Managing side effects

Tuesday 1 April, 2014

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On this page: Tiredness | Feeling low or depressed | Menopause | Bowel problems | Fluid build-up | Key points


Treatment will cause some physical and emotional changes. Some women experience limited side effects from treatment, while others are more severely affected.

There are ways to reduce or manage the discomfort that side effects may cause. 

Tiredness

It is common to feel tired or fatigued during or after treatment. Most women who have chemotherapy start treatment before they have had time to fully recover from their operation. Travelling to and from hospitals and clinics for treatment can be tiring.

If you are working during the treatment, or if you have a home and family to care for, you may feel very tired. Women who are on their own may also feel fatigued.

Your tiredness may continue for a while after treatment has finished. Some women find that it takes them up to 1–2 years to feel well again. It may help to talk with your family and friends about how you feel and discuss ways in which they can help you. You may need to plan your activities so that you get regular rest breaks.

"I rested as much as possible, but I don't think that I got good sleep because of my fear and uncertainty. I also found that after lying around and resting, I lost a lot of muscle mass." — Patricia

Feeling low or depressed

It is natural to feel low or depressed after a cancer diagnosis, during treatment or when you are recovering. Some people feel sad or depressed because of the changes that their cancer has caused. Others are frightened about the future.

There is a difference between feeling down and feeling depressed. You may be depressed if you are in a low mood for most of the time, or if your sadness lasts two weeks or more. Some of the other signs to look out for include feeling flat, teary, anxious or low most of the time, loss of interest in and pleasure in normal activities, having negative thoughts about yourself most of the time, or feeling tired a lot of the time.

Talk to your doctor if you experience one or more of these signs for a few weeks or more. For further information on support for depression, see the Beyond Blue website.

Depression will not go away by itself – you will need specific treatment. There are many effective treatments for depression, including both medication and non-medication options, such as counselling. Being honest with your doctor about how you feel will help you get the right type of support and care.

"My advice to other women is: be kind to yourself, this is really tough. Don’t feel like you have to be strong all the time. It is ok to be sad at times. You don’t always have to ‘keep it together’." — Patricia

Menopause

In women who are still having periods, an operation to remove the ovaries will bring on menopause. This means that your periods will stop and it will no longer be possible to become pregnant.

The sudden onset of menopause can be physically and emotionally difficult. Menopausal symptoms include hot flushes, mood swings, trouble sleeping, tiredness and vaginal dryness. Symptoms may be more severe than a natural menopause because the body has not had time to get used to the gradual loss of hormones.

Tips
  • Use moisturisers to relieve vaginal dryness. Some products contain oestrogen, but moisturisers without oestrogen can also be used.
  • Use extra lubrication to try and make intercourse more comfortable for you. Choose a water- or silicone-based gel without perfumes or colouring to reduce irritation.
  • Ask your doctor for advice if you want to try any herbal remedies or dietary changes.
  • Talk to your gynaecological oncologist about the benefits and risks of hormone replacement therapy (HRT) for you. HRT can help reduce symptoms. Using HRT with oestrogen may increase the risk of some diseases, such as breast cancer. If you were already on HRT when the cancer was diagnosed, you will need to weigh up the risks of continuing it.
  • Ask your doctor about medication for relieving the symptoms of menopause. You can also call Cancer Council 13 11 20 for suggestions.

Infertility

Some treatments for ovarian cancer can impair your fertility . Younger women and those who hope to have children may feel deeply upset if told that they can no longer have children naturally.

For some women, having children is a long-held dream. You may feel extremely upset if you are told you will be infertile. Even if you had not planned to have children or have finished having a family, the removal of your reproductive organs may make you feel less feminine.

These feelings are all understandable. It may help to talk about your feelings with a family member, friend, counsellor or gynaecology oncology nurse. There are also fertility specialists that can support you and provide information on the fertility options available. Talking to someone and becoming well informed about your options can be valuable.

Talk to your doctor about your fertility before treatment. You may be referred to a fertility clinic. 

Bowel problems

After surgery, during radiotherapy or chemotherapy, some women have bowel problems, such as diarrhoea, cramps or constipation. These can occur for some time. Ask your doctor or dietitian for advice about eating and drinking, and see the tips below for ideas to prevent or relieve these side effects.

Try and avoid becoming constipated, as this will put more pressure on the bowel. Talk with your doctor, nurse or dietitian about ways to prevent constipation.

Surgery may sometimes cause the bowel to become blocked (bowel obstruction). However, this blockage can also occur because the cancer has come back. If you have symptoms such as feeling sick, vomiting, or abdominal discomfort and pain, you should see your doctor or specialist as soon as possible.

A bowel obstruction can usually be relieved with treatment in hospital. Occasionally, another operation may be needed to unblock the bowel. 

Tips
  • Prevent or manage constipation by eating more high-fibre foods, such as wholegrain bread and pasta, bran, fruit and vegetables.
  • Drink plenty of fluids. This will help loosen the bowels if you are constipated and replace the fluids lost through diarrhoea. Warm and hot drinks work well.
  • Ask your chemist or doctor about medication to relieve any symptoms of diarrhoea.
  • Eat small, frequent meals instead of three big ones.
  • Avoid fried, spicy or greasy foods, which can cause pain and worsen diarrhoea.
  • If you have a stoma, allow yourself time to adjust to this change. A stomal therapy nurse will be able to help.
  • Call Cancer Council 13 11 20 for free information about food and cancer.

Fluid build-up

Sometimes fluid can build up in the body:

  • Ascites: This is when fluid collects in the abdomen. It can be uncomfortable because of swelling and pressure. If ascites becomes a problem, a procedure called a paracentesis or ascitic tap can drain away the fluid and relieve discomfort. This may require an overnight stay in hospital.
  • Pleural effusion: This is fluid that collects in the lining of the lungs. This may cause pain and make you feel short of breath. Draining the fluid using a procedure called a thoracentesis or pleural tap can provide relief.
  • Lymphoedema: Radiotherapy or the removal lymph glands in the pelvic area (lymphadenectomy) may cause one or both of your legs to swell. This is due to a build-up of lymph fluid and may make movement and some activities difficult. It can occur at the time of treatment or months later. Your medical team can give you ways to deal with lymphoedema, such as gently exercising your legs or receiving a massage from a qualified manual lymphatic drainage practitioner.

To find a qualified practitioner, see the Australian Lymphology Association website. You can also contact Cancer Australia for a copy of the Lymphoedema – What You Need to Know booklet.

Key points

  • Some women experience a few side effects from treatment, while others have more. There are ways to reduce or manage the discomfort that side effects may cause.
  • The most common side effects are tiredness and fatigue. This may continue for a while after treatment has finished. It may help to plan your activities so you can take regular rest breaks.
  • Some people feel sad or depressed during or after cancer treatment. Depression is when you are in a low mood for most of the time, or if your sadness lasts two weeks or more. If you feel depressed, you will need specific support and/or treatment.
  • If your ovaries have been removed, you will go through a sudden menopause. This means that your periods will stop and it will no longer be possible to become pregnant.
  • If you are unable to have children as a result of treatment (infertility), you may feel very upset. Talking about your feelings with your family, friends or a counsellor may be helpful.
  • After surgery, some women have bowel problems such as diarrhoea, cramps or constipation. Surgery can also cause the bowel to become blocked (bowel obstruction).
  • Fluid may build up in your abdomen, lungs or legs. This can cause uncomfortable swelling or pressure. Your medical team may drain the fluid or give you advice about some exercises to help move the fluid around.  

Reviewed by: A/Prof Martin K Oehler, Department of Gynaecological Oncology, Royal Adelaide Hospital, SA; Lucinda Hossack, Cancer Genetic Counsellor, Peter MacCallum Cancer Centre, VIC; Dr Kevin Palumbo, Radiation Oncologist, Adelaide Radiotherapy Centre, Flinders Private Hospital, SA; Nicole Wilton, Support Programs Manager, Ovarian Cancer Australia, VIC; Ilka Carapina, Consumer; and Cancer Council Queensland Helpline Operators.

Updated: 01 Apr, 2014