Home>Cancer information>Survivors' guide>Long-term side effects

Long-term side effects

Friday 29 January, 2010
Reviewed by: A/P Michael Jefford MBBS, MPH, MHlthsevMt, PhD, MRACMA, FRACP, Consultant Medical Oncologist, Peter Mac; Dr. Carrie Lethborg, MSW, PhD, St. Vincent's Hospital

On this page: Fatigue | Pain | Changes in the way you look and feel | Cognitive problems (chemo brain) | Your sexuality and sex life | Menopausal symptoms (women) | Effects of hormone treatment (men) | Feeling low or depressed | Fertility problems | Other problems | Using complementary therapies

After your cancer treatment is over, you may think that you won't have to cope with side effects anymore. Unfortunately, this isn't true for everyone.

‘I had no idea that I would still be feeling tired 5 months after finishing treatment ... I didn't know how to make it better and I was scared that's how it would be: that I wouldn't go back to normal, that I would never go back to having energy again.' (Georgina)

It can take time to get over the effects of your treatment. Some problems will disappear quite quickly. Others can take weeks, months or even years to go.

For some people there may be permanent or ‘late' side effects. ‘Late' side effects are problems that develop a long time after treatment finishes. If this concerns you, talk to your doctor, who will tell you if you are at risk.

The side effects will vary depending on the type and stage of your cancer as well as the type of treatment you had. Some people need to make big changes to their life, such as people who have lost a limb or can no longer eat and drink in the same way. Other changes may include sexual problems, incontinence, pain and fatigue and sometimes emotional changes such as anxiety, depression and loss of confidence.

Everyone is different. Someone who had the same type of cancer and treatment as you may recover faster. You may have side effects that they didn't. But this doesn't mean that your cancer is more serious or more likely to come back.

Your body will cope with the treatment and recovery in its own way. Try not to worry too much if it is taking a while to feel right again. The important thing is that you find the right support to help you manage and cope with any side effects that you have.

The most common problems that cancer survivors say they have include:

often feeling very tired (fatigued)
pain
loss of self-esteem and confidence about your body
changes in the way their bladder and bowel work
coping with menopausal symptoms
problems with eating, drinking and weight
mouth and teeth problems
bone loss problems (osteoporosis)
fertility problems
swelling in the limbs (lymphoedema)
changes in their sexuality and sex life.

Any change in how your body looks, feels or functions can be very hard to deal with. Other people may not understand how much these changes can affect day to day living, especially if it's a few months or years after your treatment finished. This can be very isolating and make it even harder to cope with your side effects.

You may also find it helpful to join a support group or talk to someone who has been through a similar experience. Many cancer survivors say that talking to others who are having similar difficulties after their treatment can help a lot.

Fatigue

Fatigue means feeling very tired and lacking energy to do day-to-day things. Fatigue for cancer survivors can be very different from normal tiredness. It doesn't always go away with rest or sleep.

Fatigue during treatment can be caused by the cancer treatment, poor nutrition, pain or having too few red blood cells (anaemia). But doctors are still trying to find out the exact causes and ways of managing fatigue after treatment ends.

Fatigue is the most common side effect of cancer treatment. Many cancer survivors say that in the first year after treatment, fatigue is very disruptive. Some people say that it greatly affects their quality of life. Day-to-day tasks such as bathing, cleaning, shopping, eating and cooking leave you feeling exhausted. Even talking to those close to you can sometimes feel too tiring. Some people may feel they have to give up working because they feel too tired.

Fatigue can go on for weeks or months after treatment. Most people will get their energy back between 6 and 12 months after treatment. But it can take longer, and for some people it gets worse over time and continues for years. For example, people who've had a bone marrow transplant may lack energy for years after they finish treatment.

Cancer survivors have described their fatigue as:

overwhelming, unbelievable and frustrating
unrelated to how much you do
affecting your whole body: every part of you feels tired and worn out; your muscles may even ache
difficult to describe and hard for others to understand
not helped by rest or sleep
exhausting for the mind, body, emotions and spirit
like a heaviness in the arms and legs.

Many survivors say that they worry their fatigue is a sign that their cancer has come back or that it never really went away. This can be difficult to cope with.

If fatigue continues for long periods of time you may also begin to feel quite down about it. You may lose interest in things that you usually like doing or feel unable to concentrate on one thing for very long. It can affect how you feel about yourself and others, which in the long term may affect your close relationships.

You may worry that your friends or family won't believe you or they might think that you're complaining too much if you keep saying how tired you feel. They may not appreciate the long-term effects that fatigue can have on you. But research in this area is growing, and showing just how long fatigue can affect cancer survivors. Doctors are taking more notice of this symptom in survivors and finding more ways to help relieve fatigue.

Letting those close to you know will help them to understand why you might be feeling down or lacking motivation.

A lot of cancer survivors don't ever report fatigue to their doctor because they think that nothing can be done about it. However, if you have fatigue, discuss it with your doctor or nurse, as there are things that can help. For example, research has shown that mild exercise helps to increase energy levels and your doctor can advise you about this.

Tips on how you can help to relieve your fatigue

You can't always stop your fatigue but you can find ways of managing it. If your fatigue is caused by low red blood cells or the side effects of drugs that you are taking your doctor may be able to treat that cause. But otherwise you may have to learn to take short cuts and get help from others to make sure your fatigue doesn't take over your life.

Not all of these things will work for everyone but you may be surprised how small changes can help to save your energy.

Set small goals that you can achieve. Plan your day.
Don't be afraid to ask for help: ask friends to pick the kids up from school, do the shopping, or come to clean the house once a week.
Plan ahead. For example, get all your clothes ready before you shower, this way you only have to walk to your wardrobe once
Rest before you get too tired.
Try not to rush: leave plenty of time to get to appointments.
If possible, sit down to do some household chores like cutting up the vegetables and ironing.
Say no to things that you really don't feel like doing. Try not to feel you have to please others all the time.
Get some exercise. This may be the last thing you feel like doing. But research shows that exercise can boost energy levels and make you feel better-even if you just walk around the garden or block a few times a week. It all helps.
Leave chairs around the house so that you can sit down whenever you feel tired.
Sit down when you are talking on the phone.
Smoking reduces your energy. If you smoke, talk to your doctor or the Quitline on 13 7848 about stopping.
Don't do the shopping during busy times. Write a list of what you want; this saves you time thinking on your feet
If you have children, try to play with them sitting or lying down: board games, puzzles and drawing are good ideas.
Eat nutritious meals and snacks throughout the day to keep your energy levels up.
Try to take some time out to do things that you enjoy. For example, sitting in the garden or listening to some music may help you relax and for a short time, take your mind off how tired you feel.
Call the Cancer Council Helpline on 13 11 20 to be put in touch with a Cancer Connect volunteer, who can share their story of how they coped.
Join a Cancer Support Group. The Cancer Council Helpline can help you find one near you. It's good to talk and hear how people in similar situations have managed. Alternatively you may prefer to be linked to an internet or telephone support group.

Pain

Pain following cancer and its treatment is not uncommon.

For example, chemotherapy and surgery can injure nerves and cause pain and numbness in certain areas of the body. Or skin may be very sensitive in the area that received radiotherapy; this can last for a few months. Scars from surgery can also be painful for a long time.

Some people have pain in a missing limb or breast. Doctors call this ‘phantom pain'. It is common when people lose a limb, and is an effect caused by your brain and nervous system. This type of pain is sometimes hard to treat.

Whatever type of pain you have, you need to get pain relief. Be clear with yourself and your doctors about the pain. Once your doctor knows how much pain you are in, how often and the type of pain, they will plan suitable treatment.

Try not to put up with the pain and think that you should be able to handle it. Asking for help isn't a weakness. It is your right and you deserve to be pain-free. You are likely to have enough to deal with right now and trying to live with pain on top of it all will only make things harder for you and those close to you.

Pain relief after cancer treatment

Depending on the type of pain and how severe it is, your doctor may prescribe drugs for pain relief (analgesia).

Your doctor will usually begin with something mild and see what works for you. If you do need something stronger, such as codeine or morphine, don't be afraid to take them as often as your doctor tells you to. If your doctor prescribes it, this is because it is the best drug to help control your type of pain. Take it as often as your doctor prescribes it: you should not leave a dose out because you are not in pain at the time. Drugs for pain relief work best if you take them before pain becomes severe and then according to the dose prescribed by your doctor.

Morphine is a very effective drug for pain relief. It is prescribed for people at different stages of the cancer journey, not only for people with advanced cancer. Don't feel that being prescribed morphine says anything about the stage of your cancer: it's about the pain relief needed at that time, not about your cancer.

Some people worry that they will become addicted. But this is very unlikely if you take the correct dose and see your doctor regularly. Most people who take pain relief for severe pain find it easy to stop when they don't need it any more.

Others feel very frightened of being too drowsy or ‘high' while on them. Again, this is unlikely if you take them as your doctor prescribes. You may feel drowsy to begin with but this usually wears off within a couple of days. If it doesn't, it may mean that the dose is too high and your doctor can change this if necessary.

If your pain is very severe you may need to take high doses of these drugs to help control your pain. This is quite safe. Don't worry that your body will become resistant to the drugs and they will no longer work for you. Your doctors and nurses will monitor you very closely for any side effects that you may have.

In addition to morphine, your doctor may also prescribe other types of drugs to help relieve your pain. This may include anti-depressants and anti-epilepsy drugs. Again, these are safe and can help control some people's pain a lot more. Being prescribed these drugs does not mean that you have depression or epilepsy.

Strong drugs for pain relief almost always cause constipation. It is very likely that your doctor will also prescribe medication to deal with this.

You may need to have physiotherapy to help with pain. The therapist may use heat, cold, massage or exercise. Some people find relief in acupuncture. This is a method for relieving some types of pain. The acupuncturist puts small needles into pressure points to help control your pain.

Nerve blocks and surgery can help some people. But your doctor will usually only use these when nothing else is working.

How you relieve your pain is best discussed with your doctor. They will know what type of cancer and treatment you had, why you have your pain and a bit about you as a person. Try to be as honest as you can. They need to know exactly how bad it is and how much it is affecting your day-to-day life. All these things are important in helping to decide the best treatment and care for you.

Other ways of helping relieve your pain

You and your family can do several things that may help with your pain. They may not be miracle cures but may give you some relief, even if only for a short time. And many people say that doing something for themselves gives them a feeling of having more control over their pain.

Your pain may be worse at certain times of the day or when you are feeling anxious or upset. Take note of these times.
Some of the following tips may help.
Use relaxation techniques such as deep breathing, meditation or listening to your favourite music.
If you have trouble getting to sleep at night because of your pain, listen to some music or relaxation CDs with earphones in bed.
Get up at night to read, watch TV or listen to some music.
Ask someone close to you to give you a gentle relaxing massage. It can help relieve aches and pains in the back.
Complementary therapies such as massage, aromatherapy, reflexology, hypnosis, yoga and acupuncture are known to help some people relax and better cope with their pain.
Apply a warm or cold pack to the area of pain. Wrap the pack in a soft towel and check your skin regularly to make sure the heat or cold is not damaging your skin.
Take a warm bath or shower.
Don't sit or lie too long in one place. Move around to help prevent stiffness and sore skin.
Talk to friends or family about your pain. This may help you relieve tension and make it easier to cope. Some people find it easier to talk with a counsellor rather than someone close to them.

Before you try any type of complementary therapy, check with your doctor that it's okay. Sometimes a doctor will advise against a therapy. For example, your doctor may advise against a strong deep tissue massage if you have bone problems. Always let the complementary therapist know that you have had cancer.

If you would like more information and support with your pain and how to manage it, contact the Cancer Council Helpline on 13 11 20.

Changes in the way you look and feel about yourself

Cancer and its treatment can affect how people look and feel about themselves. You may have changes in:

speech
how well you can eat and drink including swallowing problems
breathing
weight (weight loss or gain)
memory and being able to concentrate
bladder and bowel (for example, if you now have a colostomy or ileostomy)
sexuality and sex life being able to have children (fertility).

How you look and how your body works is an important part of your self-esteem. Many cancer survivors say that they feel very angry and upset by the changes their cancer and its treatment may have caused. For some people these feelings can last a long time.

It can be hard to accept sudden or unexpected changes to the way you look. You may worry about how your friends and family now look at you, and whether you are still attractive. Others worry more about how they will cope when they go back to work or even if they will be able to return to their old job.

It is normal to worry like this. Try to get support from those close to you. Let them know how you are feeling. They are likely to want to support you and tell you that they still love and see you in the same way as before. Hearing these words may help you feel more confident.

If you don't want to talk to friends or family about how you feel, it may help to talk to a professional counsellor. Some people say it helps to talk to someone who has had a similar experience.

Call the Cancer Council Helpline on 13 11 20. They will be able to give you information about your concerns and refer you to resources and support services. For example, Cancer Connect is a telephone peer support service that puts people in touch with others who have had a similar cancer experience. You can talk to someone who understands what you are going through-who knows what it is like to have cancer affect their life and the lives of those close to them.

Cognitive problems (‘chemo brain')

After chemotherapy many people say they find it hard to concentrate, focus and remember things. This is often called ‘chemo brain'. ‘Chemo brain' is not a proven side effect of chemotherapy and it is not clear how many of the cognitive problems described in this section are due to chemotherapy.

It can be very frustrating, especially if you need to concentrate on fine detail, for example in your work or study. People who have always been able to concentrate well may find the changes embarrassing and hard to cope with. It may help to know that ‘chemo brain' can happen to anyone who has chemotherapy.

Researchers are trying to discover what causes these memory and concentration problems after chemotherapy. The problems usually get better with time, but it may take a year or more. Some of the following tips may help:

Use a calendar or daily planner to keep track of tasks, appointments, social commitments, birthdays, etc.
Make lists of things you have to remember: things you need to do that day, things you need at the shops, even where you parked the car.
See if ‘exercising your brain', for example by reading, crosswords, puzzles, study or doing a hobby helps you to concentrate more.
Plan your activities so you do things that require more concentration when you are more alert, such as in the morning.
Get plenty of sleep and exercise. Deep sleep is important for memory and concentration. Exercising every day will help you sleep better.
If your ‘chemo brain' affects your study or work, let your supervisor or manager know. See if project deadlines, performance reviews and so on can be rescheduled.

Try to be patient. Talking to others, for example, your partner, manager and colleagues, can help to prevent misunderstanding and frustration.

Your sexuality and sex life

Cancer and its treatment may affect your ability or desire to have sex (libido).

You may not even be aware that you are not taking an interest in sex or being as intimate as you might have before. If you have a partner, this can be confusing for them. See our sexuality and cancer section for more.

Some people won't feel any differently sexually. But if you do, it can be difficult to deal with. Some of the changes are temporary; others may be longer lasting.

Anyone who has had cancer may have sexual concerns following their treatment, but those most likely to report long-term problems are:

women who have had treatment for breast cancer, ovarian cancer, cancer of the uterus and cervical cancer
men treated for prostate cancer.

What causes the problems?

Sexual problems can be caused by many things including:

feeling down and depressed
changes in how your body looks or functions because of your treatment
pain and the side effects of drugs for pain-relief
feeling very tired a lot of the time (fatigue)
how you see yourself (your body image)
a range of emotions due to the cancer and treatment, such as anger, sadness and fear
how your partner reacts and responds to you
practical matters such as your job, money and caring for children.

All of these things can affect how relaxed you can feel about having sex.

The types of problems you may have

Because we are unique and have different sexual needs and desires, it is not possible to predict how each person will be affected. A lot will depend on the type of cancer and treatment that you had.

Some women may find that changes to their body make it difficult or painful to have sex. Pain is often related to changes in the size of the vagina or vaginal dryness because of hormone treatment, pelvic surgery or radiotherapy. Early menopause brought on by treatment can also affect women's desire.

Men may not be able to have an erection or ejaculate. Some prostate, bowel and rectal surgery or radiotherapy can make it difficult to have an erection. Erection problems can be difficult to come to terms with and may have a big effect on your sex life.

Your cancer and its treatment may just have made you feel differently about your body. You may feel less sexual because you look different or feel less attractive: perhaps you have had weight loss or gain, a colostomy bag, or a testicle or breast removed. These don't mean you can't have sex, but may feel less like having sex.

You may feel embarrassed and upset by the changes and not want your partner to see you naked. This is very natural. It may take some time before you feel confident about your new appearance and want to have sex again.

Some people say that they were not prepared for the sexual changes from 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 your cancer treatment has affected your ability to have children, this may also change the way you feel about having sex.

Don't think that you have to do anything that you don't want to. It usually helps to talk to your partner about any issues. Let them know why you don't want sex but reassure them that you love them and want to be close. Most partners will understand and be happy to do things at your pace.

Ways of coping with any sexual changes

Coping with sexual concerns will vary from person to person. What works for one person may not be helpful for another. Some of following tips may help you.

If you have some pain but want to have sex, it can help to plan ahead. It may not be as spontaneous and exciting, but taking drugs for pain relief an hour or so before sex may make things more enjoyable.
Concentrate on being intimate in other ways such as kissing, massaging, talking and holding hands.
If you have low or no sex drive, talk about it with your partner. They need to know so that they can think of ways to help get you in the mood.
Try experimenting with ways of making you feel ‘in the mood'. For example, dress up, use candlelight and music, have a nice meal and some wine with your partner.
Change position during sex to see which is easiest for you.
Talk to your partner about what you want and both feel happy with. This may be difficult at first but might also be very reassuring.
Talk to your doctor. They may be able to prescribe medications to help with some problems such as difficulties having an erection.
If you have vaginal dryness or tightness, try a lubricant during sex or, if you have had radiotherapy to your vagina, use a dilator during treatment and before sex.
If you feel that you need more foreplay to help you relax and enjoy making love, let you partner know this.
If you are having trouble being aroused by your partner, some people say that it can help to try to pleasure themselves. This may help give you the confidence that you can still enjoy sex. It might just take some time with your partner.

There are many other things that may help you and your partner enjoy sex more.

You may find it helpful to talk to someone about sexual concerns. But not everyone finds it easy to talk to someone close to them. If you would like to talk to someone outside your own friends and family, call the Cancer Council Helpline on 13 11 20. They will be able to talk things through at your pace and may be able to reassure you about your concerns.

Menopausal symptoms (women)

For women, certain cancer treatments can cause an early menopause. These include:

certain chemotherapy drugs
radiotherapy to the pelvic area
hormone therapy
surgery to remove your ovaries.

Going through a natural menopause is often tough for women. But menopause can be more severe if it happens suddenly because of cancer treatment.

What changes can happen?

Menopause means that your ovaries no longer produce an egg each month and you no longer have periods. This means that you can no longer become pregnant and have a baby.

For women who want children and have not yet had them, this can be extremely sad. Even if you have had children, don't want any more or never did want children, it may still be upsetting. Some women just find it hard because it has taken away a part of their identity as a woman.

Other symptoms of menopause include:

mood changes: some women may notice that they feel a bit low at times; others suffer anger, depression or anxiety problems
vaginal dryness, which can make it painful or uncomfortable to have sex
hot flushes and sweating (often made worse by taking hormone blocking treatments such as tamoxifen)
feeling very tired
loss of concentration, self esteem and confidence
bone thinning (osteoporosis).

Many of these symptoms will pass but it can take up to a couple of years for this to happen.

For many women, moderate to severe symptoms can often be relieved by taking hormone replacement therapy (HRT). HRT is taken as a daily tablet or skin patch and contains female sex hormones to replace those that your body is no longer naturally.

After some types of cancer, taking HRT is not advised. For example, if you had a breast cancer that is likely to grow in the presence of hormones, your doctor is likely to strongly advise against taking HRT as it could increase your risk of your cancer coming back (recurrence).

Sometimes, where women are having a lot of problems and nothing else has helped, some breast cancer specialists may suggest using HRT.

Talk over these issues with your doctor and weigh up the possible benefits and risks for yourself.

Coping with menopausal symptoms

For some women, coping with symptoms without HRT may be very difficult. You may find that your confidence and self-esteem suffer quite a bit. Some women find it helps to talk with a counsellor about how they feel. Others find comfort and support from their friends and family. The important thing is to do what works best for you.

What happens to you and your body during menopause is in many ways not under your control. So be kind to yourself and try not to lose too much confidence. Below are some suggestions, other than taking HRT, which may help lessen some of the physical effects of menopause.

Vaginal dryness

Some women may be able to use vaginal oestrogen. This comes in the form of a cream or pessary that you put into your vagina a couple of times a week.

Your body will only absorb a very small amount of the oestrogen, so it won't affect the rest of your body. If you think this may help, ask your doctor if this is an option for you.

Other options include using non-hormonal creams that you can buy from the chemist or using water based lubricants during sex.

Hot flushes and sweats

If you can't take HRT, these symptoms can be very difficult to control. Many women want to try non-drug type methods to help stop their hot flushes. Some women use acupuncture, homeopathy, evening primrose oil or plant oestrogens (phyto-oestrogens). Research is needed to show whether there is any evidence that they really do help.

Research has shown that low-dose progesterone helps to reduce hot flushes and sweats in some men and women who are taking hormone therapy for their cancer. Many doctors think that very low doses are safe even if you have a hormone-dependent cancer. Another drug that has shown to help some women cope with hot flushes is an anti-depressant drug called venlafaxine. Your doctor is the best person to talk to about whether or not either of these drugs might help you.

Simple ways of coping with hot flushes include standing near an open window or keeping a small fan nearby. Use cotton clothing and sheets to help let your skin breathe. Dress in layers so you can remove some clothing when having a hot flush. Have a cool drink when a flush starts may also help.

Mood changes

Mood changes during menopause can become very upsetting not only for the woman but also for people close to them. Feeling low, sad, angry, anxious, irritable, frustrated or depressed is not uncommon. You may find it very hard to cope with your feelings and not know who to talk to.

There is probably no magic cure to feeling any or all of these. But many women say that it can help to:

be active: develop a daily exercise program that suits you and try to stick to it
eat healthily: a balanced diet keeps your body and mind healthy
drink plenty of water
try relaxation techniques such as deep breathing, listening to music that you like or meditation: regular practice may help you to feel calmer and more in control of your feelings
let people close to you know how you are feeling: if they don't understand your moods it is likely to cause more problems.

All of these suggestions may help control other symptoms of meno-pause as well.

Effects of hormone treatment (men)

The symptoms described in the menopause section above are commonly associated with menopause in women. But men who are taking hormone therapy or have had their testicles removed may also have these symptoms. It may help you to read the section above.

Feeling low or depressed

It isn't uncommon to feel very low or depressed for some time after your treatment finishes. Or you may feel okay for a while and then start to feel sad or down a few weeks, months or even years later.

Feeling low

Try not to be too surprised if you do feel fed up and unhappy at certain times. With all that you have been through, it is quite normal.

Knowing why you feel like you do can help you to work your way through your feelings. Some people feel sad or depressed because of the changes that their cancer has caused. Others feel very down because they are frightened about the future. Will their cancer come back? Will they be able to work again? How will the family cope if they can't earn any money?

Whatever is making you feel down it is important that you get support.

Signs of depression

There is a difference between feeling down and sad for a while and feeling very depressed for long periods. Depression is much harder to shake and can go on for a long time if you don't get the right sort of help. Depression is quite common and needs to be treated.

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

feeling very sad and low most of the time
not being able to enjoy life as you usually do
having negative thoughts about yourself a lot of the time
changes in your eating habits: eating much more or less than usual
weight gain or loss
feeling very tired a lot of the time
loss of concentration
loss of interest in sex
changes in your sleep habits: not being able to get to sleep, waking in the early hours of the morning or sleeping more than usual
often feeling very anxious and upset
feeling that you want to die or would like to kill yourself.

These are not the only signs of depression. Some of these symptoms may be caused by other medical conditions. But if you have some of these signs or think that you may be depressed, it is important that you get some professional help.

It often helps to let someone close to you know how you are feeling. Also, it is important to let your GP know. Be honest with them about how you feel. This will help your doctor and you make the right decisions about the type of support and care you need.

What help can I get with feeling depressed?

It isn't a weakness to feel depressed and ask for help. Try not to ‘beat yourself up' and think that you should be able to cope alone. It takes a lot of courage to ask for help and you deserve to feel good about yourself and life again.

There are lots of things that can be done to help with depression, for example professional counselling or psychotherapy. Anti-depressant drugs can make a dramatic difference for some people. Whatever works for you is all that matters.

Your doctor will be able to explain the difference between counselling and psychotherapy, and between a counsellor, psychologist and psychiatrist. This information will help you to choose the support you need.

Ways to help yourself feel better

These suggestions may help you feel more in control and positive that things can get better.

Complementary therapies such as massage, yoga, hypnosis, acupuncture and reflexology may help improve your mood.
Make sure you take care of yourself. Eat a well balanced diet with lots of fresh fruit and vegetables and drink plenty of water.
Get regular exercise. Many people say that being active helps lift their mood.
Share your feelings with someone close to you: just having them know how you feel can help you feel less alone.
Even if you don't feel like it, try to push yourself to go out and do something you enjoy. A change of scenery can often make you feel better.
Some people find it helps a lot to write down how they are feeling. Others might find it easier to express themselves in painting, drawing, music or singing.

If you have signs of depression (see the section above), see your doctor. Some of these approaches may also help, but depression really needs the care of a doctor as well.

Herbal products to treat depression

Over the past few years there has been a lot of interest in the use of herbal products to help treat depression. But just because something is labelled ‘natural' it doesn't always mean that it is safe to take. Some can have very serious side effects and may interact with other drugs that you are taking.

Two herbal products that have been given a lot of attention in the media as being able to help 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 not found this to be the case.

Both have side effects and should not be taken with other anti-depressant drugs. The Cancer Council strongly discourages anyone from using any herbal products without first consulting their doctor.

See the ‘Support services and resources' section at the end for websites that provide information about complementary and alternative treatments.

Fertility problems

Loss of fertility can be a side effect of some cancer treatments. This means that you will no longer be able to have children. For some people this is only temporary, but for others it is permanent.

Having children may not be a priority for you: other long-term side effects may be more difficult to cope with.

If you have always wanted to have children, you may be very sad to hear that is no longer possible. While you may have coped well with the news during treatment, you may find it very difficult to cope with after treatment finishes.

Your age and whether or not you have children already can play a part in how you deal with the news of infertility. But even if you have children and were not planning to have any more, you may still feel a sense of loss: that you are less feminine or manly because you can't have children. You may feel very angry, sad or anxious that your cancer and its treatment caused these changes to your body.

If you are finding it hard to come to terms with being told that you can't have children, call the Cancer Council Helpline on 13 11 20. You will be able to speak with a qualified cancer nurse, who can offer you support and advise how you and those close to you can best cope.

About using complementary therapies

Some cancer survivors say that using complementary therapies after their cancer treatment helps them to:

cope with some side effects such as pain and fatigue
relieve the stress of rebuilding their life
relax and feel good again
feel more in control of their situation.

Complementary therapies are used with, not instead of, medical treatments. Examples include yoga, gentle massage, reflexology, acupuncture, meditation, hypnotherapy and counselling.

Although there is no research to prove that these therapies can stop your cancer coming back or prevent a new cancer, they can be comforting. The touch, talk and time people receive from their therapist can be very reassuring. Music or art therapy can be useful in helping people to express their feelings and remain positive about their future.

Most complementary therapies are safe to use and if they help, most doctors will be happy for you to use them. But it is important to talk to your doctor before using any type of therapy. A good complementary therapist will always encourage you to talk with your cancer doctor or GP.

If you would like information about a type of complementary therapy, call the Cancer Council Helpline on 13 11 20.