Is Fatigue A Symptom Of Breast Cancer?

IS FATIGUE A SYMPTOM OF BREAST CANCER?

Do I have breast cancer if I feel fatigued often? According to the Centers for Disease Control and Prevention, breast cancer is the most commonly encountered cancer in American women with prevalence in other countries of the world at the rate similar as in America. Sometimes there are no symptoms of breast cancer, especially in its early stages. The earlier breast cancer is found, the easier it usually is to treat. This is why early detection is so important.

Among the visible symptoms of breast cancer like lumps in the breast,  changes in the nipples, underarm lump, changes in the skin of breast, irritation, redness, thickness, discoloration and dimpling of skin the symptoms that might go unnoticed are fatigue. (1)

This article is focused solely on the providing you with enough information on breast cancer related fatigue.

Cancer-related fatigue (CRF) is “a persistent, subjective sense of tiredness related to cancer or cancer treatment that interferes with usual functioning” (National Comprehensive Cancer Network [NCCN], 2003, p. FT-1).

Fatigue is a common and frequently disabling symptom in cancer patients and cancer survivors. Fatigue is also often a presenting symptom at cancer diagnosis. Cancer fatigue differs from other manifestations of fatigue in that it is generally not alleviated by sleep or rest, is typically of greater duration and severity, is often associated with high levels of distress, and is disproportionate to the level of exertion. (2)

This fatigue comes in package with other symptoms like pain, depression and sleep disturbances. These factors along with extreme fatigue have negative impact on the patient’s quality of life.  The patient is forced to compromise on his personal, work, and social engagements. Some studies have reported that fatigue in cancer patients impacts their quality of life more than any other symptom. (3)

Fatigue is often times interchanged with sleepiness. Cancer patients complain about both feeling sleepy and fatigued. As similar as these two terms seem, they are very different from each other. Sleepiness comprises inclination towards a natural tendency to falling asleep more often than normal. Sleepiness could be due to body’s underlying physiological need for sleep.

On contrary, fatigue is influenced by both physiological as well as psychological factors.  Fatigue is a broader term covering concepts like lack of energy, lethargy, decreased strength, feelings of tiredness most of the times and finding it difficult to concentrate. (4)

Fatigue in cancer patients may be for variety of reasons. One of those reasons being Anemia in which the red blood cells count of the patient drops below the normal range. This causes decrease in level of blood received by muscles and brain. This puts the body under both physical and mental distress leading to fatigue. (5)

Similar to anemia is trouble in breathing or heart troubles. Breast cancer patients very commonly can experience distress in breathing or abnormal heart functions. Both the factors of not receiving enough oxygen and disturbed circulation of blood can lead to atrophy of muscular element of their bodies leading to feelings of extreme tiredness and fatigue. (6)

Another reason can be hormonal imbalance. The levels of hormones in women body needs to be in a check. When the levels of hormone are disturbed, either higher or lower than normal, due to cancerous cells growth in the body, the women may feel extreme level of disconnection and fatigue.

If the cancer patient is already harboring any viral or bacterial infection before cancer or while having undiagnosed cancer, the patient will have more than one battle to fight. Cancerous cells already have a damaging effect on the patient’s body and it’s healthy (unaffected) cells, the infection only adds on to it leading to fatigue.

Cancer patients often unknowingly lose appetite, weight, muscle strength and tend to be dehydrated. This changes the way how your body utilizes the available food and water for energy. The body overall is in state of constant exertion. All these signs are contributing factors of fatigue in the patient. (7)

Fatigue was the most commonly reported symptom in people with cancer, according to 2011 studies. It is most prevalent symptom in stage 4 cancer. Stage 4 Cancer or metastatic breast cancer, is considered the most advanced stage of cancer. In this stage, the breast cancer has already spread to vital organs like lungs and/or brain. By this time the cancer is no longer treatable. (8)

Psychosocial factors are strongly correlated with fatigue among breast cancer patients and survivors, particularly depressive symptoms. Although the majority of research linking depression and fatigue is cross-sectional, emerging data from longitudinal studies suggests that depression may increase the risk for significant fatigue during and after cancer treatment. (9)

Coping strategies may influence cancer-related fatigue, particularly the tendency to catastrophe (i.e., react to fatigue with negative self-statements and negative thoughts about the future) in response to fatigue symptoms. (10)

A relatively recent concept in the cancer patient’s symptom management is “symptom cluster”. This cluster is a compound of three commonly seen symptoms in Cancer patients i.e. fatigue, sleep disturbance and depression. Where two of the components of this cluster, sleep disturbance and depression, tend to be a contributing features of fatigue itself. Studies conducted in this respect reported all the women with worse sleep, more depression and fatigue.

Fatigue is correlated with sleep disturbance and pain in cancer populations. (11). Lower levels of cortisol-morning serum, flattened slopes of diurnal cortisol and blunted cortisol response to acute psychological stress are also possible contributing factors towards fatigue in breast cancer patients.

One possibility is that impairment in glucocorticoid regulation of inflammatory processes may contribute to fatigue. Indeed, there is preliminary evidence that enhanced pro-inflammatory cytokine production in fatigued cancer survivors may stem in part from decreased cortisol response to challenge. The biological underpinnings of cancer-related fatigue are an important focus for future research. (12)

REFERENCES

1.         Breast Cancer Symptoms Basics [Internet]. Healthline. [Cited 2020 Jun 22]. Available from: https://www.healthline.com/health/breast-cancer-signs

2.         Bower JE. Cancer-related fatigue: links with inflammation in cancer patients and survivors. Brain Behav Immun. 2007 Oct;21(7):863–71.

3.         Carroll JK, Kohli S, Mustian KM, Roscoe JA, Morrow GR. Pharmacologic treatment of cancer-related fatigue. The Oncologist. 2007;12 Suppl 1:43–51.

4.         Bardwell WA, Moore P, Ancoli-Israel S, Dimsdale JE. Fatigue in obstructive sleep apnea: driven by depressive symptoms instead of apnea severity? Am J Psychiatry. 2003 Feb;160(2):350–5.

5.         Wratten C, Kilmurray J, Nash S, Seldon M, Hamilton CS, O’Brien PC, et al. Fatigue during breast radiotherapy and its relationship to biological factors. Int J Radiat Oncol Biol Phys. 2004 May 1;59(1):160–7.

6.         Wratten C, Kilmurray J, Nash S, Seldon M, Hamilton CS, O’Brien PC, et al. Fatigue during breast radiotherapy and its relationship to biological factors. Int J Radiat Oncol Biol Phys. 2004 May 1;59(1):160–7.

7.         Fatigue (PDQ®)–Patient Version - National Cancer Institute [Internet]. 2020 [cited 2020 Jun 22]. Available from: https://www.cancer.gov/about-cancer/treatment/side-effects/fatigue/fatigue-pdq

8.         Symptoms of Stage 4 Breast Cancer [Internet]. Healthline. [Cited 2020 Jun 22]. Available from: https://www.healthline.com/health/10-symptoms-stage-4-breast-cancer

9.         Jacobsen PB, Donovan KA, Weitzner MA. Distinguishing fatigue and depression in patients with cancer. Semin Clin Neuropsychiatry. 2003 Oct;8(4):229–40.

10.         Jacobsen PB, Andrykowski MA, Thors CL. Relationship of catastrophizing to fatigue among women receiving treatment for breast cancer. J Consult Clin Psychol. 2004 Apr;72(2):355–61.

11.         Bower JE, Ganz PA, Desmond KA, Rowland JH, Meyerowitz BE, Belin TR. Fatigue in breast cancer survivors: occurrence, correlates, and impact on quality of life. J Clin Oncol Off J Am Soc Clin Oncol. 2000 Feb;18(4):743–53.

12.         Bower JE, Ganz PA, Aziz N, Olmstead R, Irwin MR, Cole SW. Inflammatory responses to psychological stress in fatigued breast cancer survivors: relationship to glucocorticoids. Brain Behav Immun. 2007 Mar;21(3):251–8.