Side Effects

cancer prostate PROCURE


There is three main side effects to prostate cancer : incontinence, erectile dysfunction and fatigue.


Incontinence: an Overview

Written by Isabelle Grégoire, B.Sc.N. Sir Mortimer B. Davis – Jewish General Hospital

What is Urinary Incontinence?

Urinary incontinence is an involuntary loss of urine. It is not considered a disease; it is a symptom of a condition.

There are different types of urinary incontinence :

  • STRESS incontinence is the leakage of urine as a result of physical exertion such as coughing, sneezing, lifting an object and/or exercising.
  • URGE incontinence occurs when the bladder has involuntary contractions and causes leakage of urine. There is a strong feeling of having to urinate right away and not making it on time to the toilet.
  • MIXED incontinence is a mixture of symptoms of both stress and urge incontinence.
  • OVERFLOW incontinence is the loss of small amounts of urine from a bladder that is always full.

Impact of Urinary Incontinence on Prostate Cancer Patients

Urinary incontinence in prostate cancer patients can provoke important psychological, emotional and physical reactions. It can create a lot of guilt, shame, frustration and anger. It can often result in a man being fearful and worried about wetting. Loss of self-esteem, self-image and confidence often follows.

Incontinence often implies restrictions on lifestyles. It affects activities of daily living such as consumption of fluids, choice of clothing, sexual activity and intimacy, practice of sports and travelling. Some people often isolate themselves out of fear of rejection. Having to purchase speciality urinary control undergarments can also become a financial burden. None of these responses need be the case, as many treatments are now available to effectively treat urinary incontinence.

The percentage of men experiencing urinary incontinence after being treated for prostate cancer has been difficult to evaluate. This may be due to different definitions of degree of symptoms. For example, how one individual rates his “significant” incontinence may be defined quite differently by another man experiencing similar problems.

Urinary Control Devices

There are many products available in pharmacies and home health stores that can help you manage the loss of urine, though they are not considered treatments or cure.

Protective Undergarments

protectiveundergarments

Many types of diapers and pads are now available in pharmacies and general stores. Many of these have been adapted to comfortably fit male anatomy.

 

 

 

 

Texas Condom Catheters

texascondomcatheterTexas condom catheters resemble a condom (see image), with an opening at one end so that it can be connected to a bag attached to the leg. When the bag is full of urine, it is emptied manually. The chance that you will need such a device is extremely low, i.e. less than 1%.

 

 

 

 

Clamps

clamps

 

 

 

 

The Cunningham clamp

cunninghamclampa device fastened around the penis

 

 

 

 

 

 

The C3 clamp

c3clampthe penis is inserted inside the clamp, which is fitted using a Velcro band

 

 

 

 

 

It is important here to know that the chance you will need such device is extremely low, i.e. less than 1%. Both clamps apply light pressure on the urinary canal, located on the underside of the penis, and prevent leakage. Proper tightness of the clamp is important in order to avoid pressure sores on the skin underneath the device. These clamps should not be worn for excessive periods of time. Some urologists suggest using them for only an hour or two at a time. You can ask your urologist for advice.

Treatments for Urinary Incontinence

Medications

Medications such as oxybutynin (Ditropan, Ditropan XL, Uromax, Oxytrol), tolterodine (Detrol, Detrol LA) solifenacine (Vesicare), darifenacine (Enablex) and trospium chloride (Trosec) are medications with anticholinergic properties and can be used to treat URGE incontinence. They act by preventing the involuntary contractions of the bladder that cause the urgency. These drugs increase bladder capacity and reduce urinary frequency, as well as urgency. Some side effects of these medications include dryness of the mouth, constipation, heartburn and headache. You should not take anticholinergic medications if you have glaucoma or myasthenia gravis.

Pelvic Floor Muscle Exercises (Kegels)

The floor of the pelvis is made up of muscles that are attached from the tailbone (coccyx) to the pelvic bone in the front. It is shaped like a hammock. The urinary canal passes directly through those muscles. When these are weakened as a result of prostate surgery, you might experience some leakage of urine.

Kegel exercises, indicated to treat STRESS urinary incontinence, can be performed to help strengthen those muscles and restore continence.

How to find your pelvic floor muscles:
They are the muscles around your anus that you tighten when you need to pass gas but you don’t want to because you are in a public area. Concentrate on the muscles around your anus that you tighten when you have diarrhea, and need to hold it when the bathroom is occupied OR make note of the muscles you use to stop the stream while urinating.

Simple but very effective, these pelvic floor exercises strengthen and reinforce muscles that go a long way to help regain continence.

Now that you are aware of which muscles to use:

  • Squeeze the muscles around your anus. Hold the contraction for five seconds, then relax. The relaxation phase can be twice the length of the contraction time to avoid over-tired muscles.
  • Do these exercises in series of ten contractions at a time. Repeat them throughout the day. Remember, it is not the quantity but the quality of your exercises that is important. If not done properly, they will not be as beneficial.
  • While doing these exercises, it is important that you do not hold your breath or use your abdominal (stomach) muscles instead of the ones that make up the pelvic floor. In order to ensure that you are doing the exercises correctly, do them in front of a mirror: you should see your penis lift a little bit.
  • If you experience leakage of urine while straining, such as when coughing, sneezing or lifting something, do five to ten quick contractions consecutively.
  • Include pelvic floor exercises in your daily routine – and keep doing them even when you are continent. A muscle gets weak when not exercised. Be patient!

Biofeedback

Biofeedback machine

Biofeedback is a process that uses mechanical or electronic equipment. This provides concrete visual and auditory feedback that shows you how well your pelvic floor muscles work. It helps you become more aware of how your pelvic floor muscles function, and ensures that you are doing the Kegel exercises properly. Biofeedback instruction is offered by specially trained health care professionals. It can be used to treat STRESS (more often) and URGE incontinence.

Electrical Stimulation

This technique provokes contractions using electrical stimulation. Its purpose is also to help you learn to contract your pelvic floor muscles correctly. It can be used in association with biofeedback and is offered by specially trained health care professionals. It can be used to treat STRESS and URGE incontinence.

Artificial Urinary Sphincter

Should urinary STRESS incontinence not resolve one year after prostate cancer surgery – and interfere with your quality of life – another option is the artificial urinary sphincter. This device imitates the natural opening and closing of the bladder sphincter that controls continence. A surgery is required to implant it into your body; nothing is visible from the outside. It consists of:

  • a reservoir placed behind the pubic bone
  • a cuff that surrounds the urinary canal
  • tubing attaching the pump, the reservoir and the cuff
  • a small pump that is inserted into the scrotum, next to the testicles; and
  • liquid that travels back and forth from the cuff to the reservoir

When you need to urinate and with the liquid in the cuff, squeeze the pump found in the scrotum several times. This triggers the fluid in the cuff to migrate into the reservoir releasing the pressure on the urinary canal causing urine to flow out. When the bladder is empty, the reverse process occurs automatically: the fluid in the reservoir progressively goes back into the cuff, applying pressure on the urinary canal and preventing leakage of urine. This whole process takes three to five minutes.

In order for the swelling to go down after insertion of the sphincter, a period of six to eight weeks is necessary before you can start using it. To get you through this transitional period, you will need to rely on protective undergarments. Even after you have been given the go-ahead to start using the artificial sphincter, you might still experience minor leaks or dribbling, especially with exertion, and may have to resort to use of light pads for comfort. If this is the case, it is best to get into the habit of emptying your bladder every two to three hours.

As with any other surgery, infection is a possible complication; should this occur, the artificial sphincter will need to be removed. After many uses, you may also occasionally experience a mechanical malfunction with the device. In this case, the affected part can be surgically replaced. Should you ever need a catheter to be inserted for a medical reason, the staff needs to be made aware that you have an artificial urinary sphincter so that the cuff may be deflated beforehand. If you do opt to have a urinary sphincter inserted, you should carry a card in your wallet or wear an alert bracelet that advises that this is the case.

This procedure is not available in all centres; speak with your urologist for more information.

Male Sling

A male sling is a surgical procedure performed to treat STRESS urinary incontinence. This sling is used to compress the urethra to stop any leakage of urine during activities such as coughing, sneezing or exercising. It is similar to slings used for women with STRESS incontinence. The surgeon makes an incision in the center of the perineum ands places a sling made up of cadaveric tissue, synthetic material or your own tissue that has been harvested is then sutured in place. The sling is attached to surrounding tissue. The sling applies pressure on the urinary canal, allowing continence to be regained. This procedure is not available in all centres, speak with your urologist for more information.

Counselling

For those men or couples needing assistance to cope with urinary incontinence, counselling through psychotherapy is available. This can also be used in combination with treatment recommended by your urologist. It can be very useful: psychotherapy can help you address the reactions that arise as a result of condition like urinary incontinence, and provide you with concrete strategies that equip you with hands-on approaches to help resolve conflicts that may emerge in your relationships with your loved ones – and those that love you.

More information on urinary incontinence can be obtained from the Canadian Continence Society at www.continence-fdn.ca

As you can see, there are no reasons for you to suffer from incontinence in silence. Many effective treatments are available to make your life more comfortable.


Erectile Dysfunction: an Overview

Written by Isabelle Grégoire, B.Sc.N. Sir Mortimer B. Davis – Jewish General Hospital

What Makes an Erection Work?

The penis is made up of two corpora cavernosa and the corpus spongiosum. The two corpora cavernosa are two chambers containing many blood vessels. The corpora spongiosum contains the urethra or the canal for urine.

When a man is sexually stimulated, the blood vessels in the two chambers of the penis relax, open and fill up with blood. The end result is a firm, rigid erection.

What is Erectile Dysfunction?

Erectile dysfunction is the inability to obtain or maintain an erection sufficient for penetration. This condition must have been persistent for a period of at least three months before being considered a medical dysfunction.

Impact of Erectile Dysfunction on Prostate Cancer Patients

For the man experiencing it, erectile dysfunction can be devastating. It provokes anxiety and is psychologically difficult. Men in today’s society, from a very early age, are exposed to social attitudes that imply that manhood is synonymous with a firm, erect penis. Sex is defined on how well the penis functions. It is therefore not surprising that, when the penis fails to perform, it shakes a man’s identity. What has been taken for granted for so long is no longer possible. Feelings of shame and inadequacy, loss of self-esteem, self-image and lack of confidence are all negative emotions that make it more difficult for the man to accept what is happening to him. It is thus important to realise that men can sometimes still enjoy a pleasurable orgasm without an erection, and therefore poor erection does not mean the end of sexuality.

The anger that results from his erectile dysfunction can be expressed towards oneself or one’s partner. If fearful of failure, he may avoid sexual activity altogether. This can impede on the couple’s relationship; the partner may take this to mean that she or he has become less attractive, her or his ability to excite him has decreased, or simply resigns herself or himself to the fact that she or he is getting older. The partner may also start questioning her husband. Is he having an extra-marital affair? This may create an atmosphere of rejection.

Dealing openly with the erectile dysfunction coming between a couple by talking about it will help release some of the tension created by the situation. Often, a great many men have found out just how strong their relationships with partners are through an experience like this and that there are other ways to be fulfilled in a relationship aside from sex.

DO NOT GIVE UP HOPE! In most cases, problems with erections can be effectively treated. In the meantime, if you need help to get through this, do not hesitate to talk to the medical/nursing team.

Useful links :

40 over 40
Info-Santé
Pfizer
Sexuality and U

Prostate Cancer Treatments and Erectile Dysfunction

It is important to keep in mind that, the younger you are, the better your chances are of regaining sexual function after prostate cancer treatment. Bear in mind, however, that if you were experiencing erectile dysfunction prior to treatment, it will not be restored afterwards. Talk to your urologist about your condition. What follows is some information on how different treatments may cause erectile dysfunction:

Prostate Cancer Treatments Causes Outcomes
RADICAL PROSTATECTOMY Damage to the nerves responsible for erectile function during the surgery
  • Erectile dysfunction is present immediately after the surgery
  • 40-70% chance of erectile dysfunction depending on the type of surgery and age of patient
  • May take 12 to 24 months before recovery of the nerves is complete and erections return
  • For some men, potency never returns

Note : The percentage of side effects may vary depending on the type of surgery and tumour

RADIATION THERAPY Damage to the arteries causes decreased blood flow to the penis and to the nerves responsible for erectile dysfunction
  • 20 to 50% chance of having erectile dysfunction, depending on the type of radiation therapy
  • Erectile dysfunction appears 1-2 years and may occur up to 5 years after the treatment
BRACHYTHERAPY Damage to the arteries causes decreased blood flow to the penis and to the nerves responsible for erectile dysfunction
  • Approximately 25% chance of erectile dysfunction
  • The percentage of side effects may vary depending on the type of brachytherapy received
HORMONAL THERAPY Causes a decrease in libido or sex drive as well as erectile function
  • During treatment most patients will not feel like having sexual intercourse. Once treatment is discontinued, the libido may or may not return

 

Treatments for Erectile Dysfunction

The three oral medications – sildenafil citrate (Viagra), tadalafil (Cialis) and vardenafil (Levitra) – all have the same mechanism of action. You may need to try each one out, as one medication may work better for you than the others. It is therefore important to have an open conversation with your urologist to help decide on the best treatment option for you.

  • Sildenafil citrate (Viagra)
Mechanism Of Action Viagra helps increase blood flow to the penis – and thus create an erection – by acting on a specific enzyme of the body.

Availability/Instructions
  • 25, 50 or 100 mg tablets
  • For better absorption of the pill, it should be taken before a meal or two hours afterwards; avoid fatty meals
  • Limit alcohol intake to two glasses prior to taking Viagra; additional alcohol may decrease the ability to attain an erection
  • Do not use more than once a day
  • You can engage in sexual intercourse thirty to sixty minutes after taking Viagra
  • Stimulation is required to obtain an erection, otherwise nothing will happen
  • With stimulation, the erection will come within thirty to sixty minutes
  • If the erection lasts for more than four hours, it may mean you are experiencing a condition called priapism or prolonged erection; while rare, you must go to the nearest hospital emergency room to prevent any damage to the tissues of the penis
  • Viagra needs to be tried at least six to eight times at maximum dosage before you and your doctor decide that it does not work
Precautions There must be a delay of 4 to 6 hours between taking Viagra and any of the following medications:

  • Alfuzosin HCl (Xatral)
  • Terazosin HCl (Hytrin)
  • Doxazosin Mesylate (Cardura)

This is to prevent a sudden drop in blood pressure.

Contraindications Should not be taken by men using any form of nitrates, medication used to treat angina (chest pain) such as nitroglycerine spray, nitroglycerine patch and Imdur; mixing Viagra with these medications can cause a dangerous drop in blood pressure.

Side Effects Side effects, if present, usually only last a few hours:

  • Headache
  • Redness of the face
  • Upset stomach
  • Stuffy nose

 

  • Tadalafil (Cialis)
Mechanism Of Action Cialis helps increase blood flow to the penis – and thus create an erection – by acting on a specific enzyme of the body.

Availability / Instructions
  • The starting dose is 20mg (also available in 10mg)
  • Cialis can be taken independently of a meal
  • Limit alcohol intake to two glasses prior to taking Cialis; additional alcohol may decrease the ability to attain an erection
  • Do not use more than once a day
  • You can engage in sexual intercourse thirty to sixty minutes after taking Cialis, and anytime during the next 36 hours
  • Stimulation is required to obtain an erection, otherwise nothing will happen
  • With stimulation, the erection will come within thirty to sixty minutes
Precautions There must be a delay of 4 to 6 hours between taking Cialis and any of the following medications:

  • Alfuzosin HCl (Xatral)
  • Terazosin HCl (Hytrin)
  • Doxazosin Mesylate (Cardura)

This is to prevent a sudden drop in blood pressure.

Contraindications Should not be used by men taking any form of nitrates, medication used to treat angina (chest pain), such as nitroglycerine spray, nitroglycerine patch and Imdur; mixing Cialis with these medications can cause a dangerous drop of blood pressure.

Side Effects Side effects, if present, usually only last a few hours:

  • Headache
  • Redness of the face
  • Upset stomach
  • Stuffy nose
  • Backache, muscle pain

 

  • Vardenafil (Levitra)
Mechanism Of Action Levitra helps increase blood flow to the penis – and thus create an erection – by acting on a specific enzyme of the body.

Availability / Instructions
  • Available as 5, 10 and 20 mg tablets
  • The recommended starting dose is 10 mg. It can be adjusted according to your needs in consultation with your doctor
  • Do not use more than once a day
  • Levitra can be taken independently of a meal
  • For better absorption of the pill, avoid fatty meals
  • Limit alcohol intake to two glasses prior to taking Levitra; additional alcohol may decrease the ability to attain an erection
  • Take Levitra 25 to 60 minutes before sexual activity. The amount of time it takes to have an effect varies from person to person, but it normally takes between 15 and 60 minutes and can last up to 4-5 hours
  • Sexual stimulation is required to obtain an erection, otherwise nothing will happen
Precautions The use of Levitra with alpha blockers such as the following should be avoided:

  • Alfuzosin HCl (Xatral)
  • Terazosin HCl (Hytrin)
  • Doxazosin Mesylate (Cardura)
  • Tamsulosin HCl (Flomax)

This is to prevent a sudden drop in blood pressure.

Contraindications Levitra should not be taken by men using any form of nitrates, medication used to treat angina (chest pain) such as nitroglycerine spray, nitroglycerine patch and Imdur; mixing Levitra with these medications can cause a dangerous drop in blood pressure. Use of Levitra with indinavir, ritonavir, ketoconazole or itraconazole is contraindicated.

Side Effects Side effects, if present, are usually transient, mild to moderate in nature, and decrease with continued dosing.The most common are:

  • Headache
  • Redness of the face
  • Upset stomach
  • Stuffy nose

 

  • Penile Injections
Mechanism Of Action The drug relaxes the blood vessels in the corpora cavernosa of the penis, increasing blood flow to create an erection.

Instructions
  • Provides the best quality of erection
  • It consists of injecting a medication into the penis see (image 1 | image 2)
  • The feeling experienced by the injection itself is most often described as “a mosquito bite” – what is upsetting is more fear of the unknown
  • With proper dosage and good injection technique, the erection should come within five to fifteen minutes and ideally last between half an hour to one hour
  • The erection may last after ejaculation and/or orgasm as it is drug-induced and dose-dependent
  • Injection can only be used once a day, if not effective on that day you must wait at least twenty four hours before re-injecting
  • Injections cannot be used more than three times a week
  • It requires teaching from a specialized health care professional
Side Effects
  • Bleeding at the injection site: apply pressure until it stops
  • Bruising at the injection site is reabsorbed by the body
  • 20-30% of men will experience pressure or a burning sensation at the injection site; if this occurs, the medication can be changed to another kind
  • Fibrosis or scarring in the penis, a condition called Peyronie’s disease: can be prevented by alternating injection site from right to left
  • If the erection lasts for more than four hours, it may mean you are experiencing a condition called priapism or prolonged erection; while rare, you need to go to the nearest hospital emergency room. Another medication will be injected into the tissues of the penis to counteract the effect of the previous one. If left untreated, damage can occur in the penis due to a lack of oxygen.

 

  • Muse
Mechanism Of Action The drug relaxes the blood vessels in the corpora cavernosa, increasing blood flow to the penis to create an erection.

Instructions
  • A suppository, a tiny pellet of medication, is inserted at the end of the urinary canal using a small applicatorsee image
  • With the right dosage of medication the erection should come within ten minutes and lasts between thirty to sixty minutes
  • The result is an erection sufficient for intercourse
  • Muse can be used twice in the same twenty-four hour period
Contraindication Should not be used if your partner is pregnant.

Side Effects
  • Pain or burning sensations in the penis
  • May cause a decrease in blood pressure; men should sit or walk around for ten minutes after inserting Muse
  • If some bleeding occurs at entry of the urinary canal, apply pressure at the site until it stops
  • May cause some burning in the vagina of the partner

 

  • Vacuum Constriction Device
Mechanism Of Action An erection can be obtained with a vacuum constriction device due to the negative pressure obtained by the pumping. It brings blood to the penis, which is then trapped by a tension ring applied at its base to create an erection.

Instructions
  • A tension ring is placed at the base of the cylinder see image
  • The penis is lubricated along its shaft and base with water-soluble jelly and inserted inside the cylinder
  • Pumping the device draws blood into the penis. When erect, the ring is applied at the base of the penis preventing the blood from flowing back into the body. The cylinder can then be removed and you can engage in sexual activity
  • The ring CANNOT be worn for more than thirty minutes as blood circulation to the penis is cut off
  • As it is a non-invasive device, there are no restrictions on the number of times you can use it, as long as the ring is worn for no more than thirty minutes each time
  • Using a vacuum constriction device requires some practice before you get familiar with it; also, you may have to experiment before finding the right size and fit of tension ring
Side Effects
  • A good seal at the base of the penis is needed because an air leak may cause a rapid loss of erection or the absence of one
  • Too rapid pumping may induce redness, irritation, bruising, discomfort or pain
  • A wrongly fitted ring may create pain if too small; if too big, blood can escape the penis which results in losing the erection
  • The tension ring may make the penis feel cold to the touch by you or your partner. This can be alleviated by warming up the tube of lubricant in hot water
  • The tension ring may prevent ejaculation
  • A tension ring can also be worn by itself if you find it enough to keep the erection firm

 

Penile Prosthesis

A penile prosthesis is inserted surgically. All parts are concealed inside the body so that nothing is visible from the outside. This treatment should only be used as a last resort, as there is no turning back. The two corpora cavernosa in the penis are destroyed by the insertion of rods. After surgery, the look of your penis will permanently change: the length and the girth will be less than the natural erection.

No sexual activity of any kind is allowed for six to eight weeks after the surgery, as it can damage the area or the incision. The prosthesis does not affect orgasm, ejaculation or sensation. As with any other surgery, implanting a penile prosthesis brings a risk of infection, in which case the prosthesis will need to be removed. The average life-span of a penile prosthesis is eight to ten years. Once you have had a penile prosthesis inserted, be sure to always carry an identification card in your wallet that provides this information. There are two types of penile prosthesis:

Semi-rigid or malleable :

  • Least expensive
  • The length of the rods of the prosthesis are fitted in the operating room
  • Has no mechanical parts; cannot break
  • Provides a constant, firm erection which can be hard to conceal; the penis can be placed at different angles for comfort

Inflatable:

  • Comes in a two-piece or three-piece option
  • Provides the most natural-looking penis in both flaccid and erect states
  • After inflation, the glans or tip of the penis is not firm
  • Mechanical failure is a possibility

The three-piece inflatable cellpadding=”3″prosthesis (most common) consists of:

  • A pump placed next to the testicles in the scrotum
  • Two small hollow rods, one inserted into each corpus cavernosum of the penis (one on each side)
  • A reservoir, filled with a benign saline water solution, put in behind the pubic bone

Steps for use:

  • Squeeze the pump found in the scrotum; this triggers the saline water stored in the reservoir to flow into and fill the rods installed in the penis to create a firm erection.
  • After sexual intercourse, apply pressure on each side of the pump to return the saline water from the rods back into the reservoir.

Counselling

For those men or couples needing assistance to cope with erectile dysfunction, counselling through psychotherapy is available. This can also be used in combination with treatment recommended by your urologist. It can be very useful: psychotherapy can help you address the reactions that arise as a result of conditions like erectile dysfunction, and provide you with concrete strategies that equip you with hands-on approaches to help resolve conflicts that may emerge in your relationships with your loved ones – and those that love you.

It is very important not to attempt to try any of the above treatments for erectile dysfunction without first discussing your treatment options and what is best for you with your urologist. The above information is only intended to provide you with basic information and general guidance about what is available. You might have a condition that may prevent you from using any of the treatments described, which may put your overall health at risk. Have an open discussion with your urologist.


Fatigue : Cancer-Related Fatigue

The majority of people with cancer feel fatigue, especially those who have had surgery or are receiving radiotherapy and/or chemotherapy treatments. Fatigue can disrupt your sense of well-being, limit your activities and interfere with your relationships. It is often described as the symptom that causes the most distress and the one that lasts the longest.

What is fatigue?

Cancer-related fatigue is different from ordinary tiredness (the tiredness that healthy people sometimes feel). They are different in the following ways:

Cancer-Related Fatigue Ordinary Tiredness
Appears at any time, no matter what you are doing

Has a specific cause that you can identify
(example: staying up too late)

Does not go away with rest Goes away with rest
Lasts for a long time Does not last for a long time
Disrupts usual activities Does not disrupt usual activities

 

Characteristics of fatigue

Cancer-related fatigue can have an effect on the physical, emotional and mental aspects of daily life.

  • Physical: You feel weak. Your arms and legs feel heavy. Your sleep is disturbed. You have trouble completing your usual activities.
  • Emotional: You feel unmotivated. You have lost interest in your usual activities. You feel sad, frustrated or irritable.
  • Mental: You have difficulty concentrating. Your short-term memory is poor.

Patterns of fatigue

Patterns of fatigue depend on the type of treatment you are receiving.

  • Surgery-related fatigue: After any surgery, it is normal to feel tired or weak for several months. Energy levels will be worst right after surgery and will gradually pick up afterward.
  • Radiotherapy-related fatigue: Fatigue increases steadily from one treatment to the next. When the treatments are done, the fatigue will disappear but this may take several months.
  • Chemotherapy-related fatigue: Fatigue increases a few days after each treatment. It may decrease slightly before the next one but will not return to normal levels until several months after they are all finished.

What causes fatigue and how will I manage?

Fatigue is seldom caused by only one factor. It is usually caused by a combination of factors related to cancer or cancer treatments. Here are some of the causes of fatigue and how they can be managed:

Emotional distress

Studies suggest that 40% of cancer patients have significant depression or anxiety. Being depressed or anxious can rob you of energy.

How to manage:

It is normal to have periods of feeling “down” but if these persist for a long time, it is wise to speak with a healthcare professional. Sometimes just talking about your feelings is enough to help. In other cases, medications may help to relieve the distress.

Disturbed sleep

People with cancer have more trouble falling asleep and staying asleep than “healthy” people.

How to manage:

  • Try to go to sleep and wake up at the same time each day.
  • Take short naps (30 minutes) but avoid long, late afternoon naps.
  • Make sure that your bedroom is dark and quiet.
  • For several hours before bedtime, avoid alcohol, caffeine, exercise and eating.
  • If you wake up and can’t fall back to sleep, get up and do something quiet and boring until you feel tired again. While you are up, try not to watch the clock or turn on bright lights.
  • Speak with your healthcare professional about sleeping medications.

Poor Nutrition

People with cancer or cancer treatments often lose their appetite and may experience nausea, vomiting or diarrhea. Weight loss is a sign that you are not taking in enough energy to meet your body’s needs. When you are not taking in enough energy, you may feel fatigue.

How to manage:

  • Eat your meals at the same time each day
  • Eat smaller, more frequent meals (ie: six small meals per day)
  • Eat foods that are high in protein (chicken, fish, meat, dairy, peanut butter, eggs)
  • Drink plenty of fluids
  • Speak with your healthcare professional about seeing a dietitian
  • If you continue to experience a lack of appetite, ask your healthcare professional about appetite stimulants

Lack of Exercise

Many people believe that resting in bed will help them to recover faster from their cancer. This is not true. Prolonged bed rest has many dangerous effects on the human body including weakness, blood clots, depression, poor balance and fatigue. Low to moderate daily exercise is one of the most effective ways to manage fatigue.

How to manage:

  • Try low to moderate daily exercise (such as walking) balanced with periods of rest
  • If you have any of the following conditions, you are advised to see a physiotherapist before exercising: infection, cancer in your bones, low platelets, low red blood cells

Chronic Pain

Unrelieved pain is strongly associated with fatigue. Your body uses energy as it struggles to function through the pain.

How to manage:

  • Use pain medications as prescribed. It is very important to keep on top of the pain. The longer pain continues, the harder it is to treat.
  • If you continue to feel pain, speak with your healthcare professional. They may help you to find a more suitable pain medication or they may suggest some other ways to manage pain.

Medications

There are several medications which can cause fatigue. They include: blood pressure medications, opioids (morphine-based pain medications), anti-depressants, anti-nausea medications, antihistamines.

How to manage:

  • Ask your doctor if your medications cause fatigue. If so, your doctor may adjust the dose or choose another medication.

Other Medical Conditions

If not properly managed, other medical conditions can contribute to fatigue.

How to manage:

  • Please tell your healthcare professional about any previous health problems.

Anemia

Red blood cells are produced in your bone marrow. They carry oxygen to your body tissues. Because radiotherapy and chemotherapy can affect your bone marrow, they can slow the production of red blood cells. When fewer red blood cells are produced, it is called anemia. Studies suggest that 75% of people with radiotherapy or chemotherapy will have anemia. Anemia is a main cause of fatigue.

How to manage:

  • Ask your healthcare professional if you have anemia. If so, find out which of these ways to manage anemia is suitable for you:
  • Eating iron-rich foods or iron supplements
  • Blood transfusions
  • Erythropoietin: this is an injection that helps your body to produce more red blood cells

Other Body Processes

  • Healing: Your body uses energy to repair tissues that are damaged during treatment or surgery.
  • Chronic inflammation: when you have cancer or cancer treatments, your body can produce inflammatory molecules that may cause fatigue.
  • Disease progression: although there are many other causes of fatigue, fatigue can sometimes signify disease progression.

These causes of fatigue are difficult to reverse. It is important to learn how to conserve and manage the energy that you have.

How to manage:

Strategies for conserving your energy include:

  • Performing demanding activities at peak energy times
  • Balancing activities with periods of rest
  • Prioritizing
  • Delegating
  • Pacing yourself
  • Using labor-saving devices (raised toilet seat, electric can opener etc…)

Strategies for increasing your energy include:

  • Spending time in a natural environment (outdoors)
  • Doing things that you enjoy
  • Certain medications may increase your mental alertness. Ask your healthcare professional if these are appropriate for you.