possible.

Macmillan Cancer Support publish an information booklet called Coping With Fatigue, which may be useful for you to read. Order it from their website or via their phone service on 0808 808 00 00.

Sleep disruption

Sleep patterns often become disrupted around the time of diagnosis but this can continue long after treatment has ended. In most cases sleep patterns eventually return to normal. The main causes of sleep disruption are stress and anxiety resulting from the cancer diagnosis and the side effects of treatment.

• Anxiety can be related to many things. It could be uncertainty about the future or worries about relationships with friends and family and their expectations of you. Feeling anxious can stop you from getting off to sleep or cause you to wake early.
• Your sleep pattern may have changed while you were having chemotherapy.
• You might be experiencing night sweats because of the onset of menopause or a return of menopausal symptoms due to taking hormone therapies.
• Changes in your daily routine can also affect your sleep. Being diagnosed with breast cancer affects what you do on a daily basis. For example, you may have stopped working during treatment and may be getting up later, or you may have less energy and be doing less exercise.

Once treatment has ended you may feel guilty for feeling tired during the day or frustrated that your sleep pattern has not returned to normal immediately after treatment ended. This is a common problem experienced by people who have had treatment for breast cancer, especially if it takes some time before your sleep pattern returns to normal.

What can I do to improve my sleep patterns?

A lot of people believe that if they have a bad night’s sleep they should go to bed especially early the next night but this can make the problem worse. Try to get into the habit of going to bed and getting up at the same time each day.

It is important to get into a routine of getting up at the same time every day. Look at how much sleep you get on average each night and go to bed at a time that allows you to get the sleep you need. For example, if you are sleeping for six hours a night and you get up at 6am, you should go to bed at midnight.

For people who have difficulty sleeping, the bedroom can become a place of stress and anxiety, which can make it harder to get to sleep. Strengthening the link between your bedroom and sleeping can help. For example, you should avoid using the bedroom for other activity such as watching TV. Turn the light off when you go to bed. If you are not asleep within 15 minutes after lying down get out of bed and, if possible, go to another room until you feel tired enough to go back to bed.

You could also try to do some light exercise, have a light evening meal, reduce your alcohol intake and avoid stimulants such as coffee or tea in the evening.

It may be difficult for some people to return to their old sleeping pattern. Sleeping tablets are one option, and you may want to discuss this with your GP (local doctor) or breast care nurse.

Counselling or cognitive behavioural therapy (CBT) can be useful and can help you change your patterns of thinking and behaviour. CBT for insomnia (difficulty getting to sleep or staying asleep) includes a number of components designed to help solve problems in people's lives by breaking them down into smaller, more manageable tasks. If you think you might benefit counselling or CBT, discuss these with your GP or breast care nurse.

Some people find things such as yoga, meditation and relaxation techniques help them to relax and aid sleep. For more on this, download or order our Complementary therapies booklet.