Mayo Clinic Q&A: Breast cancer left me exhausted. How do I get my life back?

DEAR MAYO CLINIC: I am thrilled to say I am a breast cancer survivor. It has been almost six months since I finished treatment. But I can’t shake the fatigue. I was never a napper, but I find myself feeling desperate to close my eyes in the middle of the workday. I don’t feel sharp in my thinking, and I fall asleep in front of the TV at night. I’m worried. How can I get past this stage? I want my life back.

ANSWER: Cancer-related fatigue can be distressing. It is a persistent, subjective sense of physical, emotional and cognitive tiredness and/or exhaustion related to cancer or cancer treatment that is not proportional to recent activity. It interferes with daily function and quality of life. Cancer-related fatigue is different from the usual tiredness we all experience. It’s more intense, it’s not temporary and it’s not relieved by rest alone.

Several factors can contribute to cancer-related fatigue. The cancer itself can lead to fatigue.

Some cancers weaken muscles, damage organs or alter hormones, which can cause fatigue.

Sometimes treatment damages healthy cells in addition to cancer cells. Treatments such as chemotherapy, molecular targeted therapy, hormonal therapies and radiation all may cause fatigue.

Side effects of treatment may result in a blood problem called anemia, pain or stress, all of which can add to your fatigue.

If you’re not feeling well, your activity level may lower, which causes the body to decondition, causing fatigue. Preexisting conditions, such as anxiety and depression, also may worsen with cancer and play a role in fatigue.

Cancer-related fatigue can happen at any stage. It might start before treatment, become more pronounced during treatment, and sometimes linger even after treatment has ended. Everyone experiences this differently.

The duration of cancer-related fatigue can be variable. For some people, it might improve a few weeks after finishing treatment. For others, it can last for months or even longer. It affects a lot of cancer patients but doesn’t always get proper attention from healthcare professionals. It’s important to communicate with your healthcare team about any ongoing fatigue.

Treatments can include physical therapy and exercise guidance to help increase activity levels, medications, complementary and integrative medicine approaches such as yoga and tai chi, and psychological and mindfulness-based strategies to manage emotional stress and monitor fatigue levels. As every patient is different, a combination of these approaches typically works best.

While there’s no way to prevent cancer-related fatigue, several self-care strategies can help boost energy levels, including:

• Staying as active as possible, even if it’s just light exercise. Start slow and find a routine.
• Eating a balanced diet and staying hydrated. When you have cancer, you may need more protein and nutrients than ever. Drink plenty of fluids, and limit caffeine.
• Setting a regular sleep schedule, taking short naps if needed, and finding time to relax and reduce stress.

If you need guidance or you are experiencing fatigue that is not responding to these modalities, ask your primary care team for help. You may need help from family and friends to help with household tasks too. — Touré Barksdale, M.D., Physical Medicine & Rehabilitation, Rochester, Minnesota

Mayo Clinic Q & A is an educational resource and doesn’t replace regular medical care. This Mayo Clinic Q&A represents inquiries this healthcare expert has received from patients. For more information, visit www.mayoclinic.org.