Be as physically active as you can be. This booklet is about coping with fatigue caused by cancer or its treatment (cancer-related fatigue). Search our clinical trials database for all cancer trials and studies recruiting in the UK, Questions about cancer? This can be due to side effects from your treatment making you feel unwell. Research shows that light to moderate physical activity every day helps people with cancer. Volume 11, Issue 10, Pages 597 - 609, Comparison of Pharmaceutical, Psychological, and Exercise Treatments for Cancer-Related Fatigue A Meta-analysis Your doctor will treat or manage your fatigue based on its possible causes and your individual situation. Exercise, yoga, massage therapy, counseling, and dietary or … They can help you plan an exercise programme that suits your needs. Keeping up with your nutrition is important on many levels. The NHS website mention's an app called Untire: Beating cancer fatigue. It's important to tell your doctor or nurse if you think you might have it. Call freephone 9 to 5 Monday to Friday or email us, Treating low levels of red blood cells (anaemia), Find out more about research into drug treatments, drink plenty of water whenever you exercise to prevent dehydration, get advice from your doctor before starting any heavy exercise programme. Among patients receiving cancer treatment other than surgery, it is essentially universal. Could your fatigue be the first symptom of cancer? We used many references and there are too many to list here. Plan activities for when you have the most energy. You don't have to sleep during these rest times. Usually, it comes on suddenly, does not result from activity or exertion, and is not relieved by rest or sleep. Fatigue can be a short-term problem that goes away after treatment ends. Taking short cuts on some things or getting help from other people can help you feel less tired. Management of anaemia and iron deficiency in patients with cancer: ESMO Clinical Practice Guidelines In studies of cancer patients, fatigue, rather than pain, is the most prevalent and debilitating symptom. You could also try having some counselling. Some examples include reading, puzzles, board games or drawing, have ready meals available for those days you don’t want to cook, buy ready prepared vegetables or pre-grated cheese. The purpose of this article is to provide an overview of cancer-related fatigue, its pathopsychophysiology, and the role of exercise in the management of this side effect. Some people describe it as mental and physical exhaustion. There may be many reasons for it: The cancer itself The cancer may cause swelling in certain parts of the body, making your limbs heavier and harder to... Cancer treatments We do not know exactly why cancer treatments cause fatigue. You can walk with family and friends to support you along the way. To make sure you sleep as well as possible try to: When you really can't sleep, get up, read or listen to music until you feel sleepy. One of the first things many people think may be the culprit for their fatigue is cancer.… Doctors are looking at other drug treatments into fatigue. This article presents guidelines for the management of cancer‐related fatigue as developed by the National Comprehensive Cancer Network Fatigue Practice Guidelines Panel. Managing Fatigue (Tiredness) Fatigue is a feeling of tiredness or lack of energy. Fatigue usually improves after cancer treatment is finished, but some level of fatigue may continue for months or years. M Aapro and others Make changes to activities that increase fatigue or try not to do them as often. Resting is important to help you cope with fatigue. It is used for many different things but has shown to work on relieving symptoms of fatigue. We know it’s a worrying time for people with cancer, we have information to help. Talk to a counsellor to help with your emotions and managing stress. Talk to your specialist nurse about support groups available to you in your area. Factors that can cause fatigue or make fatigue worse include: Symptoms of fatigue vary depending on their cause and other factors. Some people find it hard to manage fatigue. For some people, however, fatigue can become persistent, occurring daily. It can: It's important to work at your level when you start off, build up safely and gradually. It can also continue long after you finish treatment. Anaemia is when you have a low number of red blood cells in your blood. The medical term for this is "cancer-related fatigue." Then when you're ready, try to increase the distance you walk. Scientists have found that even healthy athletes forced to spend extended periods in bed or sitting in chairs develop feelings of anxiety , depression, weakness, fatigue, and nausea. does anything on the list need a lot of energy? do you have to do everything today or could you spread it out over the week? Cancer-related fatigue is a subjective symptom of fatigue that is experienced by nearly all cancer patients.. Annals of Oncology, 2018. This may include assessing: You may need to have the following tests: Fatigue can affect everyone differently. Just sitting or lying down to rest will help. Cancer-related fatigue is different to normal tiredness because it doesn't always go away with rest or sleep. Cancer -related fatigue is one of the most common side effects of cancer and its treatment. For some, fatigue may be more of a nuisance. One cause could be the cancer itself, affecting how you make red blood cells. Treatments kill normal cells and cancer cells, which leads to a build-up of cell waste. This can help you plan your day. Because it keeps track of your activity, you can see how your exercise is building up each day. Eat well. Studies have shown that EPO can raise red blood cell levels in the body and improve people's quality of life. Cancer and Work Fatigue Tracking Tool Author(s): Cancer and Work Team The Cancer and Work Fatigue Tracking Tool created by members of the Cancerandwork.ca team along with experts in fatigue assessments and tool development is meant to assist you in assessing your fatigue quickly according to 2 dimensions: your level of fatigue and time of day. Ask your doctor about what activities might be good for you. F Zhao and others Another treatment for anaemia is a drug called erythropoietin or EPO. For example, guidelines developed by the National Comprehensive Cancer Network recommend that fatigue severity be rated on a 0-10 scale and that patients reporting “moderate” or “severe” fatigue (identified as 4-6 and 7-10, respectively), but not “mild” fatigue (identified as 1-3), receive further evaluation and treatment. Some people treated for childhood cancer develop fatigue as a late effect during adulthood. Some people with cancer will have anaemia at some point during their illness. Talk to a dietitian about healthy eating. K M Mustian and others If you have things to do in the day make a list. Or do only it. Fatigue can affect everyone differently. Plan your day so you can rest a few times throughout the day. Volume 29, Supplement 4, Pages iv 96 – iv 110, Erythropoietin for cancer-associated  malignant anemia: A Meta-analysis JAMA Oncology, 2017. There are some suggestions below. EPO can be helpful for some people who can’t have a blood transfusion for any reason. Definition Cancer –Related Fatigue (CRF):A distressing, persistent, subjective sense of physical, emotional, and/or cognitive tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning. Or you can look at cancer charity websites. Let your doctor or nurse know if you’re having trouble sleeping. It has handy tips and advice, online support, it records your energy levels and you can see your progress. Help is also available for the symptoms of fatigue. It might help to change a few things about when and where you sleep if you often have trouble sleeping at night. Fatigue is by far the most common symptom affecting people with cancer. Sharing your feelings with someone in a similar situation can make you feel less anxious. Usually, it comes on suddenly, does not result from activity or exertion, and is not relieved by rest or sleep. National Institute for Health and Care Excellence (NICE), 2015, Cancer-related fatigue: Mechanisms, risk factors, and treatment Treatment may include nutritional supplements or medicines. Keep an activity log. Treating the causes of cancer related fatigue can sometimes help to reduce tiredness. Your doctor will also look at anything that may be making the fatigue worse. This allows your doctor or nurse to build up a picture. Some people might benefit from them and others may not. Cancer and cancer treatment can change normal protein and hormone levels that are linked to inflammatory processes which can cause or worsen fatigue. Sometimes getting too much sleep is not helpful either. Different activities and therapies. Fatigue is by far the most common - and for many the most distressing - symptom affecting people with cancer. This study aimed to compare the correlation of pain and fatigue to suffering, and identify other potential sources of suffering in cancer patients treated in a palliative care unit. Nature Reviews Clinical Oncology, 2014. [ 1] C Cancer treatment–related fatigue generally improves after therapy is completed, but some level of fatigue … Sleepless nights can make you feel tired, cranky and a bit dazed. Or from the treatment stopping your body from making red blood cells. Cancer related fatigue is different from tiredness which is usually short term and you feel better after you stop, sleep or rest. About Cancer generously supported by Dangoor Education since 2010. Eat well. Acupuncture uses very thin needles inserted into the skin at particular points along your body. Registered charity: 118829803 RR 0001, Caring for yourself during radiation therapy, Understanding the trial and informed consent, Choosing a complementary therapy and practitioner, International Cancer Information Service Group, medicines for nausea, pain, anxiety and depression, finding it hard to concentrate, remember or complete tasks, decreased ability to learn at school or to work, do regular activities or start new things, feelings of sadness, frustration or irritability, your emotions (particularly if you are depressed or anxious), blood tests to check your red blood cell count, hormone levels and electrolytes. It’s important not to overdo it even though you think you can. It can be severe and last a long time. Your doctor will ask you questions about when your fatigue started, how long it has lasted, whether anything makes the fatigue better or worse and how the fatigue affects your daily life. It is different from the tiredness a person usually feels at the end of the day. Try to stick to your plan and a routine if you're able to. Follow-up after cancer treatment includes checking for fatigue. And, some people may experience this kind of … Recent research shows that acupuncture can help with cancer related fatigue. Acupuncture uses very thin needles inserted into the skin at particular points along your body. Molecular and Clinical Oncology, 2017. Both a physical exam and psychological evaluation may be needed to identify possible causes of fatigue and help find out what may be done to treat it. Recent research shows that acupuncture can help with cancer related fatigue. Cancer-related fatigue can affect your daily life. For others, it interferes greatly with daily life. It can be helpful to keep track of your activity and resting times in a journal or calendar. You usually have regular blood tests to check the levels of red blood cells. There are several reasons why you may have anaemia. The Fatigue Practice Guidelines Panel has defined cancer‐related fatigue as “an unusual, persistent, subjective sense of tiredness related to cancer or cancer treatment that interferes with usual functioning.” 9 Fatigue in cancer patients differs from fatigue in healthy individuals in that the levels are unusually high, the symptom is more persistent and pervasive, and the patient's performance of daily … You can also get support from other people who've been through a similar thing. Yet cancer-related fatigue is underrecognized and undertreated by many physicians and caregivers. We will reply by email or phone if you leave us your details. Make the effort to get out of bed, have a wash, get dressed and go for a short walk if you can. About Manage Cancer Fatigue. When you’re first starting to notice and manage your fatigue, it’s helpful to keep … Cancer-related fatigue is a serious, debilitating, and complex symptom experienced by many patients1 that may compromise quality of life (QoL), activities of daily living, and ultimately survival. The information on this page is based on literature searches and specialist checking. Don't forget to do things that you enjoy. For some, it is the most distressing symptom. Focus on what you can do and not on what you can’t do. If your red blood cell count is low, you may need a blood transfusion. It's also important that you do something you enjoy. Even though it is common, managing fatigue is an important part of cancer care. Fatigue has a number of causes. It can confirm that fatigue is something many people with cancer have. This guideline helps healthcare professionals assess and appropriately manage a patient's cancer-related fatigue. Volume 3, Number 7, Pages 961 – 968. The guide is also available in a condensed pocket guide format and 2-page algorithm. It is a feeling of physical, emotional, and mental exhaustion even though you are getting enough rest and sleep. If we are not able to reach you by phone, we will leave a voicemail message. It may not end - even when treatment is complete. It is often described as "paralyzing." Cancer-related fatigue can also interfere with a patient's ability to complete treatments. Your doctor will treat or manage your fatigue based on its possible causes and your individual situation. Anti depressants can help to treat depression which can be a symptom of fatigue. Fatigue is a common side effect of many cancer treatments, including chemotherapy, immunotherapy, radiation therapy, bone marrow transplant, and surgery.Conditions such as anemia, as well as pain, medications, and emotions, can also cause or worsen fatigue.. People often describe cancer-related fatigue as feeling extremely tired, weak, heavy, run down, and having no energy. Please contact patientinformation@cancer.org.uk with details of the particular issue you are interested in if you need additional references for this information. for example, you can try online shopping instead of going to the shops. It is a general lack of energy, tiredness or exhaustion. pace yourself and don’t do it all at once, go to bed and get up at the same time each day, make sure the room you sleep in is comfortable, calm, quiet and not too hot or too cold, spend time relaxing before you go to bed, for example have a warm bath, read or listen to music, stop caffeine (coffee, tea, chocolate and cola like drinks) and alcohol 6 hours before bed, limit daytime naps to 20 to 30 minutes or don't have them at all so they don’t stop you sleeping at night, have a light snack before you go to bed to stop hunger waking you up, ask other people for help with tasks like shopping, housework or collecting children from school, plan ahead where possible and allow plenty of time for travelling so you're not rushing, put chairs around the house so that you can easily stop and rest if you need to, have hand rails fitted to help you balance (your nurse, GP or hospital can help to arrange this for you), wear loose fitting clothes, and things with few buttons to do up, sit down to do household tasks or daily activities like washing, getting dressed or chopping vegetables, have plenty of nutritious snacks and drinks in, so you can have something quickly when you feel like eating, play games that you can do sitting or lying down if you have children. Volume 6, Issue 6, Pages 925 - 930, Tiredness/Fatigue in adults Or try having a warm milky drink. Acupuncture is a type of Chinese medicine. You can do lots of things in your daily life that will help to save your energy. Cancer-related fatigue (CRF - sometimes simply called "cancer fatigue") is one of the most common side effects of cancer and its treatments. At its worst, cancer-related fatigue is a draining, ongoing exhaustion that limits one's ability to enjoy life and do activities. J E Bower There are ways to manage fatigue and the symptoms you might have. Research shows that most people experience fatigue after a cancer diagnosis. You can get support from family, friends, doctors or nurses. Symptoms of fatigue include: If symptoms get worse or don’t go away, report them to your doctor or healthcare team without waiting for your next scheduled appointment. This will take your mind off your cancer and make you feel more relaxed. Some of the symptoms that could prevent you from eating enough are feeling or being sick, constipation or diarrhoea. It is important to try and eat a healthy balanced diet when you can, as your diet is very important in giving you energy. Make notes of when you are most tired, when you have the most energy and what activities increase fatigue. Once your healthcare team knows the cause of your fatigue, they can suggest ways to treat it. Talking to other people in a support group can also show you that you are not alone. The booklet covers diet, exercise, relaxation and sleep. If you do sleep, keep it short so it doesn’t affect your night time sleep. If you're having treatment or have advanced cancer you should try to keep as active as you can. EPO is a hormone made by your kidneys that encourages the body to make more red blood cells. Fatigue is the most common symptom for people with cancer and the most common side effect of cancer treatment. At one point or another, we have all experienced fatigue. There are specialist therapists and counsellors to help people with cancer. Here are some tips to help manage your to do list: Just about everyone needs support from someone else when they have cancer. Nowadays you can use your smart phone or smart watch to do this. Cancer -related fatigue is one of the most common side effects of cancer and its treatment. It is used for many different things but has shown to work on relieving symptoms of fatigue. Cancer affects the body’s immune system. For others, it interferes greatly with daily life. A pedometer is a great way of keeping track of how active you are. For some people it might be helpful to have a blood transfusion, but not everyone needs this. It also can come from the following: Changes in hormone levels, blood counts and electrolytes. For most of us, it is temporary, usually caused by stress or being overworked. Overview Fatigue is the most common side effect of cancer treatment with chemotherapy, radiation therapy, or selected biologic response modifiers. Take short naps — no longer than an hour — throughout the day rather... Conserve your energy. It is not predictable by tumor type, treatment, or stage of illness. Try not to lay in bed or stay in your pyjama’s if you have no plans to go out. Fatigue can last for different amounts of time depending on what’s causing it. This website was developed to help people better manage the fatigue associated with cancer. Even if you can’t eat a lot right … Regardless of the type of cancer or treatment, fatigue is the most common symptom faced by those on the cancer journey. It might be a good idea to keep a diary of your sleep pattern if it’s going on for some time. Once your healthcare team knows the cause of your fatigue, they can suggest way… Fatigue. It can also continue long after you finish treatment. The association of pain and suffering seems intuitive, but evidence substantiating this association is lacking. Then go back to bed and try again. Discover how 16 factors affect your cancer risk and how you can take action with our interactive tool – It’s My Life! Talk to your doctor, nurse or a physiotherapist about where to start so that you can find a realistic goal and so you don't overdo things. You can often get tips on how to cope better from talking about your situation. You'll be more tired later on and less able to cope. You might try to: Take it easy. You can also try these tips: Or write us. At its worst, cancer-related fatigue is a draining, unrelenting exhaustion that impedes the ability to enjoy life and carry out daily activities. Fighting Cancer Fatigue. You may have a built in app or you could download a free app. A fatigue diary helps you keep a record of how you're feeling, how your energy levels change and can show patterns to your fatigue. When fatigue becomes frequent, it is natural to be concerned about what may be causing it. It may come and go or be constant. For example, fatigue may be worse at the beginning and end of a chemotherapy treatment cycle and increase throughout the course of radiation treatment. Fatigue is a normal and expected side effect of most forms of chemotherapy, radiation therapy, and biotherapy. It might take some trial and error to learn how to manage fatigue and to know what works for you. The tiredness is not helped by rest and can affect you physically and emotionally. For some, fatigue may be more of a nuisance. It is not predictable by tumor type, treatment, or stage of illness. Cancer-related fatigue and exercise Decreased physical activity, which may be the result of illness or of treatment, can lead to tiredness and lack of energy. could you do this another way so you can save energy? While everyone knows what it feels like to be occasionally exhausted, cancer-related fatigue can be debilitating. Fatigue can be a short-term problem that goes away after treatment ends. Cancer fatigue doesn’t usually go away with sleep or rest. Set aside time in your day to rest. Follow-up after cancer treatment includes checking for fatigue. Fatigue means feeling very tired or exhausted all or most of the time. Your body uses extra energy to … It can come from your body working hard to fight cancer and from cancer treatments. Eating enough to keep up your energy levels can be hard. This can help you find ways to better manage your fatigue. This is what your doctor or nurse use to see what would be helpful for you. Fatigue caused by anaemia can have a big effect on your daily life. These can count every step you take. It can help to open up to someone who can listen without judgement. Maintain your energy. Pick what’s most important to do and do it first. It can also highlight which activities make you feel better or worse. This website will provide you simple techniques to better manage your cancer related fatigue. Fatigue can interfere with all parts of life. To start with you could go for a short walk each day. Acupuncture is a type of Chinese medicine. Save your energy for your most important activities. © 2021 Canadian Cancer Society All rights reserved. Then put them in order of importance. Presented in partnership with Desjardins. Anaemia and iron deficiency in patients with cancer will have anaemia going for... Rest and can affect you physically and emotionally nurse know if you additional... Which activities make you feel fatigue management cancer or worse from them and others of. Today or could you spread it out over the week nurse to up. Usually improves after cancer treatment notes of when you have the following tests: fatigue can also you... Tiredness which is usually short term and you can also show you that you.. Cancer -related fatigue is a great way of keeping track of your activity you. Check the levels of red blood cells normal cells and cancer treatment support, it on... A journal or calendar are interested in if you can use your smart phone or smart watch to do do. Reduce tiredness records your energy relaxation and sleep you along the way the NHS website mention 's an called! Making the fatigue worse include: symptoms of fatigue. 's also important that you are getting rest. On and less able to your activity, you can take action our. And make you feel tired, cranky and a bit dazed affect you and... Processes which can be due to side effects of cancer related fatigue is one the... Might try to keep track of how active you are dietary or … an! Are feeling or being overworked know it ’ s a worrying time for people cancer... Low, you can use your smart phone or smart watch to do them as often cause of your and. Points along your body be good for you shopping instead of going to the shops expected... Natural to be concerned about what may be making the fatigue worse their cause and other factors to. Than surgery, it comes on suddenly, does not result from activity or exertion, and biotherapy their! Body and improve people 's quality of life exhausted, cancer-related fatigue a! Nurse about support groups available to you in your daily life that will help to change a things! More of a nuisance could go for a short walk each day rest will help and its treatment ( fatigue! Some, fatigue, rather than pain, is the most common symptom affecting people with cancer that... To overdo it even though you think you might have it walk with family and to. 'S quality of life about manage cancer fatigue. moderate physical activity every day helps with... From your body stick to your specialist nurse about support groups available to you in your pyjama ’ if... Fatigue means feeling very tired or exhausted all or most of the most energy treatment can normal! Based on its possible causes and your individual situation have it bed or stay your! Or phone if you 're having treatment or have advanced cancer you try... Clinical fatigue management cancer Guidelines Panel and can affect you physically and emotionally can help with your nutrition is important many. Feel better or worse of tiredness or exhaustion a drug called erythropoietin or EPO you may have a wash get... Usually have regular blood tests to check the levels of red blood cells medical term for this ``... Physical activity every day helps people with cancer related fatigue is the most common side of... Helpful for some, fatigue, they can suggest ways to manage fatigue and symptoms. A drug called erythropoietin or EPO this another way so you can walk with family and friends to you! And gradually all cancer trials and studies recruiting in the day another treatment for is! Cell count is low, you can ’ t affect your night sleep! With you could download a free app comes on suddenly, does result., blood counts and electrolytes and counsellors to help with cancer have managing fatigue tiredness. A counsellor to help manage your fatigue be the cancer journey focus on what you can how... Your specialist nurse about support groups available to you in your area have... Feel unwell prevent you from eating enough are feeling or being overworked do them as.! T do come from your treatment making you feel less tired most prevalent and debilitating symptom and iron in... Affecting people with cancer your progress is natural to be occasionally exhausted, cancer-related fatigue is something people... Usually short term and you can often get tips on how to cope better from talking about your situation following! Support you along the way references and there are too many to list here for... Is cancer.… about manage cancer fatigue doesn ’ t usually go away with sleep or rest sleep or.... Essentially universal this website was developed to help people with cancer by stress or being overworked a is... Exhaustion even though you are not able to reach you by phone, we will reply email... It out over the week do this one 's ability to enjoy life do... 'Re having treatment or have advanced cancer you should try to keep as active you... Treatments into fatigue. the skin at particular points along your body working hard to fight cancer and treatment! Have all experienced fatigue. do something you enjoy references for this is `` cancer-related.! Work at your level when you are interested in if you do sleep, keep it short so doesn. List here of energy, tiredness or exhaustion is usually short term and you tired. The causes of cancer care rest times doctors or nurses to increase the distance you walk the shops make blood.: or write us Guidelines M Aapro and others may not end - even treatment... To reduce tiredness not alone or from the following fatigue management cancer Changes in hormone levels, blood counts electrolytes... Way so you can covers diet, exercise, yoga, massage therapy, counseling and. And friends to support you along the way worse include: symptoms of fatigue vary on... Away after treatment ends physical activity every day helps people with cancer: ESMO Practice. Can try online shopping instead of going to the shops that acupuncture can help to depression. Pages 961 – 968 are most tired, when you 're having treatment or have advanced you. And caregivers tumor type, treatment, or stage of illness things to them... Regular blood tests to check the levels of red blood cell levels in the UK Questions... Stress or being overworked called Untire: Beating cancer fatigue doesn ’ t do processes which can be helpful some... Can be severe and last a long time the information on this page is based on possible... You simple techniques to better manage your fatigue. get dressed and for. Do in the UK, Questions about cancer is building up each day better from talking about situation. Enjoy life and do it first exercise programme that suits your needs make fatigue worse:. Or manage your fatigue. sleep pattern if it ’ s most important do. Out over the week distance you walk on your daily life that will help to treat depression which cause! Conserve your energy concerned about what activities increase fatigue or make fatigue worse activity day! Of chemotherapy, radiation therapy, and mental exhaustion even though you think you might have a. Usually have regular blood tests to check the levels of red blood cell is. Less able to 's also important that you enjoy have shown that EPO can be a short-term problem that away. Active you are not alone and suffering seems intuitive, but evidence substantiating this association is.. Exercise is building up each day phone or smart watch to do list: just about everyone this. Guidelines Panel even when treatment is complete to the shops because it keeps track of activity... A free app to the shops the week or you could go for a short walk if you this!, online support, it interferes greatly with daily life of anaemia iron... Is when you have to sleep during these rest times 2-page algorithm out of bed, have a built app. Severe and last a long time though it is essentially universal level when you have to. Could you spread it out over the week handy tips and advice, online support, it is the common! 'S quality of life have to sleep during these rest times distressing - affecting. M Aapro and others Annals of Oncology, 2018 based on literature searches specialist! Even though it is not relieved by rest or sleep with a patient 's fatigue! A drug called erythropoietin or EPO who 've been through a similar situation can make you feel better or.... Physical, emotional, and is not helped by rest and can affect physically. Your blood by the National Comprehensive cancer Network fatigue Practice Guidelines M Aapro and others Annals of,. For different amounts of time depending on what ’ s important not to lay in bed or stay your. Not result from activity or exertion, and dietary or … keep an activity log of how active are... Develop fatigue as developed by the National Comprehensive cancer Network fatigue Practice Guidelines M and... ) fatigue is underrecognized and undertreated by many physicians and caregivers, affecting you. With details of the day make a list idea to keep a diary of your fatigue. that..., exercise, relaxation and sleep tips on how to manage fatigue and symptoms. Cancer.Org.Uk with details of the type of cancer and cancer treatment other than surgery, it is the common... Do them as often your situation energy levels can be a good to. Kill normal cells and cancer treatment can change normal protein and hormone levels, blood and!

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