Combating Radiation Fatigue
- Actress Danielle Fishel, 43, is making progress in her breast cancer journey after sharing her ductal carcinoma in situ (DCIS), or stage zero, diagnosis in August, but the mom of two says she has been suffering from some uncomfortable side effects after 20 rounds of radiation.
- Every person’s pain tolerance and experience is different, but there are certain things you can do to help reduce the discomfort, like proper hydration and exercise/stretching, which is Fishel’s plan going forward, remaining optimistic that her symptoms will likely improve very soon.
- According to SurvivorNet’s medical experts: “The more physically fit you are going through your cancer treatment, the less side effects you’ll have and the faster you’ll get back to your normal quality of life.” Of course, don’t push yourself, and always listen to your body.
Every person’s pain tolerance and experience is different, but there are certain things you can do to help reduce the discomfort, like proper hydration and exercise/stretching, which is Fishel’s plan going forward, remaining optimistic that her symptoms will likely improve very soon. In the meantime, she’s not sugar-coating the situation.
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“Physically, I have a very sunborn,” she added. “I also have a rash on top of the sunburn, which is just great. It’s very itchy, and also, you can’t itch it, because if you come close to touching it, you wanna cry — hurts to wear a bra, hurts to not wear a bra. It just hurts to sleep on my side, hurts to sleep. period. Hurts to be awake.”
But Fishel knows it will get better very soon. Her doctors told her two to three months. “It’s not gonna last forever. Physically, every day now, I’m supposed to be getting better. Fatigue-wise, I’m really stinking tired.”
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Fishel also shared some other important advice her doctors gave. “If I wanna feel better faster, I need to work out and drink water,” she said, noting that she is starting a workout plan on Friday, aiming to hydrate herself as much as possible to help her body “get rid of all the damage that radiation did.”
‘There Is No Easy Cancer’
Though she is grateful to have been diagnosed at the earliest stage of breast cancer, Fishel recently reiterated something else she found very important that her doctor shared, which is “there is no easy cancer,” she told Good Morning America in a sit-down that aired in October. “And I get it now.”
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As far as Fishel’s treatment past her lumpectomy surgery, the decision was hers on whether or not to have radiation, and she went forward with the 20 rounds to be on the cautious side. Elsewhere in Sunday’s podcast, Fishel added that she will also be starting the hormone therapy Tamoxifen now that her radiation is complete.
“They didn’t wanna overload me with negative side effects.”
Stage Zero Breast Cancer
Stage zero breast cancer, as mentioned, refers to ductal carcinoma in situ (DCIS). DCIS are abnormal cells that line the duct in a breast. A normal breast is made up of lots of ducts (these ducts carry milk to the nipple in a woman who is lactating).
DCIS is not an invasive cancer, meaning it hasn’t spread outside the milk duct and it cannot invade other parts of the breast. In some instances, if left untreated, doctors believe that DCIS can evolve into a more invasive breast cancer. This is why historically, the standard treatment for DCIS is to remove it surgically and in some instances offer radiation as well.
However, many doctors aren’t sure if even that is necessary for DCIS, because it may or may not turn into cancer. And in an effort to reduce the fear around the earliest stage breast cancer we want you to understand the definition and the debate around treatment.
Two important facts about DCIS breast cancer are:
- It doesn’t spread to other parts of the body.
- The risk of death is essentially zero.
RELATED: Why Active Surveillance is Being Studied for Stage Zero Breast Cancer
As for the debate, some doctors don’t consider it cancer, but rather a collection of abnormal cells or a pre-cancer, which is why some women opt for a watch-and-wait approach.
Others may recommend the surgery route which usually involves a lumpectomy and potentially radiation as well. This somewhat more aggressive treatment (which is the standard protocol at major cancer centers) does have side effects, and potentially, long-term effects.
The Debates Around Radiation for Breast Cancer
The purpose of radiation is to kill cancer cells in a targeted way.
With breast cancer, it is often used after surgery to kill off any cancer cells that may remain in the breast or surrounding area. But there are three main areas of debate about radiation all with the focus of reducing side effects while maximizing outcomes, says Dr. Chirag Shah, Director of Breast Radiation Oncology at the Cleveland Clinic Cancer Center.
There’s the question of whether to radiate the whole breast versus partial breast radiation, there’s debate about whether some patients even need radiation at all, and there’s debate about which radiation techniques offer the best outcomes with the least side effects.
“We often believe that more treatment is better treatment,” Dr. Shah previously told SurvivorNet. “But I would say that, when it comes to radiation therapy to the breast, what we’re learning is that shorter courses of radiation, like short course whole breast, may be associated with equal clinical outcomes and even the potential for reduced side effects.”
Dr. Chirag Shah discusses breast cancer radiation with SurvivorNet
“I think that the three major debates at this time focus on, really, maximizing outcomes and reducing side effects,” Dr. Shah continued. “But I think the first debate that we have is whole breast radiation versus partial breast radiation and the idea of reducing duration of treatment and reducing side effects for patients, albeit with less than 10 years’ worth of long term data.”
“The second major controversy is finding patients for whom radiation is no longer needed and really trying to find a group of patients who don’t benefit from radiation — omitting radiation is therefore associated with a lower risk of side effects for patients. And so that’s very important.”
“The final real controversy,” he added, “is techniques in radiation and trying to devise the best techniques to maximize outcomes and reduce side effects. And that includes cosmetic outcomes, as well as lung and heart side effects.”
Understanding Radiation Fatigue
Radiation therapy, in general, can affect the heart when given to breast cancer patients.
“When the radiation is delivered, unfortunately, the heart happens to be somewhere very near to where they have their breast cancer and it becomes an innocent bystander absorbing some of the radiation,” Dr. Jean-Bernard Durand previously told SurvivorNet. “Shortness of breath, fatigue, development of heart failure. So, we make it a point to see them on a regular basis so that we can catch these things very early and treat them.”
The side effects might not even appear for “as much as 10 to 20 years after exposure” making consistent check ups all the more important. And even though proton therapy minimizes damage to healthy cells, recipients still can still see side effects like fatigue.
“Radiation is a form of energy. A form of energy that, when we give radiation, has an ability to what we call ‘scatter,'” Dr. Durand said. “Even though we may target, one particular area, that ‘scattering’ of energy of protons, of radiation, can cause injury to the local surrounding structures including the heart. In response to injury, there can be swelling and, unfortunately, there can be the development of scar tissue.”
The scar tissue, Dr. Durand says, is what often causes problems.
“This scar tissue that develops within the heart’s electrical system, within the blood supply, within the muscle,” he explained. “We believe is what causes all the injury, that ultimately leads to the symptoms.”
Exercise & Cancer
Radiation fatigue, along with other cancer treatment side effects, can potentially be mitigated by exercise. In fact, MD Anderson Cancer Center says it’s important to keep exercise during cancer treatment “in most cases.” Carol Harrison, a senior exercise physiologist, from the cancer center believes “exercise has the potential to help reduce some of the fatigue experienced during and after treatment, especially if you’re undergoing radiation therapy.”
Dr. Sairah Ahmed, associate professor in the Division of Cancer Medicine at the University of Texas MD Anderson Cancer Center, also commented on the benefits of exercise, wanting the SurvivorNet community to know that being in good shape during your cancer battle is very beneficial.
Guidelines for diet and fitness for patients undergoing treatment
“I think that, in terms of cancer, oftentimes patients feel that they don’t have any control over any part of their life, and that’s not true,” Ahmed told SurvivorNet in an earlier interview.
“The more physically fit you are going through your cancer treatment, the less side effects you’ll have and the faster you’ll get back to your normal quality of life.”
According to the National Cancer Institute, physical activity is beneficial for cancer survivors. The NCI cited findings from a report of the 2018 American College of Sports Medicine International Multidisciplinary Roundtable on physical activity and cancer prevention and control in saying that exercise is generally good for cancer survivors. The roundtable also found:
- Strong evidence that moderate-intensity aerobic training and/or resistance exercise during and after cancer treatment can reduce anxiety, depressive symptoms and fatigue and improve health-related quality of life and physical function.
- Strong evidence that exercise training is safe in persons who have or might develop breast-cancer-related lymphedema.
Some evidence that exercise is beneficial for bone health and sleep quality. - Insufficient evidence that physical activity can help prevent cardiotoxicity or chemotherapy-induced peripheral neuropathy or improve cognitive function, falls, nausea, pain, sexual function or treatment tolerance.
Questions for Your Doctor
If you have been diagnosed with breast cancer, you may have questions about keeping your strength through treatment. Here are a few questions to help you begin the conversation with your doctor:
- What treatment will I be receiving?
- What side effects are associated with this treatment?
- Are there steps I can take daily to help minimize these side effects?
- What physical activity routine do you recommend for me during treatment?
- Do you have recommendations for someone who doesn’t particularly enjoy exercise?
- Can you recommend a dietician who can help me with healthy eating tips and weight maintenance?
- I’ve been having trouble sleeping. Do you have any treatment recommendations?
Contributing by SurvivorNet staff.
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