Coping with side effects

Sunday 1 April, 2018

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On this page: Fatigue | Sleep disturbance | Pain | Lymphoedema | Memory and thinking changes | Tingling or numbness in hands or feet | Other physical problems | Changed body image | Sexuality and intimacy | Menopause | Fertility problems | Key points


It can take time to recover from the side effects of treatment. Side effects can be both physical and emotional. They can vary depending on the cancer type and stage, and the treatment you had.

Some side effects go away quickly; others can take weeks, months or even years to improve. Some may be permanent. Your body will cope with the treatment and recovery in its own way. It is important not to compare yourself to others.

Common side effects include:

  • feeling very tired (fatigue)
  • sleeping difficulties
  • pain
  • numbness or tingling in feet or hands (peripheral neuropathy)
  • persistent swelling (lymphoedema)
  • forgetfulness or memory problems (chemo or cancer brain)
  • changes in bladder or bowel functioning
  • heart problems
  • mouth or teeth problems
  • bone density loss (osteoporosis)
  • joint pain
  • problems with eating or drinking
  • changed body image, e.g. hair loss, weight loss or gain
  • changes in sexuality and sexual function
  • menopausal symptoms for women
  • fertility problems.

Some people experience late side effects. These are problems that develop months or years after treatment finishes. They may result from scarring to parts of the body or damage to internal organs. Talk to your doctor about whether you are at risk of developing late effects from your treatment. If you are concerned about a new symptom, talk to your doctor.

This chapter outlines many side effects common to cancer survivors and offers suggestions on how to cope with them. For further information and support, call Cancer Council 13 11 20.

Fatigue

Fatigue, or feeling very tired and lacking energy for daily activities, is a common physical side effect of cancer and its treatment. Fatigue is different from tiredness, as it doesn't always go away with rest or sleep.

Now that treatment is over, you may think you should be full of energy, but often this isn't the case. If you were unable to be active during treatment, you may have experienced a loss of muscle strength and fitness. This could contribute to your fatigue.

Many people say that fatigue has a big impact on their quality of life in the first year after treatment.

If you have a chronic medical condition following cancer treatment, talk to your GP about developing a Chronic Disease Management Plan or Team Care Arrangement to help you manage the condition.

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

Most people find that their energy returns 6–12 months after finishing treatment. However, some people lack energy for years after treatment and their energy levels may never fully recover.

Symptoms of fatigue

Signs of fatigue include:

  • lack of energy – you may want to stay in bed all day
  • difficulty sleeping
  • finding it hard to get up in the morning
  • difficulty completing tasks, especially in the afternoon, when energy levels can be unexpectedly low
  • feeling anxious or depressed, particularly if fatigue persists
  • muscle weakness – you may find it hard to walk or climb stairs
  • reduced mobility and loss of muscle strength (weakness)
  • breathlessness after light activity, such as making the bed
  • difficulty concentrating
  • finding it hard to think clearly or make decisions
  • having little or no interest in sex (low libido).

Many cancer survivors don't tell their doctor about fatigue because they think that nothing can be done about it. However, your treatment team may be able to help. For example, your fatigue may be caused by a low red blood cell count (anaemia), an underactive thyroid gland, depression or the side effects of drugs, which your doctor may be able to address. You may also find the tips below helpful.

How to manage fatigue

  • Set small, manageable goals – Focus on doing a little bit each day rather than a lot all at once.
  • Ask for, and accept, offers of help – Family and friends can help with school pick-ups, shopping or mowing the lawn.
  • Plan your day – Make a task list and do the most important activities when you have the most energy.
  • Take it slow – Work at your own pace and take regular breaks. Leave plenty of time to get to appointments.
  • Exercise regularly – Light to moderate exercise can boost energy levels and reduce fatigue.
  • Make time to relax – Try activities like walking on the beach, spending time in the garden or listening to music.
  • Adapt your play – If you have children, sit down to play. Try activities like reading, board games, puzzles and drawing.
  • Be realistic – Don't expect to be able to instantly do everything you used to do. Your body is still recovering and it will take time for your energy levels to return.
  • Say no – Don't feel pressured to do things that you don't feel like doing. If you have trouble saying no, ask someone to do it for you.
  • Stop smoking – Smoking reduces your energy. If you smoke, consider quitting.
  • Take it easy – Sit down to talk on the phone or do light chores. Do your shopping online. Talk to an occupational therapist for more tips on reducing fatigue in specific daily activities.
  • Eat nutritious foods – Aim to eat a healthy, well-balanced diet.
  • Seek help – Talk to your GP if your fatigue is caused by depression.

Sleep disturbance

Difficulty sleeping is common among people who have had cancer. Sleep can be affected by symptoms related to cancer treatment, such as pain, breathlessness, anxiety or depression. Some medicines can also disrupt sleep (e.g. hormone therapy for breast cancer). People who have pre-existing sleep problems can have additional sleep difficulties after their cancer treatment. If you have ongoing problems with sleeping, talk to your GP.

Managing sleep disturbance

  • Get up at the same time each morning, including weekends.
  • Exercise regularly but not right before bed.
  • Limit or cut out the use of alcohol, caffeine, nicotine and spicy food.
  • Avoid daytime naps.
  • Only go to bed when tired.
  • Set up a pre-sleep routine to help you relax.
  • Call 13 11 20 for a free copy of Cancer Council's relaxation and meditation CDs. Done regularly, these exercises may help you sleep better.
  • Avoid using electronic devices such as computers or smartphones before bed or in the bedroom.
  • Ensure the room is dark, quiet and a comfortable temperature.
  • If you wake up during the night, get up for a while.
  • If medicines interfere with your sleep, discuss alternatives with your doctor.
  • Cognitive behaviour therapy (CBT) has been shown to be effective in addressing sleep problems. Ask your GP for more information.

Pain

Pain can have a big impact on your life and prevent you from doing the things you want to do.

Chemotherapy and surgery may damage nerves and cause pain and numbness in certain areas of your body. Your skin may be sensitive in the area where you had radiation therapy; this can last from a few weeks to several months. Scars from surgery may also be sensitive or painful for a long time.

How you manage your pain depends on the type of pain you have. Pain may be a side effect of cancer treatment or it may be caused by an unrelated problem, such as arthritis.

Learning how to manage your pain may allow you to return to many of the activities you enjoy and improve your quality of life. Discuss your pain with your doctor so that the cause of the pain can be worked out and the best treatment plan developed. In cases where no fixable cause of the pain is found, the focus will shift to improving your ability to function despite the pain.

Common methods of pain relief

Persistent pain can be treated in a variety of ways:

  • A physiotherapist or exercise physiologist can develop a
  • program to improve muscle strength and increase your ability to function, which may help relieve pain.
  • Movement is very important: daily stretching and walking can help you deal with the pain. It is important to pace activities throughout the day, including rest and stretch breaks.
  • Cognitive behaviour therapy (CBT) can help people think about their pain differently. It has been shown to increase people's sense of control, improve mood, and decrease stress and anxiety.
  • Some complementary therapies may also help, especially those that require your active participation (see below). Always let your treating therapist know that you have had cancer.
  • Pain-killing drugs, called analgesics, are widely used to relieve pain caused by cancer. However, they have a more limited role in relieving pain experienced by cancer survivors. Paracetamol or non-steroidal anti-inflammatory drugs are the main drugs used to relieve pain in survivors. Opioids such as codeine and morphine have been shown not to work very well to control chronic pain.
  • Medicines normally used to treat depression or epilepsy have been found to help for some types of pain.
  • Rarely, some people have surgery or an anaesthetic injected into their body (nerve block).
  • If your pain is not well controlled, ask your doctor about referring you to a multidisciplinary pain clinic.
  • For more information about cancer-related pain, see Overcoming Cancer Pain or call Cancer Council 13 11 20.

Using pain-killers safely

All medicines including non-prescription pain-killers, may have side effects, particularly if they are not taken as directed:

  • Talk to your doctor, nurse or pharmacist about any pain medicines you are taking, side effects to look out for, and any possible interactions with other medicines, vitamins or herbal remedies.
  • Follow the directions for use and only take the recommended dose. This will reduce the risk of misuse or accidental overdose.
  • Let your doctor know if you have any side effects. They may need to adjust your medicines.
  • Most people taking opioids won't become addicted. The risk of becoming addicted depends on the dose and length of treatment. Some people are at increased risk.
  • You may experience withdrawal symptoms when you stop taking a drug, but this is not addiction. For this reason, your doctor will reduce your dosage gradually. Talk to your doctor if you are concerned about drug dependence.

Other methods of pain relief

  • A physiotherapist or occupational therapist can suggest ways to address physical or practical problems that are causing your pain.
  • Relaxation techniques, such as deep breathing, meditation or listening to music, may improve the effectiveness of other pain-relief methods, help you sleep and focus your attention on something other than the pain.
  • Massage or hot packs may relieve muscle spasms, stiffness and contractions.
  • Acupuncture may help by stimulating nerves to release the body's natural chemicals, which help reduce pain.
  • Other therapies may help, e.g. hydrotherapy or electrotherapy. For more information, see a physiotherapist.
  • Let your doctor know about any complementary therapies you are thinking about trying. Some therapies may not be appropriate. For example, your doctor may advise against a strong, deep tissue massage if you had surgery or bone problems during treatment.

Lymphoedema

Lymphoedema is swelling that occurs in the soft tissues under the skin due to a build-up of lymph fluid. If lymph nodes have been removed during surgery or damaged by infection, injury, or radiation therapy, the lymph fluid may not drain properly.

Swelling usually occurs in an arm or leg, but it can also affect other areas of the body. The likelihood of developing lymphoedema after treatment depends on the extent of the surgery, other cancer treatment and your body weight. Lymphoedema can take months or years to develop. Not everyone who is at risk will develop it.

Lymphoedema may be permanent, but it can usually be managed, particularly if diagnosed early. The main signs of lymphoedema include visible swelling, which may be associated with feelings of tightness or heaviness, an aching or tingling feeling, not being able to fully move the affected limb, or pitting of the skin.

Lymphoedema requires lifelong self-care and management. The focus of treatment is to improve the flow of lymph fluid through the affected area. This will help reduce swelling and improve the health of the swollen tissue. Reducing the swelling will lower your risk of infection, improve your wellbeing and make movement easier.

Gentle exercise, compression stockings, and a type of massage called lymphatic drainage can all help to reduce the swelling. It is important that you consult a lymphoedema professional who can tailor a treatment plan for you based on the location and stage of the lymphoedema and any other health conditions you may have.

How to prevent and/or manage lymphoedema

  • Treat lymphoedema early so that you can deal with the problem quickly and avoid symptoms becoming worse.
  • Keep the skin healthy and unbroken to reduce the risk of infection. Avoid cuts, scratches, bites and injections in the affected area.
  • Moisturise your skin daily to prevent dry, irritated skin.
  • Engage in activities like swimming, bike-riding or using light weights to aid the flow of lymph fluid.
  • Maintain a healthy body weight.
  • Protect your skin from the sun.
  • Avoid wearing jewellery or clothing that constricts the affected area or leaves marks on your skin.
  • Take care cutting your toenails or see a podiatrist to look after your feet and nails.
  • Raise your legs if watching TV. Avoid sitting for long periods.
  • Wear a professionally-fitted compression garment, if advised by your lymphoedema practitioner.
  • To find a lymphoedema practitioner, visit the Australasian Lymphology Association's website at lymphoedema.org.au, or ask your doctor for a referral.
  • Seek medical help urgently if you think you have an infection in the affected area.
  • For more information, download the Understanding Lymphoedema fact sheet.
"My experience is that lymphoedema is very manageable if you notice the signs early." – Suzanne

Memory and thinking changes

Many cancer survivors say they have difficulty concentrating, focusing and remembering things. This is called cancer-related cognitive impairment. Other terms used to describe this include "chemo brain" and "cancer fog".

Researchers still aren't sure exactly what causes the memory and concentration changes experienced by some cancer survivors, but there is ongoing research to try to find out.

Memory and thinking changes may be caused by:

  • the cancer itself
  • cancer treatments, such as chemotherapy, radiation therapy,
  • immunotherapy, hormone therapy, surgery and anaesthesia
  • medicines such as steroids, anti-nausea drugs or pain-killers
  • fatigue and sleep problems
  • emotional concerns, such as stress, anxiety or depression
  • infections
  • vitamin or mineral deficiencies (e.g. iron, vitamin B, folic acid)
  • other health problems, including anaemia
  • tumours, cancer or metastases in the brain
  • ageing.

These problems usually improve with time, although for some people it may take a year or more to see improvements. Tell your doctor about any memory or thinking problems you are having. Ask for a referral to a health care professional such as an occupational therapist who can advise you on strategies to overcome these difficulties and improve memory.

Managing memory and thinking problems

  • Get plenty of sleep. Deep sleep is important for memory and concentration.
  • Do some gentle exercise, including strength training, each day to help you feel more alert.
  • A psychologist can help with a cognitive training program. These mental exercises may help improve thinking, memory and concentration.
  • Some people find puzzles and brain training apps helpful.
  • Use your mobile phone, calendar or daily planner to keep track of appointments, tasks, social commitments, birthdays, etc.
  • Plan activities so you do things that require more concentration when you are more alert. You may find it helpful to have a daily schedule.
  • Discuss these problems with your partner, family or workplace and ask for their support or assistance.
  • Do tasks one at a time rather than multi-tasking.
  • Set aside time each day to read and respond to emails.
  • Let phone calls go straight to your answering machine or voicemail. You can listen to them when ready and prepare how you will respond.
  • If you are working and have your own office, close the door when you don't want to be interrupted.
  • Carry a small notepad or download an app to your phone so you can jot down things you need to remember.
  • Before your appointments, write down a list of items you would like to discuss. Don't be afraid to write down notes during the appointment or to take a support person with you.
  • Put personal items (e.g. wallet, keys) in a dedicated place at home and at work so you can find them easily.

Tingling or numbness in hands or feet

Tingling or numbness in the hands or feet (peripheral neuropathy) is a common side effect of chemotherapy. It may last for a few months after treatment finishes or it may be permanent.

Peripheral neuropathy can be painful, annoying and frustrating. It may make it difficult for you to return to normal hobbies and activities. There is no proven treatment to repair nerve damage. Talk to your GP about treatments that may help you deal with the symptoms. You can also see a physiotherapist or occupational therapist for exercises to help you carry out your daily activities.

The lack of feeling in your hands and feet can cause safety problems, such as a greater risk of falling over. See below for some ways to protect yourself and others.

Taking care with numb hands or feet

  • Check the water temperature in your home to avoid burns.
  • Use gloves to protect your hands while doing housework or washing dishes.
  • Wear well-fitting shoes with non-slippery soles.
  • Clear walkways of hazards and avoid using rugs.
  • Use non-slip rubber mats in showers and baths.
  • Regularly check your feet for minor injuries or see a podiatrist.
  • If feeling in your feet is severely affected and you can't feel the pedals in the car, ask someone else to drive for you.

Other physical problems

Cancer survivors can also experience a range of other physical problems after treatment. Some common problems are discussed below. If you would like more information about managing these or any other problems, call Cancer Council 13 11 20.

Balance or mobility problems

Surgery or cancer treatment may have affected your balance or ability to walk or move around. Balance training guided by an exercise physiologist, physiotherapist or occupational therapist may assist with these problems.

Bowel or bladder changes

Changes to how your bowel or bladder works can be very distressing and difficult to adjust to. Some medicines and cancer treatments can cause constipation, diarrhoea or incontinence. Some people have a stoma because of their treatment. These changes may be temporary or ongoing, and may require specialised help or products. If you experience any of these problems, talk to your GP, specialist doctor, specialist nurse or dietitian. Drinking more water and dietary changes may also help.

Incontinence is when a person is not able to control their bladder or bowel. Temporary or permanent incontinence can be a side effect of treatment for cancer of the bladder, bowel, prostate, penis, ovaries, uterus, cervix or vagina.

For many people, incontinence is an embarrassing problem. However there is help available, and ways to better manage or perhaps even cure the incontinence, e.g a physiotherapist can teach you exercises to strengthen your pelvic floor muscles. For more information and support, call the National Continence Helpline on 1800 33 00 66 or visit continence.org.au or bladderbowel.gov.au.

The blood vessels in the bowel and bladder can become more fragile after radiation therapy to the pelvic area. This can cause blood to appear in your urine or bowel movements, months or even years after treatment. Always seek advice from your specialist or GP if you notice new or unusual bleeding. Keep in mind that it may not be related to your treatment.

Heart problems

Radiation therapy to the chest and some types of chemotherapy may damage the heart muscle and lead to an increased risk of heart problems after treatment. Risk factors include certain types of drugs, such as anthracycline chemotherapy drugs and HER2targeted agents; radiation therapy combined with chemotherapy; younger age at treatment; diabetes; high blood pressure (hypertension); obesity; and smoking.

If you have received high-risk chemotherapy or targeted therapy drugs, radiation therapy to the chest or whole body, or combined radiation therapy and chemotherapy, talk to your doctor about your heart health and the symptoms to look out for. If you develop heart problems later in life, make sure you alert your doctors to the cancer treatment you received.

Bone density loss (osteoporosis)

Cancer and its treatment, particularly radiation therapy, can have long-term effects on your bone strength. Menopause and some types of hormone therapy may also cause bones to weaken and break more easily. Talk to your doctor about having a bone density test or taking medicine to prevent your bones from becoming weak.

Regular exercise, eating calcium-rich foods (e.g. yoghurt, milk, tofu, green vegetables) and getting enough vitamin D will also help keep your bones strong. For more information call Osteoporosis Australia on 1800 242 141 or visit osteoporosis.org.au.

Mouth or teeth problems

You may have problems with your mouth or teeth, find it difficult to swallow, or have a dry mouth. These problems can affect your ability to eat, drink, manage your weight or talk. Depending on the type of cancer and treatment, these problems may be temporary or ongoing. It may help to see a dietitian or speech pathologist. It is important to have regular dental checkups after cancer treatment, especially if you had surgery or radiation therapy to the head or neck region.

Hearing problems

Radiation therapy to the head or neck and some chemotherapy drugs can affect your hearing. Some people lose the ability to hear high-pitched sounds, or develop a constant ringing in their ears known as tinnitus. These problems may go away when treatment ends or they may be permanent. Tell your GP if you notice any change in your hearing or if these symptoms don't go away.

Changed body image

Treatment for cancer can change how your body looks and works. How you feel about yourself (your self-esteem) may be affected by:

  • changes to your appearance (e.g. from surgery) or body shape
  • hair loss or hair growing back differently
  • speech difficulties
  • problems with eating or drinking
  • breathing changes or shortness of breath
  • weight loss or gain
  • bowel or bladder changes
  • changes to your sex life and intimacy (see below)
  • early menopause or infertility
  • a sense of feeling prematurely old.

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

You may worry about how your family and friends will react, and whether your partner or a potential partner will find you physically attractive. It may help to let others know how you are feeling. They probably want to provide support and reassurance that they still love you, and hearing what they have to say may boost your confidence.

If you don't feel comfortable talking to friends or family, consider speaking to your health care team, a psychologist or a counsellor. It may help to talk to someone who has had a similar experience. Call Cancer Council 13 11 20 for information on support services.

Adjusting to changes in appearance

  • Be gentle with yourself and acknowledge your feelings.
  • Give yourself time to get used to any physical changes. Focus on yourself as a whole person, not just the part of you that has changed.
  • Talk about and acknowledge the changes. If you don't, people may avoid you because they don't know what to say.
  • For practical suggestions about dealing with physical changes, call 13 11 20.

Sexuality and intimacy

Cancer and its treatment may affect your sexuality and intimacy in physical and emotional ways. These changes may be temporary or ongoing and can be difficult to deal with.

Sexual difficulties can affect any cancer survivor, but those most likely to experience long-term sexual problems include:

  • women treated for breast or gynaecological cancers
  • women who experience early menopause
  • men treated for testicular or prostate cancer
  • people treated for cancer of the rectum or lower bowel
  • people who have had head and neck surgery
  • people who have a stoma because of their treatment.

Some people say they were not prepared for the sexual changes caused by treatment. Others say they avoid all forms of intimacy, including hugs, kisses and sharing feelings, because they're afraid this may lead to sex when they don't feel physically up to it.

You may not even be aware that you aren't taking an interest in sex or being as intimate as you were before. If you have a partner, they may feel confused or uncertain about how to react. Let your partner know how you're feeling and any fears you have about sex. Ask your partner how they're feeling – they may be worried about hurting you or appearing too eager. You may want to ask your partner to do things differently or talk about other ways of being intimate.

Some people worry that they will never be able to have an intimate relationship again. For most people, sex is more than arousal, intercourse and orgasms. It involves feelings of intimacy and acceptance, as well as being able to give and receive love. Although sexual intercourse may not always be possible, closeness and sharing can still be part of your relationship.

Common sexual problems after cancer treatment

General

  • Loss of interest in sex
  • Tiredness and fatigue
  • Changed body image
  • Feeling sexually unattractive
  • Incontinence
  • Painful intercourse
  • Depression or anxiety
  • Relationship changes or pressures

Women

  • Difficulty reaching orgasm
  • Vaginal dryness
  • Reduced vaginal size
  • Loss of sensation
  • Pelvic pain
  • Menopausal symptoms

Men

  • Difficulty getting or maintaining an erection
  • Ejaculation difficulties

Managing sexual difficulties

  • Seek professional advice and support. Talk to your doctor (with or without your partner). A referral to a sex therapist or physiotherapist may help.
  • If you're having erection problems, ask your doctor if medicine can help.
  • If radiation therapy or surgery has narrowed or shortened the vagina, you may be advised to use a vaginal dilator to help keep the walls of the vagina open and supple.
  • Show affection by touching, hugging, massaging, talking and holding hands.
  • Do some physical activity to boost your energy and mood. Talk to your GP if your low libido is caused by depression.
  • Be intimate at the best time for you (e.g. when your pain is low or energy levels high).
  • Take some pain-killers before having sex if you have ongoing issues with pain.
  • Spend more time on foreplay and try different ways of getting aroused: shower together, have a weekend away, dance, wear something sexy. Do whatever makes you feel good about yourself.
  • Use a water or silicone-based lubricant during sex. Avoid products with perfumes or colouring to reduce irritation.
  • Try different positions during sex to work out which is the most comfortable for you.
  • If sexual penetration is painful or difficult, explore different ways to orgasm or climax.
  • If you feel comfortable, stimulate yourself. This may reassure you that you can still enjoy sex. Or you may want to stimulate your partner and help them reach orgasm, even if you don't want any stimulation for yourself.
  • For more information, see Sexuality, Intimacy and Cancer.

Menopause

Menopause means that a woman's ovaries no longer produce eggs and her periods stop. For most women, menopause is a natural and gradual process that starts between the ages of 45 and 55.

Some cancer treatments, including certain chemotherapy drugs, radiation therapy to the pelvic area, hormone treatment and surgery to remove the ovaries (oophorectomy), can cause symptoms of menopause. These symptoms can be temporary or permanent.

For women who want to have children, menopause can be devastating. If your family is complete or you didn't want children, you may still have mixed emotions or worry about the impact of menopause on your relationship. See more information about fertility. Some women find menopause difficult because they feel it has taken away part of their identity as a woman.

Symptoms of menopause

When menopause occurs suddenly as a result of cancer treatment, symptoms may be more severe because the body hasn't had time to get used to the gradual decrease in hormone levels.

Symptoms may include hot flushes, sweating (especially at night), dry or itchy skin, loss of confidence, mood swings, anxiety, trouble sleeping, tiredness, loss of libido and vaginal dryness. Many of these symptoms will eventually pass, although this may take months or a few years. Some women who have already been through menopause find that these symptoms return during or after treatment.

Managing menopause symptoms

  • Meditation and relaxation techniques may help reduce stress and lessen symptoms.
  • Maintain a healthy weight and eat a healthy diet with lots of fresh fruit, vegetables and wholegrains.
  • Ask your doctor for advice about diet changes or herbal remedies.
  • Cholesterol levels can change after menopause, which can increase your risk of heart disease. Talk to your doctor about lifestyle changes or cholesterol-lowering drugs.
  • Menopause can increase your risk of developing thinning of the bones (osteoporosis).
  • Hormone replacement therapy (HRT) can help reduce symptoms of menopause, but may not be recommended for some women who had hormonedependent cancers, such as breast or ovarian cancer.
  • If vaginal dryness is a problem, take more time before and during sex to give yourself time to become aroused and for the vagina to become more lubricated.
  • Look for a vaginal moisturiser at the chemist to help with vaginal discomfort and dryness.
  • See your doctor about trying an oestrogen cream, which may relieve vaginal dryness. If you need to avoid products containing oestrogen, talk to your doctor about nonhormonal medicines that may help with menopausal symptoms such as hot flushes and night sweats.
  • See more tips about sexuality and intimacy.
  • Ask whether your hospital has a menopause clinic. If you need help adjusting to menopause symptoms after cancer treatment, talk to your doctor about a referral.

Fertility problems

Some cancer treatments can cause temporary or permanent infertility (inability to have a child). Although chemotherapy and radiation therapy can reduce fertility, after treatment some women may be able to become pregnant and some men may be able to father a child. Other people take steps to preserve their fertility before treatment starts by storing eggs, sperm or embryos.

If you are thinking about trying to get pregnant after treatment, talk to your doctor about the impact that your treatment might have on your health during pregnancy. Your doctor may suggest you wait a certain period of time before trying to conceive, to give your body time to recover and to allow eggs or sperm to become healthy again. Some form of contraception must be used during this time.

If you are told your infertility is permanent, you may feel a great sense of loss and grief, even if your family is complete. You may feel angry, sad or anxious that the cancer and its treatment caused these changes to your body or your plans for the future. Talking to a psychologist or counsellor about how you are feeling might help. See Fertility and Cancer or call Cancer Council 13 11 20.

If you have trouble conceiving after cancer treatment or would like to learn about ways to improve your chances of getting pregnant, ask your doctor for a referral to a fertility specialist.

Key points

  • After treatment, side effects can take weeks, months or even years to resolve. Some may be permanent.
  • Side effects can be both physical and emotional, and vary depending on the cancer type and stage, and the treatment you had.
  • If you have ongoing side effects, your GP can use your survivorship care plan to develop a Chronic Disease Management Plan.
  • Fatigue is one of the most common physical side effects of treatment.
  • Learning how to manage any pain may increase your ability to function and improve your quality of life.
  • Persistent pain can be treated in a variety of ways, including exercises, stretches, cognitive behaviour therapy, and painkilling drugs.
  • Lymphoedema can occur if the lymph nodes are damaged or removed. It is managed by preventing or controlling the swelling, and avoiding infections.
  • Many cancer survivors say they have difficulty concentrating. This is often referred to as "chemo brain". It usually improves with time.
  • Changes to your body after treatment can change how you feel about yourself.
  • The effects of cancer treatment on sexuality may be temporary or ongoing.
  • Some cancer treatments can cause symptoms of menopause. This can be temporary or permanent.
  • Some people become infertile after treatment. This can be distressing regardless of whether you want to have children in the future.

Reviwed by: Dr Haryana Dhillon, Senior Research Fellow, Centre for Medical Psychology & Evidence-based Decision-making, School of Psychology, University of Sydney, NSW; Polly Baldwin, 13 11 20 Consultant, Cancer Council SA; Jessica Barbon, Dietitian, Southern Adelaide Health Network, SA; Dr Anna Burger, Liaison Psychiatrist and Senior Staff Specialist, Psycho-oncology Clinic, Canberra Region Cancer Centre, ACT; Elizabeth Dillon, Social Worker, Peter MacCallum Cancer Centre, VIC; Prof Paul Glare, Chair in Pain Medicine and Director, Pain Management Research Institute, University of Sydney, NSW; Nicole Kinnane, Nurse Coordinator, Gynaecology Services, Peter MacCallum Cancer Centre, VIC; Amanda Piper, Manager, Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, VIC; Kyle Smith, Exercise Medicine Research Institute, Edith Cowan University, WA; Aaron Tan, Consumer; Dr Kate Webber, Medical Oncologist and Research Director, National Centre for Cancer Survivorship, NSW.

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