Why do I feel so tired most of the time?
Anemia is a common problem for many dealing with cancer. It is especially an issue for those undergoing chemotherapy. By definition, anemia is an abnormally low level of red blood cells (RBCs). These cells contain hemoglobin, which provides oxygen to all parts of the body. If RBC levels are low, parts of the body may not be receiving all the oxygen they need to work and function well. In general, people with anemia commonly report feeling tired. The fatigue that is associated with anemia can seriously affect quality of life for some patients and make it difficult for patients to cope at times.
Medications such as epoetin (Procrit, Epogen) or darbepoetin (Aranesp) may be recommended to stimulate your bone marrow to make more red blood cells, raising your blood cell count and increasing your energy level. Such a medication is given by injection under the skin using a very small thin needle. The doses vary and it is common to be given one of these medications for this side effect once a week. You might be advised to also take an oral iron supplement while getting these injections.
I’ve heard that some chemotherapy drugs can damage the heart. Is this true?
There are several drugs that can produce a side effect of heart problems: Doxorubicin (Adriamycin), which is a chemotherapy agent, and trastuzumab (Herceptin), which is a biological targeted agent. Your doctor will use a MUGA scan or an echocardiogram (ECHO) to help determine if it is safe to give these medications.
The MUGA or ECHO may be repeated every few months to re-evaluate the heart function and ensure that all is well and that it is safe to continue with your treatment. Congestive heart failure, a weakness of the heart muscle, can occur but is not common. These risks are greater when Herceptin or Adriamycin are given together. Some women are given Herceptin alone with a very low risk to their heart.
It seems harder to remember things, especially doing math or trying to recall where I put my keys. What is causing these symptoms?
Some refer to this as “chemo brain.” People dealing with cancer who are getting chemotherapy as part of their treatment can have trouble remembering names, places, and events or have trouble with concentration or arithmetic. Currently scientific studies are being done to better understand what is causing it and how to counteract it. If you are finding that these symptoms are pretty severe and impacting your ability to function well, ask your family to assist you with the things that are difficult. Make a list of things you need to do and mark each item off as you do it. Keep your keys in the same place so they are easier to find. Most importantly, get your family members to assist you with medication management. A pill box that has the times of day to take your medications is a good idea rather than relying on your memory that you took your medications out of the prescription bottle when they were due. Be sure to tell your doctor if you are having symptoms of chemo brain. Sometimes these same symptoms can be a sign of metastatic cancer cells in the brain, drug side effects, or other causes.
Where did my energy go, and what can I do to get it back?
Feeling exhausted or extremely tired is probably the most common side effect patients report. This can happen as a side effect of chemotherapy and/or radiation therapy. Approximately 70 percent of patients with advanced cancers report this as a chronic frustrating symptom. Fatigue can also be triggered by anemia. If there are specific problems you are experiencing that are related to fatigue, such as difficulty sleeping, make your doctor aware so that he might prescribe something for you to help. Ask about how to better manage your pain, if that is a contributing factor. Also ask about coping with your emotional distress, which can increase fatigue. Conserving your energy is important so you are spending your time doing things that are important to you. Make a list of the activities and chores you are trying to accomplish and see about recruiting family and friends to assist you. You may also notice that your energy is better during certain times of the day. The Oncology Nursing Society has a website that provides some specific recommendations related to this side effect. Take a look at http://www.cancersymptoms.org/symptoms-from-chemotherapy-cancer-treatment. Also visit the National Comprehensive Cancer Network’s website for more information at www.nccn.org.
I’ve been in treatment for my metastatic breast cancer that spread to my lungs. Lately I’ve noticed it is getting harder to breathe. What might this be?
Fluid around the lungs, or pleural effusion, is a condition that presents commonly as shortness of breath, dry cough, heaviness feeling in the chest, inability to exercise, and a feeling of not being able to take a deep breath. This is due to extra fluid building up around the pleural spaces of the lungs. A malignant pleural effusion is caused by cancer cells that grow into the pleural cavity.
Many patients with metastatic breast cancer develop this problem. The diagnosis of pleural effusion is made by physical examination and chest X-ray. Treatment is based on the amount of fluid in your chest and if you have any symptoms. If the fluid collection is considered to be large and given your noticeable symptoms, the doctor may decide to insert a needle through the ribs into the pleural space and remove the fluid. Sometimes this is done with the help and guidance of ultrasound. This procedure is called a thoracentesis. It can be done on an outpatient basis. Sometimes the fluid comes back and you will need to have it drained again. If this happens frequently, your doctor may suggest a procedure called pleurodesis. Sitting up and using pillows for support can make breathing sometimes easier. Reclining chairs may be more helpful for sleeping than trying to lie flat in bed. Oxygen may be given as well to help with breathing. If oxygen is given at home, great care must be taken. The use of matches, cigarettes, or candles is not allowed in the room where the oxygen is in use or being stored. Oxygen containers should be kept far away from gas or electrical heating elements, too. The respiratory therapist or company that provides the oxygen will review other safety measures with you and your family or caregivers.
What is lymphedema and how can I manage it if I develop it?
Lymphedema is an abnormal collection of lymph fluid in the arms or legs. Lymphatic fluid is in our bodies to fight infection and cancer. When lymph nodes in relatively large numbers have been surgically removed or radiated, however, the pathway for lymphatic drainage can become disrupted and fluid that is sent down the arm, for example, may have trouble returning back up the arm. This results in the arm swelling and staying swollen. Infection, trauma to the arm, or other factors may trigger the lymphedema. Lymphedema can cause discomfort, pain, and limit the use of your arm. Most patients do not develop lymphedema from having nodes removed or having radiation to the armpit area. The incidence of lymphedema is lower in the last 15 years because of improvements in surgical and radiation therapy techniques.
If you develop lymphedema you may experience heaviness, throbbing pain or soreness, or a feeling of tightness from your wristwatch, rings, or clothing. Some prevention steps you can take to help reduce the risk of developing lymphedema include the following: Perform gentle strengthening and stretching exercises to keep the affected arm working normally. Avoid lifting or moving heavy objects using that arm after surgery. Keep skin clean and moisturized, avoid cuts or cracks in the skin, and avoid insect bites whenever possible. Avoid getting any needlesticks in that arm-such as IVs, vaccinations, or blood draws from the arm where lymph nodes were surgically removed or radiated.
Avoid getting blood pressures taken in that arm too. Report signs of infection to your doctor right away. If you do get a cut or injury to this arm, wash the cut immediately and apply over-the-counter antibiotic ointment right away. Report any changes you notice to this arm, such as swelling or feeling of heaviness. If you develop lymphedema, there are several things that may be helpful. You can elevate the arm, use a compression sleeve, have a massage by a rehabilitation therapist who specializes in lymphedema management, use compression bandaging, or use a pressure pump. For more information about lymphedema, contact the National Lymphedema Network at 800-541-3259 or visit their website at www.lymphnet.org
Terms:
Red blood cells (RBCs) – Cells in the blood with the primary function of carrying oxygen to tissues.
Hemoglobin – The part of the red blood cell that carries the oxygen. The fatigue that is associated with anemia can seriously affect quality of life for some patients and make it difficult for patients to cope at times
MUGA test – A special heart X-ray that determines the strength of the heart.
ECHO test – A special test using ultrasound that determines the strength of the heart.
Pleural cavity – A space between the outside of the lungs and the inside wall of the chest.
Thoracentesis – The removal of fluid from the pleural cavity through a hollow needle inserted between the ribs.
Pleurodesis – A procedure that gets rid of the open space between the lung and the chest cavity.
This is done to stop fluid from building up in this space. When cancer cells are growing in this space, they make fluid that can collect and cause difficulty breathing. During this surgery, a chemical is placed in the space. Your body’s reaction to the chemical causes the lining around the lung to stick to the inside lining of the chest wall
Lymphedema – A condition in which lymph fluid collects in tissues following removal of, or damage to, lymph nodes during surgery, causing the limb or area of the body affected to swell.
Lymph – Fluid carried through the body by the lymphatic system, composed primarily of white blood cells, and diluted plasma.
