Physical Effects of Cancer
What is body image and why is poor body image a struggle for many survivors?
Many survivors experience physical changes in their bodies as a result of cancer or its treatment. Each survivor may react to physical changes in a different way. It may be very difficult for you to accept the changes to your body. On the other hand, you may think the physical changes don't really affect the way you feel about your body.
It's also possible that your body didn't change as a result of cancer, but you still feel differently about the way you look to other people. If you feel negatively about yourself or your body after cancer, you might want to consider ways to improve your body image.
Your body image is what you believe about your own appearance, even though other people might see you differently. A poor body image may cause you to feel ashamed, self-conscious and anxious about your body. If you have a poor body image, you might think that your body size or shape makes you unattractive to other people.
Cancer can affect your body image by:
- Changing your physical appearance
- Damaging how your body functions
- Challenging your self-worth
If you have experienced changes to your body as a result of cancer or treatment, you might feel less confident about your physical appearance. However, it is important to remember that your body is only one part of who you are as a whole person. If you focus only on what your body looks like, you might overlook the strength of your personality, your interest in life and the talents you bring to many areas of your life.
Physical changes can be difficult to accept, and they may be a temporary or permanent part of who you are. Being a cancer survivor may also seem like a big change in how you see yourself. Finding your personal way of dealing with these changes may improve your quality of life and help you feel more confident during your survivorship.
Who might be at risk for having a poor body image?
Your body does not have to change as a result of cancer in order for you to be at risk for having a poor body image. Survivors who experience temporary or permanent physical changes to their bodies may be at risk for having a poor body image as they learn to adjust to changes in their bodies. The effects of a temporary physical change on your body image may last for a short time. A permanent physical change may have a more lasting effect on your body image.
Examples of temporary changes that can affect your body image:
- Hair loss
- Weight loss
- Weight gain
Examples of permanent changes that can affect your body image:
- Amputations, such as, limbs or mastectomies where prostheses can be fitted
- Permanent stomas, e.g. colostomy or ileostomy
- Infertility
- Scars from surgery or tattoo markings from radiation fields
Both permanent and temporary physical changes may or may not be visible to other people. When physical changes aren't visible to others, you may not notice any changes in how you feel about your body. However, even changes that no one else can see can affect you because body image relates to how you feel about your body, not how it actually looks to others.
Many people think that the only survivors who are at risk for having a poor body image are survivors who experience temporary or permanent physical changes to their bodies. This is not true. Even if you do not experience any physical changes from cancer, you might still feel that others see you differently. You may think that others don't understand you or can't relate to you now. Feelings of insecurity and uncertainty may affect your body image, even if your body looks exactly like it did before cancer.
What are some signs that a poor body image is affecting a survivor's quality of life?
- You don't want to leave your house because you don't want people to see you.
- You don't want to date or meet new people.
- You shy away from intimacy or sex with your current partner.
- You are afraid to undress in front of your spouse.
- You won't let your partner see your scars.
- You are embarrassed because you lost or gained weight.
- You feel ashamed for having cancer.
- You are unable to accept yourself for who you are now.
Why can cancer affect a survivor's body image?
Cancer and its treatment affect each survivor differently, and physical changes caused by cancer are unique to each survivor. Sometimes physical changes caused by cancer prevent you from working or doing the things you used to enjoy before cancer. This can be very difficult to accept. Even small changes in your body may seem overwhelming.
Your physical changes may also affect how others react to you, which can affect your body image. Not everyone knows how to react to people who have had cancer or who have physical changes from cancer or its treatment. Some people will react negatively, and that can cause hurt feelings and discomfort. Having a strong, positive body image may help you worry less about how other people react to your physical appearance.
After treatment ends, many cancer survivors want their lives to return to the way they were before cancer. If you have a permanent physical change, it can seem like a constant reminder that life is different. Also, if you see yourself differently after cancer, you may worry that your life will never be normal again. All these things can affect how well you feel about yourself and your body. You might want to consider giving yourself time to adjust to changes in your body or changes in how you feel about yourself. In time, your body image may improve as you start to adjust to life after cancer.
Are survivors always going to be at risk for having a poor body image?
If your body image didn't change right after you finished treatment, it's still possible for an aftereffect of treatment or a change in how you feel about your life after cancer to affect your body image. If you had problems with your body image before cancer, you may see your problems become worse over time if you don't address them. On the other hand, you may also see an improvement in your body image. You may think that cancer changed how you feel about certain things in your life. You may think that what others think of you isn't as important anymore.
Anytime you experience a major change in how you look or how you feel you look, you might be at risk for having a poor body image. Doing your best to remain positive and recognize your strengths beyond your physical appearance may help decrease your risk for having a poor body image.
What can survivors do to improve their body image?
All survivors deal with changes in body image in their own way. It is a personal experience. However, there are some general approaches that may help you improve your body image and begin to better understand your body after cancer.
Below is a brief list. For more information, speak with your health care team/PALS nurse -
- Talk to other survivors who have had similar struggles with their body image.
- Gain confidence in your appearance.
- Seek out professional counseling, either for yourself or with a partner.
- Include a healthy balance of exercise and good nutrition to improve how you feel after cancer.
Constipation is a decrease in the frequency of bowel movements, difficulty in passing stool, hard stools, incomplete emptying of the bowel, or any combination of these. It is an uncomfortable yet common side effect of medications for pain, nausea, or chemotherapy medications such as vincristine, vinblastine, or vinorelbine. Other causes of constipation include:
- Ignoring the urge to have a bowel movement.
- Not having enough time or privacy to use the toilet.
- Decreased activity or mobility.
- Decreased fluid intake.
- Not eating enough fiber from sources such as whole grains, fruits, and vegetables.
- Illnesses such as diabetes, depression, diverticulosis, Parkinson’s disease, hypothyroidism, or hypercalcemia.
Tips to Help Prevent or Treat Constipation
- Establish a pattern of using the bathroom to promote regularity.
- Respond to the urge to have a bowel movement immediately.
- Exercise as tolerated; walking is an excellent form of exercise.
- Drink eight, 8-ounce glasses (2 liters) of fluid daily. Water, juices, soups, ice cream shakes, and other beverages are some of the fluids you could have.
- Gradually increase the daily amount of fiber in your diet to a total of 25 – 35 grams. Foods such as fruits, vegetables, whole grains, and cereals contain fiber.
Key Notes:
- If you have an ostomy or have had recent abdominal surgery, please check with your doctor or nurse before making any changes in your diet.
- Notify your doctor or nurse if you have not had a bowel movement for two days.
- If you have diarrhea, do not take an antidiarrheal medication (such as Imodium® or Kaopectate®) until you speak to your doctor or nurse.
- Do not use rectal suppositories or enemas unless directed by your doctor
What are cognitive changes?
Cognitive changes are problems with thinking, including memory, concentration and behavior. These changes can influence many parts of your life, such as your ability to work or even to complete everyday tasks. Some cancers, cancer treatments and medications can cause cognitive changes for cancer survivors. However, there are many other causes of cognitive changes that are not related to cancer.
Experiencing problems with thinking and concentration can be very scary. It can be very upsetting to realize that you have successfully treated your cancer but are now experiencing cognitive problems as a result of the cancer, its treatment or some other cause. Just because you had chemotherapy, radiation or surgery does not mean that you will definitely have cognitive changes. But it is important to know what the symptoms are so that you know what to look for.
If you do notice problems with thinking, memory or behavior, talk to your health care team right away. To get the correct treatment, it is important to find out what is causing the cognitive problems.
Sometimes the cognitive changes that are related to cancer are very minor and are reversible, meaning the changes will go away. Some cognitive changes can be more noticeable, however, and may not be reversible. Cognitive changes can happen suddenly (acute onset), or they can come up slowly over time (gradual onset).
Who is at risk for cognitive changes?
Survivors who experienced the following might be more at risk for cognitive changes:
- Central nervous system (CNS) involvement with tumor
- Treatments administered directly to the CNS
- Treatments administered when extremely ill
- Chemotherapy and radiation given to the brain at the same time
- Chemotherapy given into the spinal fluid after radiation
Cancer survivors who did not experience any of the above procedures may still experience some cognitive changes. Cognitive changes can occur in survivors of all ages who received all types of chemotherapy and radiation. Those who had surgery to remove a brain tumor can also experience cognitive changes. The frequency and severity of cognitive changes associated with chemotherapy varies with the dose and type of medicine used. Cognitive changes are sometimes related to higher dose treatment of chemotherapy and the use of immunotherapy, treatment to boost the immune system. The frequency and severity of cognitive changes associated with radiation and surgery to remove a brain tumor depends on the amount of damage caused to surrounding healthy tissue.
What are some of the symptoms of cognitive changes?
Acute onset cognitive changes (delirium)
Acute onset cognitive changes are those that occur suddenly and come and go with no real pattern, often during treatment with chemotherapy agents. Delirium is the term used to describe these cognitive changes. Certain medications and chemotherapy treatments can cause delirium, and it may be reversible.
Symptoms of delirium may include:
- Difficulty concentrating
- Reduced level of consciousness (person seems “out of it”)
- Person does not understand what is going on around him or her
- Unusual sleep patterns (awake at night, asleep during the day)
- Agitation
- Confusion
- Memory loss
- Loud, aggressive behavior
- Hallucinations (seeing things that aren’t really there)
- Disorientation (person doesn’t know where s/he is)
- Quiet, inactive behavior (including sedation and confusion)
Gradual onset cognitive changes (dementia)
Gradual onset cognitive changes are considered to be chronic, meaning they come about slowly over time and are long-lasting. Dementia is the term used to describe these cognitive changes. Symptoms of dementia might not appear until you finish active treatment for cancer. Dementia symptoms can be very mild and only slightly noticeable, or they can be very noticeable.
Symptoms of dementia may include:
- Poor short-term memory
- Poor long-term memory
- Difficulty with abstract thinking (adding numbers together)
- Poor judgment (makes unsafe decisions)
- Changes in personality (may become moody or upset without a noticeable cause)
- Difficulty with problem solving and following directions
- Disorientation (person doesn’t know where s/he is)
Chemo-brain (mild dementia)
Sometimes survivors experience slight changes in their ability to remember or concentrate well after they have received chemotherapy. This very mild form of dementia is sometimes called “chemo-brain.”
Symptoms of “chemo brain” may include:
- Difficulty concentrating
- Difficulty remembering things that occurred recently
- Difficulty completing tasks
- Confusion
- Inability to think clearly
What causes cognitive changes in cancer survivors?
Cancer cells in the brain (a tumor) destroy healthy cells and can cause cognitive changes. Chemotherapy, radiation and surgery are used to remove or destroy cancer cells, but these treatments can also damage the surrounding healthy cells. Depending on how much damage occurs, there could be noticeable problems with thinking, memory and behavior. Additionally, chemotherapy can cause factors like fatigue and anemia, which may also lead to cognitive problems, particularly with being able to pay attention.
Also, a survivor can experience other conditions that may or may not be related to cancer or its treatment that can cause cognitive changes. Some of these conditions are reversible; some are not.
Some other conditions that can cause cognitive changes:
- Medication problems
- Stress
- Anxiety
- Depression
- Electrolyte derangements
- Hypoxemia (low oxygen levels)
- Other diseases of the brain (Alzheimer’s disease and Parkinson’s disease for example)
- Thyroid problems
- Severe nutrition problems
It is important to discuss with your health care team all of the possible causes of cognitive problems so that you receive the correct diagnosis and treatment.
When do cognitive changes occur?
Cognitive changes can occur at any point during your experience with cancer. Sometimes cognitive changes are the first sign of a brain tumor. Cognitive changes may also occur after completing cancer treatment or after taking certain medications.
Delirium may occur suddenly during treatment. Delirium usually occurs after an identified cause (chemotherapy, for example) and is often reversible.
Dementia occurs gradually over time and usually occurs after treatment is completed. Dementia may be harder to identify than delirium, and may not have one identifiable cause. It can develop as early as three months after radiotherapy, but can also occur 48 months or longer after completion of radiation therapy to the brain. “Chemo brain” can occur during chemotherapy treatment or after the treatment has been completed. Dementia symptoms may also occur after surgery to remove a brain tumor.
Can cognitive changes be cured?
Whether cognitive changes will improve or be permanent depends on their cause. Acute cognitive changes (delirium) that occur because of certain medicines often improve when you stop taking the medicine. Chronic changes (dementia) are often not reversible, but may be improved if the cause of the problems can be corrected.
If you notice changes in your thinking, memory or behavior, keep a record of the problems that you have and ask your family or friends to watch for additional problems. Make an appointment to talk to your health care team about these symptoms as soon as possible. Treating the underlying condition often reduces or removes cognitive problems.
What are some suggestions for survivors who may be experiencing cognitive changes?
Below is a brief list. For more information, speak with your health care team/PALS nurse
- Keep a journal to communicate symptoms and side effects of medicine with your health care team.
- Take the medication your health care team prescribes to help cognitive changes as directed.
- Avoid dangerous activities if you are alone.
- Ask your family to watch for safety issues.
- Talk to your family and an attorney about legal documents you may need to make sure your medical and financial wishes are respected.
- Get plenty of sleep.
What is fatigue?
Fatigue is a feeling of tiredness or not having enough energy. There are two main types of fatigue. Acute fatigue is when you feel tired for a short time. Chronic fatigue is a feeling of tiredness that is always with you or a feeling of tiredness that comes and goes but never goes away completely.
Many cancer survivors experience chronic fatigue after their active treatment has ended. Survivors can experience chronic fatigue because of the treatment they received for their cancer or because of the different emotions they are feeling in their life after cancer. Chronic fatigue can also be a sign of a recurrence or another illness.
Currently, you may be working with your health care team to manage your fatigue symptoms. You may notice that you are tired all the time and feel like you shouldn’t complain or that no one will listen. Feeling tired all the time isn’t something you should ignore just because your treatment is over and your cancer is in remission. You and your health care team can take steps to help you with your fatigue.
Do all survivors experience fatigue?
Studies show that 30 percent of cancer survivors experience fatigue that can last for years. Survivors who received certain types of treatments for their cancer are more at risk for fatigue.
You may be more at risk for fatigue if:
- You were treated with chemotherapy
- You received high doses of chemotherapy followed by a bone marrow transplant or a stem cell transplant
- You are still taking certain medications that can cause fatigue
- You were treated with chemotherapy, radiation or surgery that affected your hormones
What are the symptoms of fatigue
Some symptoms of fatigue that survivors might experience include:
- Feeling tired even though you had a good night’s sleep
- Feeling sleepy throughout the day
- Feeling sudden, extreme tiredness
- Feeling too weak to stand
- Finding it difficult to start routine activities
- Needing to stop in the middle of activities to rest or not being able to do activities for very long
- Difficulty concentrating
- Irritability
In most cases, a survivor’s energy level will return to normal within the first six months after active treatment ends. However, during that time, you can still get help with your fatigue and work with your health care team to minimize your symptoms.
If you have been feeling good but suddenly start to become extremely tired again, you may be experiencing a new, severe fatigue. This can be a sign of infection or a late effect of cancer treatment. Make an appointment to discuss your fatigue with your health care team.
What are some of the physical causes of fatigue?
Some of the physical causes of fatigue are:
- Low red blood cell counts (anemia)
- Difficulty breathing
- Changes in how well your heart pumps blood
- Changes in muscle or bone due to surgery or treatment
- Changes in the hormone levels in your body
- Changes in your immune function or the way your body responds when your immune system is challenged
- Changes in kidney function so your body is not as good at clearing out waste products
- Trouble sleeping
- Symptoms such as pain or numbness in your feet that make it harder to move
- Side effects of medications
- Chronic pain
Sometimes the exact cause of your fatigue may be unknown, but that does not mean that you and your health care team can’t work together to help manage your fatigue.
What are some of the emotional causes of fatigue?
Some emotional causes of fatigue are:
- Anxiety
- Frustration
- Boredom
- Depression
Depression is a common emotional cause of fatigue. When thinking about the causes of your fatigue, you should also discuss with your health care team any feelings of sadness or depression you may be experiencing.
Fatigue and depression can both happen during your survivorship and both are real problems that you should discuss with your health care team. But being tired does not necessarily mean a survivor is depressed. Sometimes survivors hear things like, “You’re not tired – you’re just depressed.” While depression may be one cause of fatigue, it’s important that you discuss all possible physical and emotional causes with your health care team.
When is a cancer survivor likely to experience fatigue?
Many people think that fatigue is something that survivors will only experience during treatment. This is not true. Some survivors experience fatigue months or years after completing active treatment.
A type of fatigue called post-cancer fatigue affects some survivors after their active treatment has ended. If you have experienced symptoms of fatigue and have worked with your health care team to rule out any other causes, you might be experiencing post-cancer fatigue.
Post-cancer fatigue is different than chronic fatigue. With post-cancer fatigue, the cause – treatment for cancer – is known. Not enough research has been done to know a lot about the exact causes of post-cancer fatigue. But it exists, and you can discuss it with your health care team.
Can fatigue be cured?
Right now, the medical community does not know enough about why people experience persistent fatigue to cure it. However, fatigue is a treatable condition, and you can work with your health care team to manage the symptoms.
What can survivors do to minimize the risk of fatigue?
Below is a brief list. For more information, speak with your health care team/PALS nurse.
- Maintain a comfortable balance between activity and rest.
- Try to find balance with a healthy lifestyle.
- Pay attention to your sleep habits.
Loss of Appetite
The lack or loss of appetite (anorexia is the medical term), is the second most commonly reported symptom in patients with advanced cancer (65-85%). Studies have shown that appetite and ability to eat are the most important physical aspects of patients' quality of life.
Involuntary weight loss (cachexia is the medical term) is associated with disordered metabolism characteristic of certain diseases including cancer. Studies also found a direct link between weight loss and quality of life, as patients had significant symptom distress due in part to the weight loss such as -
- Fatigue/muscle weakness
- Musculoskeletal pain
- Nausea
- Breathlessness (dyspnea)
Information concerning anorexia and cachexia may provide ways to help patients and families gain control of a disease process that often seems to be invading every part of their life.
Please note that cachexia is not the same as starving as patients do not report feeling hungry. What is happening is that their body protein is being consumed - it is not something that is felt, it happens in a painless way - in a way that we experience most cellular processes.
Prevention
First of all, not everyone with cancer experiences anorexia and anorexia often stops after cancer treatment is complete. When this happens, there are medications that can be prescribed for you to help to manage anorexia.
As with any aspect of your care, how you approach it may well affect how well you respond to the treatment. Talk about your feelings. Become well informed about cancer and treatment options. Plan various ways to cope with the symptoms. This will help to reduce your worry and anxiety and increase your feelings of control. Being in control is good for your appetite.
- Give food a chance. Even if there are eating problems, there can be times when eating is a pleasure.
- Don't be afraid to try new foods. Tastes can change and different foods may be a pleasant addition to your menu. There aren't any hard and fast nutrition rules for cancer related anorexia.
- Get a good supply of your favorite foods so you don't have to shop as often. Include items that can be eaten during periods of illness.
- Keep foods available that require little or no preparation, like cheese, eggs, pudding, peanut butter, and tuna fish.
- Enlist friends and family to help with shopping and cooking.
- Freeze food in meal size portions.
- Talk with a nutritionist to develop a grocery list with foods that might help you with potential eating problems.
- Be sure to include any cultural and ethnic food preferences in your diet.
Involuntary weight loss is more difficult to manage, and it is an anticipated phenomenon related to how cancer progresses. In fact, the rate and amount of weight loss is often used to help your health care team know how fast the cancer may be progressing.
What is often most distressing for patients and their families is the change that they experience in their body image. While little can be done to prevent this, much can be done to prepare people to expect this.
Please supplement the information provided here, or found on the internet/given by family and friends, by asking questions or by talking with your health care team/PALS Nurse to obtain the resources you need to successfully face cachexia/anorexia.
What is neuropathy?
Neuropathy – sometimes called peripheral neuropathy – is a condition that occurs after peripheral nerve damage. Neuropathy may affect a single nerve or several.
The nervous system is divided into central and peripheral parts:
- The brain and spinal cord make up the central nervous system.
- The peripheral nervous system includes the nerves that leave the brain and the nerve roots that come off the spinal cord and go to the internal organs, limbs and skin.
Diseases, injuries and toxins, such as chemotherapy, can cause neuropathy in cancer survivors. The damage may lead to changes in sensation or muscle function and can be mild or severe. Cancer survivors may experience this condition as tingling or numbness in certain areas of the body, especially the hands and feet. These sensations range from mild to painful.
Neuropathy can be an upsetting, and sometimes scary, condition for survivors. If you begin to notice symptoms, talk to your health care team immediately.
What causes neuropathy?
Neuropathy is a common disorder. Some causes include:
- Diabetes mellitus (sugar diabetes) – the most common cause of neuropathy in the industrialized world
- Infections (such as leprosy, syphilis, HIV and some forms of hepatitis)
- Nutritional deficiency (particularly of thiamine)
- Inherited disorders of metabolism and other diseases passed down through families
- Alcohol
- Pesticides
- Drugs used in cancer treatment, particularly the platinum compounds, the taxanes, the vinca alkaloids and thalidomide
- Hypothyroidism
- Renal failure
- Extreme stress (such as the stress of living with a chronic illness)
- Radiation therapy (effects may be delayed for many years)
- Some cancer tumors are associated with neuropathy as a remote effect.
What are the symptoms of neuropathy?
The types and severity of neuropathy symptoms vary greatly. Determining the amount of peripheral nerve injury just by the amount of symptoms produced is difficult. Symptoms are almost always greatest at night.
Common signs and symptoms of peripheral neuropathy include:
- Fatigue
- Weakness
- Clumsiness
- Loss of balance, particularly in the dark
- Dizziness, especially when getting up from a bed or a chair
- Numbness, especially of hands or feet
- Cramps, commonly in the calf muscles
- Pain, often burning or shooting in quality
- Sexual dysfunction
- Sensitivity to temperature
- Muscle wasting in the hands and feet
- Loss of reflexes
- Smooth, dry and red skin of hands and feet
Which cancer survivors are at risk?
Neuropathy can affect almost any cancer survivor, but the following are high risk conditions.
Cancer types
- Lung
- Breast
- Ovarian
- Prostate
- Myeloma
- Lymphoma and Hodgkin’s disease
- Testicular
Having one or more of the following characteristics may increase the chances of developing neuropathy.
- Advanced age
- A family history of neuropathy (familial, diabetes)
- Malnourishment
- Excessive use of alcohol
Some medications, including chemotherapy medications, also increase risk. Discuss your medication-related risk with your health care team/PALS nurse.
Chemotherapy medications that increase your neuropathy risk include:
- Platinum
- Taxanes
- Vinca alkaloids
- Thalidomide
- Cytosine arabinoside
- Misonidazole
- Interferon
Can a survivor experience neuropathy during, immediately after and/or years after treatment?
Neuropathy related to cancer may develop in the course of treatment or shortly after. More often, neuropathy has a delayed onset, with symptoms developing weeks or months after therapy has ended. Nerve injury from radiation therapy may be quite delayed, with symptoms occurring in some instances years after treatment.
Peripheral neuropathy symptoms are often ignored by both patients and health care professionals and frequently are not recognized as being related to peripheral nerve damage. For lung cancer, neuropathy may be the earliest sign of the cancer. Report any symptoms to your health care team/PALS nurse right away.
Can neuropathy be cured?
The peripheral nerves have a great ability to heal. Even though it may take months, most patients recover. However, in some situations, neuropathy is difficult to cure. Nerve injury caused by radiation often does not recover well. Neuropathy caused by platinum chemotherapy is also difficult to cure — recovery may take 18 months to five years or longer. During recovery of platinum-induced neuropathy, patients may suffer increased symptoms. Unfortunately, some patients with platinum neuropathy never recover.
Even if your neuropathy cannot be cured, you may benefit from treatments to relieve your symptoms and from rehabilitation designed to help you maintain your physical abilities.
What are the treatments for neuropathy?
The treatment for peripheral neuropathy depends on the cause.
Recovery can be helped by:
- Adequate nutrition (foods rich in thiamine, protein and antioxidants)
- Controlling and correcting contributing conditions such as diabetes or hypothyroidism
- Pain medications
- Physical therapy
Medications being researched in clinical trials show promise in helping peripheral nerves to heal.
How will a cancer survivor’s life change if she/he has neuropathy?
Pain and other symptoms of neuropathy can be mild or severe. Each survivor’s experience will be different. However, with appropriate treatment, the effects of neuropathy can be limited. Medications, lifestyle changes, rehabilitation and other treatments can be used.
- Neuropathy can make standing for long periods or walking without assistance difficult.
- Balance can be affected, increasing the risk of falling.
- Activities like buttoning and tying laces or ties can be difficult.
- Survivors may be sensitive to heat or cold. Survivors with this sensitivity should avoid extreme temperatures if possible and use protective clothing and hats when needed.
- Neuropathy may cause a lack of pain sensation. Survivors should pay careful attention to the skin on their hands and feet because they could receive a wound or a break in the skin and not feel it.
- If neuropathy affects your ability to feel the foot pedals of your car, you should not drive unless your car is adapted for hand controls. Neuropathy can slow your reaction time in moving your foot from the accelerator to the break pedal and may cause an accident. Losing your ability to drive is upsetting. You may feel you are losing your independence. However, consider the increased risk to your safety and to the safety of others on the road.
Physical and occupational therapists can provide suggestions and special equipment to make daily tasks safe and easier to manage. The suggestions may include night lights, grab bars and other home safety measures to help reduce the risk of falling. Therapists can assist survivors with physical exercises that can help them maintain physical abilities.
Pain from neuropathy can greatly affect your daily activities and quality of life. For some, the pain and changes required to manage it can lead to physical and mental stress. Watch for signs of depression and talk to your health care team/PALS nurse or a mental health care professional about managing your feelings.
Good communication with your health care team/PALS nurse about your symptoms and the changes they are bringing to your life is important. The team can help you manage these changes and provide referrals to other helpful resources.
What is chronic pain?
Many cancer survivors experienced pain during their treatment and found ways to manage it with the help of their health care teams. For some survivors, the pain they experienced went away after their treatment ended. However, there are survivors who have to live with chronic pain. Chronic pain is pain that lasts for a long time. Chronic pain can be mild or very severe, and it can affect your quality of life after cancer.
You are experiencing chronic pain if:
- Your pain is ongoing
- Your pain has not responded to currently available treatment methods, and/or
- Your pain has interfered with your activities of daily living
It’s understandable if dealing with chronic pain upsets you or overwhelms you at times. In order to manage chronic pain successfully, you should form a strong partnership with your health care team. You should let your health care team know how this pain is affecting your life. They can help you address the physical causes of chronic pain and also address the emotional side effects of having to live with pain on a daily basis.
There are many causes for chronic pain, and each survivor may deal with chronic pain differently. If you experience chronic pain during your survivorship, there are ways to manage it and perhaps lessen how much chronic pain affects your quality of life.
Do all survivors experience chronic pain?
Not every survivor experiences chronic pain. For those who do have chronic pain, the causes can vary. Chronic pain can result from treatment of cancer or from the cancer spreading to other parts of the body. Individuals who have had breast, prostate, lung or colorectal cancer are at a higher risk of having chronic pain.
There are a few chemotherapy medicines that have a side effect called peripheral neuropathy. Peripheral neuropathy is a condition that causes tingling, burning, numbness or weakness as a result of nerve damage. It usually begins in the hands or feet. Most of the time the pain caused by peripheral neuropathy will go away when the treatment stops. However, if your nerves become permanently damaged, chronic pain can develop. Some examples of chemotherapy medicines that may cause peripheral neuropathy are Taxol, vincristine, Taxotere and cisplatin.
If you took steroids as part of your treatment for cancer, you may be at risk for chronic bone pain during your survivorship. Steroids can cause the bones to grow weaker. This can lead to osteoporosis, which may cause chronic bone pain.
Sometimes radiation therapy is used to treat cancer. Depending on where the radiation field is located, you may develop painful side effects. Most of these side effects are not long lasting and can usually be treated. Radiation therapy, however, can cause damage to bones, nerves and organs in your body that may lead to chronic pain.
When should survivors talk to their health care team/PALS nurse about the pain they are experiencing?
Some examples of times you should talk to your health care team about your pain:
- If you experience a new pain
- If your current pain medication stops working
- If the pain changes or feels different to you
- If you develop painful swelling in the arm or leg
- If you feel pain, numbness, tingling or a burning sensation in your hands or feet
What are some pain management strategies that survivors can discuss with their health care team?
Even if you experience chronic pain, there are things your health care team can do to help reduce or eliminate how much pain you feel. Forming a strong partnership with your health care team may help you manage the pain.
Some examples of pain management strategies you may want to discuss with your health care team:
- For mild pain, a medication called nonsteroidal anti-inflammatory medications (NSAIDS). The most common types of this medication are aspirin and ibuprofen.
- For moderate pain, a medication to go along with the NSAID. Two examples of this type of medication are Percocet or Vicodin.
- For severe pain, stronger pain medications like OxyContin (oxycodone) or long acting morphine may be considered.
- Your health care team may also use what are called adjuvant medications. These are medicines that have been proven to relieve pain even though that is not their primary purpose. An example is Neurontin, an antiseizure medication, which can help nerve pain.
- If medication does not effectively control your pain, your health care team may suggest other methods for managing your pain. Your health care team may suggest a technique called a nerve block, where medication is injected into the spinal column to block the nerves so that you will not feel the pain.
Every survivor is different and every survivor may respond differently to pain management strategies. Open communication with your health care team can help you figure out together what strategies work best to manage your pain.
What are some suggestions for survivors who are trying to manage chronic pain?
- Keep a journal and discuss what you have entered at your visits with your health care team.
- Talk to your health care team about any medication they prescribe for pain.
- Keep track of any medication you take for pain.
- Ask your health care team about complementary therapies.
What is osteoporosis?
Some survivors may experience a side effect called osteoporosis. Osteoporosis is a condition that thins and weakens your bones and causes your bones to become very fragile. Osteoporosis is sometimes called a silent disease because it can exist for years without symptoms. You may not realize you have osteoporosis until you break or facture a bone.
Osteoporosis is a treatable condition. If you experience osteoporosis, it isn’t because your health care team didn’t do a good job treating your cancer. Your health care team’s primary goal was to treat your cancer. Now, they can work with you to prevent or manage any late effects you might experience.
While it may seem frustrating at times to have to worry about health conditions after you have survived something like cancer, it’s important to be aware of your risks for developing late effects like osteoporosis and watch for symptoms. This will increase your chances of early detection.
Who is at risk for osteoporosis?
There are many different risk factors for osteoporosis that are related to the type of cancer you had, your treatment or the way your body responded to treatment. There are also risk factors for osteoporosis that aren’t related to cancer or treatment.
Survivors diagnosed and treated for any cancers that could spread to the bone are at risk, including those diagnosed with:
- Breast cancer
- Prostate cancer
- Multiple Myeloma (cancer that happens in white blood cells that produce antibodies)
- Other solid tumors such as lung, testicular, ovarian and endometrial (uterine wall) cancers
The treatment for some cancers, like breast cancer or prostate cancer, can include blocking or eliminating certain hormones in your body. Blocking the sex hormones helps kill the cancer cells. But these sex hormones also help protect the bones. If your body is deprived of these hormones, osteoporosis can happen. This does not mean that you shouldn’t have received treatment that blocks your hormones because that may have been the best way to treat your cancer. Even if you received treatment that blocked your hormones, there are things you can do to prevent or minimize bone loss.
There are also some risk factors for osteoporosis that may affect survivors but aren’t necessarily related to cancer or its treatment.
Some general risk factors for osteoporosis are:
- Health problems such as hyperthyroidism, rheumatoid arthritis or diabetes
- A history of breast cancer in your family
- Small body frame or low body weight
- Ethnicity – Caucasians and Asians have a higher risk
- Low testosterone level in men
- Certain medications taken for long period of time
- Low intake of calcium and vitamin D
- Drinking too much caffeine
- Too little or too much exercise (i.e. people who are bedridden or marathon runners)
- Smoking
- Drinking too much alcohol
What are the symptoms and signs of osteoporosis?
Some symptoms of osteoporosis may include:
- Weight loss
- Stooped posture
- Curving of the upper back or Dowager’s hump
- Bone tenderness
- Loss of one or two inches in height
If you experience these symptoms, it doesn’t mean that you have osteoporosis. Discussing your symptoms with your health care team can help you determine the cause of your symptoms.
Bone loss related to osteoporosis happens slowly over time. Sometimes, you may have osteoporosis and not experience any symptoms. If you think you are at risk for osteoporosis but don’t have any symptoms, you might want to talk to your health care team/doctor about a Bone Density test.
What can be done to minimize the risk of experiencing osteoporosis?
Below is a brief list. For more information, speak with your doctor.
Here is a list of suggestions to help minimize your risk of osteoporosis:
- Stop smoking
- Drink little or no alcohol
- Include healthy behaviors into your lifestyle
- Maintain a healthy weight
- Improve your muscle strength and bone density
- Include more calcium in your diet
- Include more Vitamin D in your diet
- Evaluate your risk for falls
- Talk with your doctor about medications that can help decrease bone loss
- Discuss alternative therapies with your health care team
Men, Cancer, and Sexual Health
Studies have shown that male cancer patients can experience sexual problems at any point in the continuum of their care. Too often, the assessment and treatment of these problems are not routinely provided, usually due to time constraints, patient embarrassment, lack of physician training, or a combination of these factors.
Common Male Sexual Health Issues
For both current and former male patients with a variety of cancers, the most commonly experienced sexual health problems include erectile dysfunction, ejaculatory dysfunction (both premature and retarded), physical deformities (such as a condition known as Peyronie's disease, which can occur as a result of certain prostate cancer interventions), and both psychologically and hormonally based sexual desire issues. In addition, there may be anxiety that can accompany cancer diagnosis and fatigue that can accompany treatment.
Any life stressor is harmful to your sex life. The most potent anti-erection drug is adrenaline. Adrenaline is released when you're tired, worried, stressed, or angry, all emotions that cancer patients may experience during the various stages of their diagnosis and treatment.
Many men deny that they have a problem, or to try to solve the problem by themselves. Even with these obstacles, the overwhelming majority of men with cancer-related erection and other sexual dysfunction problems can be successfully treated.
Using a multidisciplinary approach, employing the skills of urologists, mental health professionals, social workers, and couples' therapists, who together provide everything from evaluation to diagnostic procedures and treatment, this can be successfully addressed.
Sexual dysfunction, during and after cancer treatment can affect men of all ages.
The single biggest challenges for any man in this situation, is the erosion of his confidence. The restoration of that confidence is complex and takes time. It is a combination of a multidisciplinary approach and partner interest, motivation, and support, both are extremely important when dealing with male sexual dysfunction.
It is important to remember that it is not just a man's problem, it is a couple’s issue, and when both are willing to seek assistance it also allows treatment of sexual problems (physical and emotional) on either side of the relationship.
Please speak with your health care team/doctor, and seek the necessary support and assistance to help you both achieve and enjoy your sexual relationship again.
Women, Cancer, and Sexual Health
As any woman dealing with cancer knows, the potentially disruptive effects of the disease can reach beyond the obvious challenges encountered during treatment. Among the many secondary concerns, sexual dysfunction is a common consequence of diagnosis and treatment. Although the majority of sexual health problems experienced by women can be effectively treated, this sensitive subject is often left unaddressed.
Health care providers may not have the time, resources, or training to deal with sexual health problems experienced by women with cancer. In addition, women may feel embarrassed discussing the subject with their caregivers. As a result of these factors, sexual problems experienced by female cancer patients are often neglected and left untreated.
As more women are surviving cancer, there are an increasing number of women having to deal with the sexual ramifications of cancer therapy, and as they become more aware of the issues involved, they are demanding help.
Using a multidisciplinary approach, offering a comprehensive psychosexual and gynecological evaluation, which includes patient history, clinical physical examination, and any necessary laboratory tests, can help treat a woman's sexual problems with a wide array of tools - physical therapy, hormonal manipulation, counseling (individual, cognitive, behavioral, and psychiatric), and alternative therapies, including looking at lifestyle issues that can affect sexuality, such as diet, exercise, and stress management.
The most common sexual health problems experienced by women dealing with cancer include treatment-induced menopause and vaginal dryness, which can lead to painful intercourse and a resulting diminution in sexual desire; body image issues, due, for example, to the removal of a body part such as a breast; and fertility concerns after systemic therapy.
Sexual rehabilitation during and after cancer does not always involve sexual intercourse: What it does mean is physical connectedness and intimacy. This intimate connection between a woman and her partner means that any potential sexual problems are shared by both. Cancer does not always affect only the patient; it can also affect the patient's partner. As a result, a patient's partner should be encouraged to participate in the sexual rehabilitation process.
Nowadays, women who are married or single, young or old, heterosexual or lesbian, feel that sexuality is a vital component to overall health and quality of life, and as they are living longer, cancer survivors are demanding an improved quality of life, and a healthy sex life is an essential component of that.
Please speak with your health care team/doctor, and seek the necessary support and assistance to help you achieve and enjoy your sexuality again.