Treatment side effects

It can take time to get over the side effects of treatment. Side effects vary depending on the type of cancer you had, its stage and the treatment you were given. The changes can be both physical and emotional.

Some problems resolve quickly; others can take weeks, months or even years to improve. Your body will cope with the treatment and recovery in its own way. It is best not to compare yourself to others.

Common side effects include:

For some people there may be permanent or late side effects. Late effects are problems that develop a long time after treatment finishes. If you are concerned about a new side effect, talk to your doctor.

It can be difficult to deal with any change in how your body looks, feels or functions. Other people may not understand how much these changes affect your day-to-day living, especially if it has been a few months or years since your treatment has finished. This can be frustrating and make it harder to cope with the side effects.

Fatigue

Fatigue, or feeling exhausted and lacking energy for day-to-day activities, is the most common side effect of cancer treatment. It can be caused by the physical and emotional effects of diagnosis and treatment. Fatigue differs from normal tiredness as it often doesn’t go away with rest or sleep.

Now that treatment is over, you may think you should be full of energy, but this often isn’t the case. Many survivors say that fatigue has a big impact on their quality of life in the first year after treatment.

Most people get their energy back 6-12 months after treatment. However, some people lack energy for years after treatment and their energy levels may never fully recover.

Many survivors worry fatigue is a sign that the cancer has come back or that it never really went away. This is usually not true.

Symptoms of fatigue

People living with cancer have described fatigue as overwhelming, unbelievable, debilitating and frustrating. Symptoms include:

  • a lack of energy – you may want to stay in bed all day
  • difficulty sleeping (insomnia)
  • finding it hard to get up in the morning
  • feeling anxious or depressed, particularly if fatigue persists
  • muscle pain – you may find it hard to walk or climb stairs
  • feeling breathless after light activity, such as having a shower or making the bed
  • difficulty concentrating, even watching TV or talking to someone
  • finding it hard to think clearly or make decisions easily
  • little or no interest in sex (low libido).

You may worry that your friends or family won’t believe you or think that you are complaining too much if you keep saying how tired you feel. They may not appreciate the long-term effects of fatigue. It’s common for relationships to change if people feel misunderstood. Talking to family and friends about how you feel may help them to understand.

Fatigue and its symptoms may also sometimes be signs of depression. If you have a persistent low mood, talk to your doctor. Treating depression may help you feel less tired and give you more energy.

Managing fatigue

Many cancer survivors don’t tell their doctor about fatigue because they think that nothing can be done about it. However, there may be things that your treatment team can suggest that might help.

For example, if your fatigue is caused by low red blood cells or the side effects of drugs, your doctor may be able to treat the cause.

For some people, fatigue is linked to low moods or depression, which can be treated separately.

The tips below may help you. These suggestions might not work for everyone, but you may find that small changes make you feel better. Talk to your health professionals for more suggestions.

  • Set small, manageable goals. Focus on doing a little bit each day rather than a lot in one go.
  • Ask for help. Get a friend to help with school pick-ups, shopping or running errands.
  • Plan your day so you can do the activities that are most important to you at the time of day when you have the most energy.
  • Take rest breaks between activities.
  • Do things slowly so that you don’t use too much energy as you go. Leave plenty of time to get to appointments.
  • Try activities to help you relax, reduce stress and take your mind off how tired you feel. For example, you might walk on the beach, sit in a peaceful setting, do some gardening, have a long bath or listen to some music.
  • Say no to things that you don’t feel like doing. It’s okay not to please others all the time.
  • Have realistic expectations. As soon as treatment finishes, don’t expect to be able to instantly do all the things you used to do before the cancer. Your body is still recovering and it will take time for your energy levels to return.
  • Do some regular light exercise, which can boost energy levels and make you feel less tired. A short walk may help to restore your energy without exhausting you. Talk to your health care team about suitable activities.
  • Smoking reduces your energy. If you smoke, talk to your doctor about quitting or visit Quitline.
  • Save your energy. Sit down to talk on the phone or do chores, such as cutting up vegetables, ironing or loading the washing machine. Sit down to put wet clothes on hangers and use a trolley to transport them to the clothesline. Leave chairs around the house so that you can sit when you feel tired.
  • If you have children, play with them sitting or lying down. Board games, puzzles and drawing are good activities.
  • Eat nutritious meals and snacks throughout the day.
  • Go to the shops during quieter times or do your shopping online.
  • Get in touch with a Cancer Connect volunteer who has had the same type of cancer and can share their story.
  • Consider joining a support group.

Pain

Some people experience pain after cancer treatment. Pain can prevent you from doing the things you want to do, which has a big impact on your life. Controlling the pain may allow you to return to many of the activities you enjoy.

Chemotherapy and surgery can injure nerves and cause pain and numbness in certain areas of your body. Your skin may be very sensitive in the area you received radiotherapy; this can last for a few months. Scars from surgery can also hurt for a long time.

Whatever type of pain you have, there are usually many ways to manage it. If your pain lasts for a long time or is constant, avoid waiting until it is out of control before doing something about it. Taking medication regularly is the best way to prevent pain from starting or getting worse. Some people call this “˜staying on top of the pain’. It may mean you can use lower doses of pain relief than if you wait until the pain gets worse.

Common pain-killing medications

Pain-killing drugs, called analgesics, are available to treat different types and levels of pain.

  • Mild pain – paracetamol or non-steroidal anti-inflammatory drugs
  • Moderate  pain – mild opioids such as codeine
  • Strong pain – opioids such as morphine.

Your doctor may also prescribe other drugs. For example, medications normally used to treat depression or epilepsy have been found to be helpful for some types of pain. Although you may not have depression or epilepsy, taking these drugs may make it possible to control the pain with a lower dose of opioids.

Will I become addicted to pain-killers?

People taking opioids at the levels necessary to relieve pain are not at risk of addiction, unless they have had addiction problems in the past. However, it is common to experience symptoms of withdrawal when you stop taking a drug. For this reason, your doctor will gradually reduce your dosage. If you are concerned about drug dependence, talk to your doctor.

Will the pain-killers make me drowsy?

This is unlikely if you take the medication as your doctor prescribes. You may feel drowsy at first, but this usually wears off within a couple of days. If it doesn’t, talk to your doctor. Your dosage may need to be adjusted.

Let your doctors know how pain is affecting your day-to-day life, as this helps them plan the best treatment for you. Your pharmacist may also be able to suggest ways to relieve the pain.

Other methods of pain relief

For some people, pain can be relieved without taking tablets. Some people have surgery or have an anaesthetic injected into their body (nerve block). Doctors usually use these methods if nothing else is effective.

Seeing a physiotherapist or occupational therapist may help you address physical or practical problems that are making you uncomfortable.

Some people use complementary therapies. These therapies may enhance your general well-being and help you cope better with pain. They may also increase your sense of control over the pain, improve your mood, and decrease your stress and anxiety.

Let your doctor know about any complementary therapies you are using or thinking about trying. Some therapies may not be appropriate depending on your situation. For example, your doctor may advise against a strong, deep tissue massage if you had surgery or bone problems during treatment. Always let the complementary therapist know that you have had cancer.

Changed body image

Treatment for cancer can change the way your body looks and how it works. This may affect how you feel about your body (your self-esteem).

Your self-esteem may be affected by:

  • speech difficulties
  • eating and drinking problems
  • breathing changes
  • weight loss or gain
  • changes to your appearance (e.g. mastectomy or oral surgery)
  • hair loss or hair growing back differently
  • bladder and bowel changes (e.g. colostomy or ileostomy)
  • intimacy and sex life
  • infertility.

It will take time to adjust physically and emotionally to these changes. Many cancer survivors say they feel angry and upset by the changes the cancer and its treatment have caused.

It is natural to worry about how your family and friends will react, and whether your partner or a potential partner finds you physically attractive.

It may help to let others know how you are feeling. They probably want to support you and reassure you that they still love you and see you in the same way as they did before the diagnosis. Hearing what they have to say may boost your confidence.

If you don’t feel comfortable talking to friends or family about how you feel, consider speaking to your health care team or a professional counsellor.

Sexuality and intimacy

Cancer and its treatment may affect your sexuality and intimacy in physical and emotional ways. Some people don’t feel any differently sexually after treatment, but if you do, it can be hard to deal with. These changes may be temporary or ongoing.

Anyone who has had cancer treatment may have sexual concerns, but those most likely to experience long-term problems include:

  • women treated for breast or gynaecological cancers
  • women who experience early menopause
  • men treated for testicular or prostate cancer
  • people treated for rectal or lower bowel cancer
  • people who have a stoma because of their treatment.

Types of problems you may have

Cancer and its treatment may change your appearance and your sexual response. Hormone levels or the nerves supplying the genital area may have been affected, causing physical problems such as vaginal dryness or erectile dysfunction. This can affect your desire for sex.

You may feel less sexual because you look different or feel less attractive. Some people feel embarrassed and upset by changes to their body and don’t want their partner to see them naked.

Some people say they were not prepared for the sexual changes caused by treatment. Others say that they avoid all forms of intimacy including hugs, kisses and sharing feelings, in fear that it may lead to sex when they don’t want it. Some people worry that they will never be able to have an intimate relationship again.

If the cancer treatment has affected your ability to have children, this may also change the way you feel about having sex.

  • Plan sexual activity for the time of day when your pain is lowest. To be most effective, pain medication should be taken shortly before sex.
  • Show affection by touching, hugging, massaging, talking and holding hands.
  • Talk to your partner if you have little or no interest in sex (low libido). They may be able to help you get in the mood. They may also need to accept that you may not be able to get in the mood for some time.
  • Try different ways of getting aroused: shower together, have a weekend away, wear something sexy – whatever makes you feel relaxed and good about yourself.
  • If you have vaginal dryness or tightness, try a water- based lubricant, vaginal moisturiser or cream during sex. Some women who have had radiotherapy or surgery may be advised to use a dilator to keep their vagina open and supple.
  • Change position during sex to work out which position is the most comfortable for you.
  • Ask your doctor if any medications can help with sexual problems, such as difficulties getting or maintaining an erection.
  • Spend more time on foreplay: watch a romantic movie, look at erotic magazines or DVDs, create a sexy atmosphere with dim lighting, music or candles.
  • Physical activity can stimulate sexual desire by increasing energy and lifting your mood.
  • Dancing is not only great exercise, but it can also arouse your sexual desire as you get physically close to your partner.
  • Be intimate at the time of day best for you (e.g. in the morning when you feel refreshed) and have shorter lovemaking sessions.
  • If you feel comfortable, stimulate yourself. This may give you the reassurance that you can still enjoy sex. Or you may want to stimulate your partner and help them reach orgasm, even if you don’t want this yourself.
  • Health professionals with specialised training can help you cope with specific sexual problems. It can be helpful to get advice and support, rather than “˜put up with it’. Talk to your doctor – either with your partner or separately – and ask for a referral.

You may not even be aware that you aren’t taking an interest in sex or being as intimate as you were before. If you have a partner, this can be confusing for them and it may make them feel uncertain about how to react.

Talking to your partner about how you’re feeling can help. Let them know why you don’t want sex but reassure them that you love them. Most partners will be happy to do things at your pace.

Menopause

Menopause means a woman’s ovaries no longer produce eggs and her periods stop. The average age for a woman to experience natural menopause is 52.

Menopause after treatment for cancer may be temporary or permanent. Whether your periods stop temporarily or permanently, you may experience menopausal symptoms. Cancer treatments that can cause menopause include certain chemotherapy drugs, radiotherapy to the pelvic area, hormone treatment and surgery to remove the ovaries (oophorectomy).

For women who want children, menopause can be devastating. Even if your family is complete or you didn’t want children, you may have mixed emotions and worry about the impact on your relationship. Some women find menopause difficult because they feel it has taken away a part of their identity as a woman.

Symptoms

While natural menopause can be a difficult time for a woman, it may be more difficult if menopause happens suddenly because of cancer treatment.

Symptoms may be severe because the body hasn’t had time to get used to the gradual decrease in hormone levels. You may experience hot flushes, mood swings, trouble sleeping, tiredness and vaginal dryness. Many of these symptoms will eventually pass, though it can take months or a few years.

You are also at risk of developing weak and brittle bones (osteoporosis). Ask your doctor how to manage this condition.

  • Hormone replacement therapy (HRT) can help reduce symptoms. However, this may not be recommended because studies have shown that using HRT with oestrogen and progestogen for longer than five years can increase the risk of some diseases, such as breast cancer.
  • Talk to your doctor about non-hormone medications that might help with symptoms such as hot flushes.
  • Use oestrogen, contained in creams or pessaries, to relieve vaginal dryness. Moisturisers without oestrogen can also be used.
  • Eat a healthy diet with lots of fresh fruits and vegetables, and wholegrains. Ask your doctor if you want advice about diet modifications or herbal remedies.
  • Extra lubrication may make intercourse more comfortable. Choose a water or silicone-based gel without perfumes or colouring to reduce irritation (e.g. Sylk ® or Pjur ®).
  • Take more time before and during penetration to help the vagina relax and become more lubricated.

Fertility problems

Some cancer treatments can cause temporary or permanent infertility (inability to conceive a child).

Although chemotherapy and radiotherapy reduce fertility, it may still be possible for women to become pregnant after treatment, or for men who have had treatment to father a child.

Your doctor may suggest you wait a certain period of time before trying to conceive. For example, some people wait for a year or two to give their body time to recover, and allow eggs and sperm to become healthy again. Some form of contraception must be used during this time.

If you are told you’ll be permanently infertile, you may feel a great sense of loss and grief. You might be devastated that you won’t have your own children or additional children, and you may worry about the impact of infertility on your relationship. Even if your family is complete, you may be distressed.

Infertility may make you feel that you have lost control of what you wanted in your life. You may feel very angry, sad or anxious that the cancer and its treatment caused these changes to your body. Talking to a counsellor about how you are feeling might help.

If you have trouble conceiving after cancer treatment, ask your doctor for a referral to a fertility specialist.

Lymphoedema

Lymphoedema is a swelling of part of the body, usually a limb such as the arm. It may occur after lymph nodes are removed during surgery, or if they are damaged by other treatment. When lymph nodes do not drain lymph fluid properly, it causes fluid build-up and swelling.

Signs of lymphoedema include redness; swelling; skin warmth; a feeling of pain, heaviness or fullness in the arm; and tingling in the fingers.

Symptoms are better managed if treated early. For example, if you have swelling, it may be reduced by wearing a professionally fitted elastic sleeve. You can also have massage treatment from a trained lymphoedema drainage therapist, physiotherapist, nurse or occupational therapist.

Infection can make the symptoms worse. To prevent infection in the affected arm:

  • keep the skin moisturised
  • avoid sunburn
  • avoid cuts, burns and insect bites
  • avoid using blood pressure cuffs and having injections.

Some hospitals have specialist physiotherapists who can help reduce your risk of developing lymphoedema. You can do simple exercises such as shoulder rolls, elbow bends and hand clenching.

Cognitive problems

After treatment many people say they have difficulty concentrating, focusing and remembering things. This usually happens after chemotherapy, so cancer survivors call it chemo brain. However, other treatments (e.g. hormone therapy and radiotherapy) and side effects such as fatigue or depression can also affect how well you function.

Researchers are looking into what causes the memory and concentration problems that some patients have after treatment. Chemo brain usually improves, but it may take a year or more.

  • Use your mobile phone,a calendar or daily planner to keep track of tasks, appointments, social commitments, birthdays etc.
  • Plan your activities so you do things that require more concentration when you are more alert, e.g. mornings.
  • Set aside time each day to read and respond to emails.
  • If you are working and have your own office, close the door when you don’t want to be interrupted.
  • Put personal items (e.g. wallet, keys) in a dedicated place at home and at work so you don’t misplace them.
  • Let phone calls go through to your answering machine or voicemail. You can listen to them and think about how you will respond when you feel ready.
  • Make notes of things you have to remember, e.g. a shopping list or where you parked the car.
  • Do tasks one at a time rather than multi-tasking.
  • Get plenty of sleep and exercise. Deep sleep is important for memory and concentration, and getting some physical activity every day will help you sleep better.

Feeling down or depressed

Feeling low or depressed after treatment finishes is common. Some people may feel fine at first and then start to feel sad or down a few weeks, months or even years later.

  • Knowing why you feel low can help you to work your way through your feelings. Some people feel sad or depressed because of the changes that cancer has caused. Others become very down because they are frightened about the future. They may wonder if the cancer will come back, if they will be able to work again and how their family will cope if they can’t earn enough money.
  • Support from family and friends or health professionals may help you cope better during these periods.

Signs of depression

Depression is more than feeling down for a few days. It may mean you feel in a low mood most of the time, or your sadness lasts two weeks or more.

If you have one or more of these symptoms for a few weeks or more, you should see your GP:

  • feeling very sad and low most of the time
  • loss of interest in and pleasure in normal activities
  • having negative thoughts about yourself a lot of the time
  • eating more or less than usual
  • weight gain or loss
  • feeling very tired most of the time
  • having trouble concentrating
  • loss of interest in sex (low libido)
  • changes in your sleep habits, e.g. not being able to fall asleep, waking in the early hours of the morning or sleeping much more than usual
  • feeling restless, agitated, worthless, guilty, anxious or upset
  • having very little or reduced motivation
  • being extremely irritable or angry
  • thinking that you are a burden to others or feeling guilty
  • a desire to self-harm
  • a desire to kill yourself.

These are not only the symptoms of depression; some can be caused by other medical conditions. Talk to your doctor about how you are feeling.

Depression won’t go away by itself – it needs specific treatment. There are many effective treatments for depression, and they don’t necessarily include medication. Treatment for depression may include therapy provided by a GP, trained psychologist, psychiatrist or counsellor. Tackling depression early may mean that you can deal with problems quickly and avoid symptoms becoming worse.

  • Take care of yourself. Eat a well-balanced diet with lots of fresh fruit and vegetables and drink plenty of water.
  • Set small and achievable goals. Remember to not expect too much from yourself.
  • Get regular exercise. Studies have shown that being active helps lift a person’s mood and improves fatigue.
  • Share your feelings with someone close to you. Just having them know exactly how you feel may help you feel less alone.
  • Go out and do something you enjoy. A change of scenery can often make you feel better. Spend time outside in the fresh air. Schedule a pleasant event or daily activity.
  • Review your priorities.
  • Try not to judge yourself too harshly. Self-criticism can lead to more feelings of hopelessness.
  • List activities you used to enjoy and plan to do one of these activities each day.
  • Write down how you’re feeling or express yourself in painting, drawing, music or singing.
  • Get up at the same time each morning, regardless of how you feel.
  • Try a complementary therapy, such as massage, yoga, hypnosis, acupuncture and reflexology.

Herbal products to treat depression

Some people who have recovered from cancer are interested in using herbal products to treat depression. Though these products are labelled as natural, it doesn’t always mean that they are safe. Some can have serious side effects and may interact with other drugs that you are taking.

Two herbal products that are commonly used to treat depression are St John’s wort and Ginkgo biloba. Some research suggests that these herbs may help lift mood for some people, however other research has not found this to be the case. Both have side effects and should not be taken along with any other anti-depressant drugs. St John’s wort also interacts with many other standard medications.

Other problems

You may have other problems after treatment, such as:

  • changes in the way your bladder and bowel work
  • problems with eating, drinking and your weight
  • mouth and teeth problems
  • tingling hands and feet.

If you would like more information on managing these problems or any other problems, contact the Helpline.

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