After Chemotherapy, Fatigue May Contribute More to Balance Problems Than Neuropathy

After Chemotherapy, Fatigue May Contribute More to Balance Problems Than Neuropathy

After receiving chemotherapy for breast cancer, women who had more severe, persistent fatigue were more likely to have balance problems, whether they had peripheral neuropathy or not.
Aug 26, 2022.

After receiving chemotherapy for breast cancer, women who had more severe fatigue were more likely to have balance problems, whether they had peripheral neuropathy or not, according to a small study.

The research was published in the June 28, 2022, issue of the journal Rehabilitation Oncology. Read “Persistent Cancer-Related Fatigue After Breast Cancer Treatment Predicts Postural Sway and Postexertional Changes in Sit-to-Stand Strategy.”


About cancer fatigue

Also called cancer-related fatigue by doctors, cancer fatigue is the most common side effect of cancer treatment. According to the American Cancer Society, between 80% and 100% of people diagnosed with cancer report having fatigue.

Cancer fatigue makes you feel tired all the time. Getting a good night’s sleep doesn’t help.

A number of factors can cause cancer fatigue, including breast cancer itself, as well as treatments such as chemotherapy and targeted therapies and side effects such as pain, nausea, and diarrhea. Fatigue from breast cancer and breast cancer treatment can last for weeks, months, or years and may continue after you finish treatment.


About balance problems

Balance problems are another common side effect that can affect people after breast cancer treatment. Many people can’t physically move in the same way they did before treatment and also have problems with walking and balance — all of which increases their risk of falling.


About neuropathy

Neuropathy is the general term for pain or discomfort caused by damage to the nerves of the peripheral nervous system. Your peripheral nervous system is made up of many nerves that carry signals from the brain and spinal cord to other — or peripheral — parts of the body, such as the hands and feet. Damage to those nerves can affect the way the body sends signals to muscles, joints, skin, and internal organs. This can cause pain, tingling, numbness, and other symptoms.

For people who’ve received breast cancer treatment, chemotherapy is the most common cause of neuropathy — often referred to as chemotherapy-associated or chemotherapy-induced peripheral neuropathy.

Previous research has suggested that neuropathy caused by chemotherapy is the main cause of balance issues and other physical problems among women diagnosed with breast cancer.


About the study

In this study, the researchers wanted to look specifically at how fatigue may influence balance issues in women diagnosed with breast cancer — which few, if any, studies have focused on before.

This small study included 43 women ages 30 to 85 who had been diagnosed with stage I to stage III breast cancer. All the women had completed chemotherapy treatment at least one year before joining the study. On average, the women completed chemotherapy 3.5 years before joining the study. Of all the women who participated in the study:

  • 90.6% were white

  • 4.7% were Black

  • 4.7% were Asian

  • 30.2% received only chemotherapy

  • 69.8% received chemotherapy and radiation

  • 65% took hormonal therapy

  • 30.2% had lumpectomy

  • 39.6% had single mastectomy

  • 30.2% had double mastectomy

The researchers performed standard physical function testing on all the women. These tests included balancing on one leg and repeatedly moving from sitting to standing position, as well as balancing after doing exercises that would tire out their legs and feet. The researchers also measured how much the women swayed (if at all) after each test. The amount of swaying indicated the severity of balance issues a woman had.

The sit-to-stand test is an important way to measure physical function and can predict how likely a person is to fall.

The researchers:

  • asked the women to fill out a standard survey asking if they had fatigue and, if so, how severe it was

  • used a standard tool to see if the women had neuropathy and, if so, how severe it was

  • asked the women how much physical activity they did each week and how intense it was

Fatigue scores ranged from 0 to 100; the average score was 43.15. About 54% of the women had neuropathy in their feet. On a scale of 1 to 6, the average severity of the neuropathy was 2.3.

Overall, the women did an average of 16 hours of physical activity a week and averaged 7.4 hours of moderate-intensity activity a week.

The researchers found that the greater the level of a woman’s fatigue, the more likely she was to sway from front to back while standing.

After adjusting for other factors, the researchers calculated that fatigue accounted for about 10% of the swaying; neuropathy accounted for about 1%.

Women with more severe fatigue also were more likely to sway after doing the exercises to tire out their legs and feet. Fatigue accounted for nearly 7% of the swaying; neuropathy accounted for about 3%.

“Our results…indicate that [cancer-related fatigue], even several years following exposure to chemotherapy, may distinctly influence balance independent of a patient’s [chemotherapy-induced peripheral neuropathy] status,” the researchers wrote. “This finding is important since persistent [cancer-related fatigue] affects up to 30% of individuals well beyond one year following completion of primary cancer treatment.”


What this means for you

Although the results of this study are concerning, they’re also important for anyone who has received chemotherapy for breast cancer.

You may have balance issues if you’re experiencing fatigue related to treatment, even if you don’t have neuropathy. Also, if you do a task that is likely to tire out your legs and feet, such as climbing stairs or walking for longer distances than usual, you may have even worse balance.

But it’s important to know there are steps you can take to improve your balance, as well as ease fatigue.

Exercise, acupuncture, and yoga all can help ease fatigue. You also may want to consider working with a physical therapist or trainer, explaining that you have fatigue related to breast cancer treatment and are looking for exercises that aim to improve your balance.

If the fatigue is related to pain or low red blood cell counts (anemia), your doctor can prescribe medicines to help.

Learn more about Cancer Fatigue.

Written by: Jamie DePolo, senior editor

— Last updated on September 20, 2022, 9:28 PM

Reviewed by 1 medical adviser
Brian Wojciechowski, MD
Crozer Health System, Philadelphia area, PA
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