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Living well after cancer


Managing side effects


It can take time to recover from the side effects of cancer treatment. Side effects can be both physical and emotional, and impact on your ability to return to your usual day-to-day activities. Talk to your doctors about any side effects you have so you can develop a plan to manage them. 

How long side effects may last

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

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 and what you can do to help prevent them. Managing the side effects of treatment can feel overwhelming, but there are many sources of support.

How complementary therapies can help

Complementary therapies are widely used alongside conventional treatments, and may include acupuncture, mindfulness meditation, tai chi, and art therapy, among others. Complementary therapies may help you manage side effects of treatment, increase your sense of control, decrease anxiety and improve your quality of life.

Let your doctor know about any complementary therapies you are using or thinking about trying. Your doctor may be able to refer you to a qualified therapist who is experienced in working with cancer survivors and understands the role of complementary therapies in cancer care.

Alternative therapies are different from complementary therapies. They are used instead of conventional treatments. Many alternative therapies have not been scientifically tested, so there is no proof they stop cancer growing or spreading. Others have been tested and shown not to be effective. Cancer Council does not recommend the use of alternative therapies. 

 

Common cancer-related side effects

Sleeping problems

Getting enough sleep is important for maintaining your energy levels, managing fatigue and improving mood. Difficulty sleeping is common among people who have had cancer. It may be caused by pain, breathlessness, anxiety or depression. Some medicines and hormonal changes can make sleep difficult. If you already had sleep problems before cancer treatment, these can become worse. 

Ways to improve sleep

  • Get up at the same time each morning and avoid daytime naps.
  • Exercise regularly but not right before bed.
  • If you smoke, quit – smoking can affect your ability to fall and stay asleep.
  • Limit or avoid drinking alcohol and caffeine. Avoid spicy food if it gives you indigestion.
  • Set up a pre-sleep routine to help you relax. Try to go to bed around the same time most evenings to establish a stable sleep/wake routine.
  • Listen to our relaxation and meditation podcast Finding Calm During Cancer. Done regularly, these exercises may help you sleep better.
  • Put screens (mobile phone, tablet, computer or TV) away an hour before bedtime and avoid using them in the bedroom.
  • Keep the bedroom dark, quiet and a comfortable temperature.
  • If medicines interfere with your sleep, discuss alternatives with your doctor.
  • Speak with your GP about whether counselling or cognitive behaviour therapy (CBT) would help.
  • Listen to our 'Sleep and Cancer' episode of The Thing About Cancer podcast.

 

Fatigue

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

You may 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.

Many cancer survivors don’t tell their doctor about fatigue because they think that nothing can be done about it. However, your treatment team or GP may be able to help. For example, your fatigue may be caused by a low red blood cell count (anaemia), depression or the side effects of medicines, which your doctor may be able to manage. You may need a referral to a specialist or a fatigue clinic (if available). 

Learn more

Pain

Pain can have a big impact on your life and prevent you from doing the things you want to do. After treatment, pain may continue for months or years. This is called chronic pain and it affects some cancer survivors.

Causes include:

  • scars or nerve damage after surgery
  • nerve damage from cancer drug therapies leading to numbness and tingling in hands and feet
  • irritated, sensitive skin in the area where you had radiation therapy
  • joint and muscle pain from hormone therapies
  • a build-up of lymph fluid (lymphoedema).

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 health issue, such as arthritis.

Managing pain

Learning how to manage your pain may let you return to many of the activities you enjoy and improve your quality of life. Discuss your pain with your doctor so they can try to work out the cause and develop a pain management plan. In cases where no fixable cause of the pain is found, the focus will shift to improving your ability to function despite the pain.

Pain medicines called analgesics are widely used to help reduce pain. Non-steroidal anti-inflammatory drugs or paracetamol are the main drugs used to relieve pain in survivors. While opioids are sometimes prescribed for chronic pain, research shows that using opioids for a long time is not safe.

There are other ways to relieve pain, such as daily stretching, cognitive behaviour therapy, massage, creative therapies and relaxation techniques, among others. If your pain is not well controlled, ask your doctor about referring you to a pain management specialist in a multidisciplinary pain clinic.

 

Lymphoedema

When lymph fluid builds up in the tissues under the skin, it can cause swelling. This is known as lymphoedema. It can happen if lymph nodes have been removed during surgery or damaged by infection, injury or radiation therapy. Lymphoedema may appear during treatment or months or years later.

Lymphoedema can occur after treatment for many different cancers, but is more common in people treated for gynaecological (vulvar, vaginal, ovarian, uterine and cervical), breast and prostate cancers or melanoma. Whether or not you develop lymphoedema after treatment depends on the location of the cancer, its stage and the type of treatment you had. Not everyone who is at risk will develop it.

Learn more

Changes in thinking and memory

Many cancer survivors say they have difficulty concentrating and remembering things. This is called cancer-related cognitive impairment. These changes may make you feel anxious, upset or frustrated.

Thinking and memory changes may be caused by the cancer or cancer treatments, medicines, anxiety or depression, or other health issues. 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 thinking or memory problems you are having, and if they are affecting your day-to-day life or your work.

Tingling or numbness in hands or feet

Having tingling ('pins and needles') or numbness in the hands or feet is a common side effect of some types of chemotherapy drugs. This is called peripheral neuropathy. It may last for a few months after treatment finishes or it may be permanent. In some cases, peripheral neuropathy can get worse a few months after chemotherapy has finished.

The impact of peripheral neuropathy varies from one person to another. It can be painful, annoying and frustrating and, for some people, make it hard to return to hobbies and other activities. Although there is no proven treatment to repair nerve damage, there are some medicines that can help you deal with the symptoms.

Other common cancer-related effects

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 help improve your balance and muscle strength.

Bowel or bladder changes

Changes to how your bowel or bladder works can be very distressing and have a significant impact on quality of life. Some medicines and cancer treatments can cause constipation, diarrhoea or incontinence.

After treatment, some people have a stoma that allows urine (wee) or faeces (poo) to be collected in a bag. These changes may be temporary or ongoing, and may require specialised help or products. Radiation therapy to the pelvic area can damage the lining of the rectum, causing inflammation and swelling known as radiation proctitis.

If you have any of these issues, talk to your GP, specialist doctor, specialist nurse or dietitian. Drinking more water and changing what you eat may also help.

Heart health

Radiation therapy to the chest area 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 some targeted therapies
  • radiation therapy combined with chemotherapy (chemoradiation)
  • having treatment at a younger age
  • diabetes
  • high blood pressure (hypertension)
  • obesity
  • 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, the symptoms to look out for, and whether you need regular heart checks. If you develop heart problems later in life, make sure you let your doctors know about the cancer treatment you had.

Regular exercise, managing your cholesterol, blood pressure and weight, and stopping smoking can help you look after your heart health.

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 weight-bearing exercise (e.g. brisk walking), eating calcium-rich foods (e.g. yoghurt, milk, tofu, green vegetables), getting enough vitamin D, limiting alcohol and not smoking will also help keep your bones strong.

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 get better 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.

Mouth or teeth problems

You may have mouth sores or tooth decay, 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 check-ups after cancer treatment, especially if you had surgery or radiation therapy to the head or neck region.

 

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:

  • removal of a body part and use of a prosthesis
  • visible scars and skin tightness
  • hair loss or hair growing back differently
  • trouble speaking
  • 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
  • early menopause or infertility 
  • a sense of feeling prematurely old.

Adjusting to changes in appearance

You may be self-conscious about any changes. It will take time to get used to seeing and feeling the differences in your body. 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. Family and friends probably want to provide support and reassurance that they still love you. 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. You may find the following tips helpful:

  • Be gentle with yourself and acknowledge your feelings.
  • Give yourself time to get used to any physical changes. Some changes may improve with time.
  • Focus on yourself as a whole person (body, mind, personality), not just the part of you that has changed.
  • Talk openly about what has changed. Some people might be avoiding you because they don’t know what to say.
  • Do activities that you enjoy or make you feel good about yourself, such as walking, listening to music, working or studying, having a massage, relaxing outside or volunteering.
  • Buy some new clothes or accessories that make you feel comfortable and more confident about the way you currently look.
  • Book into a free Look Good Feel Better workshop.
  • For practical suggestions about dealing with physical changes, call us on 13 11 20.

Impact on sexuality and intimacy

Treatments for some types of cancer can directly affect your physical ability to have sex or to enjoy it. More generally, many cancer treatments can affect your desire to be intimate with others. These changes may be temporary or ongoing and can be difficult to deal with.

Most people can have a fulfilling sex life after cancer, but you may need to find different ways to give and receive sexual pleasure. This will take time and practice. Some people say that because they try new things, their sex lives actually end up being much better after cancer.

If you have a partner, they may feel confused or uncertain about how to react. Talk openly with your partner about how you’re feeling and any fears you have about sex. You may want to ask your partner to do things differently or talk about other ways of being intimate. Although sexual intercourse may not always be possible, closeness and sharing can still be part of your relationship.

Menopause

Menopause means the ovaries no longer produce eggs and periods stop. Menopause is a natural and gradual process that starts between the ages of 45 and 55. Some cancer treatments can cause early menopause.

Most menopause symptoms are related to a drop in your body’s oestrogen levels. When menopause occurs suddenly because 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 a dry or tight vagina, loss of interest in sex (low libido), hot flushes and night sweats, aching joints, trouble sleeping, dry or itchy skin, and feeling more anxious or overwhelmed.

If you are younger, reaching menopause much earlier than expected may affect your sense of identity or make you feel older than your age or friends. 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.

When cancer treatment causes early menopause, the impact on how you feel, your body image and your relationships can be significant. It may take time to accept these changes. Talking to your GP, a family member, friend or counsellor may help.

Fertility issues

Some cancer treatments can cause temporary or permanent infertility (inability to conceive a child). Some people are able to get pregnant or get their partner pregnant after finishing cancer treatment. Other people take steps to preserve their fertility before treatment starts.

If you are thinking about trying to get pregnant after treatment, talk to your cancer specialist about the impact that your treatment might have on your health during pregnancy. Depending on the treatment you’ve had, they may advise you to wait between six months and two years before trying to conceive. Discuss the timing and suitable contraception with your specialist. 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.

If you do get pregnant, you may need careful monitoring during the pregnancy. It can be helpful to ask your obstetrician to talk with your cancer specialist. 

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 fertility counsellor about how you are feeling might help. 

 

Living Well After Cancer

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Expert content reviewers:

Prof Michael Jefford, Medical Oncologist and Director, Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, VIC; Lucy Bailey, Nurse Counsellor, Cancer Council Queensland; Philip Bullas, Consumer; Dr Kate Gunn, Clinical Psychologist and Senior Research Fellow, Department of Rural Health, University of South Australia, SA; Rosemerry Hodgkin, 13 11 20 Consultant, Cancer Council WA; Prof David Joske, Clinical Haematologist, Sir Charles Gairdner Hospital and Clinical Professor of Medicine, The University of Western Australia, WA; Kim Kerin-Ayres, Clinical Nurse Consultant, Cancer Survivorship, Concord Hospital, NSW; Sally Littlewood, Physiotherapist, Seymour Health, VIC; Georgina Lohse, Social Worker, GV Health, VIC; Melanie Moore, Exercise Physiologist and Clinical Supervisor, University of Canberra Cancer Wellness Clinic, ACT; June Savva, Senior Clinician Dietitian, Nutrition and Dietetics, Monash Cancer Centre, Monash Health, VIC; Dr Elysia Thornton-Benko, Specialist General Practitioner and Research Fellow, University of New South Wales, NSW; Prof Janette Vardy, Medical Oncologist, Concord Cancer Centre and Professor of Cancer Medicine, The University of Sydney, NSW; Lyndell Wills, Consumer.

Page last updated:

The information on this webpage was adapted from Living well after cancer - A guide for people with cancer, their families and friends (2021 edition). This webpage was last updated in May 2022.

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