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Adjusting after cancer treatment


Expert reviewer Dr Adam Dangoor, Consultant Medical Oncologist
Next review due July 2020

While there’s plenty of information and support available to you during your treatment for cancer, what happens afterwards?

The impact of having cancer doesn’t necessarily finish when your treatment ends. Here we help to answer some of the questions you might have and show that you can live a healthy, happy life after cancer treatment.

Older man carving at a workbench

How you might feel after treatment

Once your treatment is over, you may feel a range of emotions. Everyone’s experience is different – you may feel happy, relieved, fearful and anxious all at the same time. Some people start to feel low and may develop depression.

Getting back to normal may take some time, as you get over side-effects and regain your strength. You might also find that your values and priorities have changed. You may change your diet, how you spend your time or the people you see. Or you may carry on exactly as you did before you had cancer. There’s no right or wrong way.

The most important thing is to give yourself plenty of time to adjust and find out what works for you. You may find support from others who’ve been through similar experiences can help − find out what’s available in your local area.

Follow-up appointments

After your treatment has finished, it’s likely that you’ll still have regular check-ups with your doctor. Over time, appointments will become less frequent and eventually you may not need to see your doctor anymore.

Your GP may follow up to see how you’re getting on. If you have any concerns or start to develop any symptoms, let your GP know. They can help to arrange any care that you need.

How your care is continued after treatment can depend on many things, such as your age, the type of cancer you had and whether you have any other health conditions.

It’s normal to feel anxious about your follow-up appointments, so finding ways to manage your anxiety can be helpful. The following tips may help.

  • Write down any questions you want to ask your doctor before your appointment. See our questions to ask your doctor for more information. Take a pad and pen so you can write down any answers to help you remember them.
  • Take a friend or relative with you. They can help you understand what has been said, take notes and support you.
  • Talk openly and honestly with your doctor about any symptoms, worries or problems you’re having.

If you have any concerns in between your scheduled appointments, contact your doctor or nurse. You don’t have to wait for your next appointment.

Fear of your cancer coming back

One of the hardest things for many people after cancer treatment is coping with the fear of the cancer coming back. This fear is perfectly normal. Living with uncertainty is hard and no one can tell you for sure whether your cancer will return. It depends on the type of cancer you had, particular features of your cancer such as the grade, but also on whether any cancer cells have survived the treatment.

It’s important to go to all your follow-up appointments so that you can talk to your doctor if you have any concerns. Your doctor can also reassure you and tell you what to look out for.

Your worries about the cancer coming back may lessen over time. You may realise that you aren’t thinking about it quite so much.

Worrying about your cancer coming back can make it hard for you to carry on with your daily life. Concentrating on what is important to you each day can be a form of distraction from these thoughts. Joining a support group or speaking to a counsellor or psychologist may also help.

Long-term effects of your treatment

The side-effects you had during treatment usually go away soon after it finishes. But there may be long-term effects of cancer treatment that can be permanent in some cases.

Everyone’s different, so you may have short or long-term effects that are different to someone who has had the same type of cancer and treatment as you.

Some of these effects include:

  • changes in your appearance
  • tiredness
  • trouble remembering and concentrating – some people describe this as ‘chemo brain’
  • pain
  • problems with feeling and sensation
  • difficulty eating
  • bowel problems
  • breathing problems
  • having your menopause early
  • problems with fertility
  • changes to your sex life and relationships
  • changes to your body organs – for example your heart, liver or kidneys
  • cancer as a result of your treatment – these are known as secondary cancers

Scroll through the sections below to find out more.

Your appearance

Cancer and treatment can affect how you look in a number of ways.

  • Chemotherapy and radiotherapy can both cause hair loss.
  • You may have had surgery to remove part of your body, for example, a breast removal (mastectomy).
  • You may have a stoma after a colostomy, ileostomy (where part of your bowel is removed or bypassed) or urostomy (after bladder removal) and be left managing a bag.
  • Cancer treatments can cause weight loss or weight gain.
  • If you’ve had a head and neck cancer, you may have had surgery that quite radically changes how you look.
  • Some biological therapies that you take long term can cause skin rashes and changes in your skin colouring.

Any of these changes can make you feel uncomfortable about your appearance afterwards. Some will get better over time. Hair grows back a few months after chemotherapy – although it may have changed colour or be thinner. It may stay patchy after radiotherapy, but there are good wigs and hair pieces available these days if you want to use them. In time, you may also regain weight that you lost during treatment.

Changes after surgery won’t completely go away with time. But they’ll usually improve. Scars will fade and you may be fitted with a prosthetic (a false breast, for example) or even have reconstructive surgery. If you have a stoma, you’ll get better at managing it and that may make you less conscious of it.

You may find it helps to talk to your family and friends about how you’re feeling. It may also help to join a support group to talk to people who have been through similar experiences to you. There are specialist support organisations to support you after head and neck surgery. See our section: Other helpful websites for suggestions. If you’re having trouble coming to terms with changes in your appearance, it may help to speak to a psychologist or counsellor.

Tiredness

Fatigue is extreme tiredness – you may lack energy and feel physically or mentally exhausted. It is common for people who have had cancer or treatment for cancer. It’s very different from normal tiredness because it doesn’t always go away with rest and sleep. Fatigue can be frustrating and can impact on your daily life.

Everyday activities, such as having a shower, doing the shopping, cooking a meal or eating can be extremely exhausting. It’s normal for some people to feel tired for several months after treatment for cancer. But the good news is there are plenty of things you can do to help. See our information: Coping with cancer at home for lots of practical suggestions for managing fatigue.

Your doctor or nurse may also be able to give you advice on coping with tiredness.

Feeling tired can be a sign of depression. If you have any concerns, talk to your doctor or nurse about this. You can also read more about depression and cancer on our page: Looking after your mental health during and after cancer.

Chemo brain

Some people who have had chemotherapy say that they feel as if they are in a bit of a fog. You may have trouble remembering things, concentrating, or managing mental tasks that you didn’t have difficulty with before (such as mental arithmetic). Although this is often called ‘chemo brain’, these problems may also be caused by biological therapies or radiotherapy to the brain.

Changes in your mood and how you feel after cancer can also affect how well your brain functions. For example, if you have anxiety or depression, you may also find it hard to concentrate or make decisions.

If caused by your treatment, these difficulties usually get better after it has finished but they may carry on for months afterwards. There are many ways you can help yourself manage.

  • Plan your day so that you do the important things when you feel most able.
  • Use memory aids such as lists, calendars and sticky notes.
  • Carry a notepad with you or make notes on your phone.
  • Make sure you get enough rest.
  • Try doing some mental exercise such as crosswords or puzzles to help improve your concentration.
  • Physical exercise can clear your mind and help you to relax and sleep better at night.

Do talk to your doctor if you are at all concerned. They can rule out or treat other possible causes, such as depression or anxiety and give you advice.

Pain

You may have pain that lingers after your treatment, although many people may have no pain at all.

Surgery and radiotherapy can damage nerves and cause pain. Scars can also be painful. This usually gets better over time, as the damaged nerves grow back, but it can last for months or even a year or two in some cases.

Some chemotherapy medicines can also damage nerves and cause pain and numbness in certain parts of your body, such as your hands, feet. There’s more about this in the section on problems with feeling and sensation.

If you have any kind of pain, tell your doctor or nurse. They may prescribe painkillers or suggest you take over-the-counter painkillers, such as aspirin or paracetamol. You can buy over-the-counter medicines from a pharmacy without a prescription. But remember to always tell your doctor or nurse about any pain you have first.

Problems with feeling and sensation

Some chemotherapy drugs can cause problems with numbness, pins and needles and tingling. This most often happens in the hands and feet. It usually gets better a few months after treatment has finished, but in some people it can be permanent.

Rarely, radiotherapy can also cause numbness and tingling. This sometimes comes on a long time after treatment has finished.

Your doctor may prescribe medicines to help control the symptoms of nerve damage. Occupational therapy or physiotherapy may be able to help if you’re having trouble with fiddly things because of nerve damage to your fingers or walking because of nerve damage in your feet.

Difficulty eating

Most problems with eating and drinking caused by cancer treatment get better gradually once treatment is over. But if you’ve had surgery to your digestive system, you may have permanent changes. Surgery to the stomach or oesophagus may mean you have to eat small amounts more often. You may also have problems with indigestion or heartburn (reflux). It can help if you:

  • avoid exercise or lying down for a couple of hours after eating
  • sleep propped up with a couple of pillows
  • keep a food diary to help identify if any particular foods make it worse

If you’ve had surgery for stomach cancer, you may feel faint or dizzy soon after eating. This is called dumping syndrome and is caused by food moving too quickly into the small bowel. Eating small meals more slowly and avoiding too much sugary food can help.

These difficulties usually slowly improve in time. But do ask to see a dietician if you need some support.

Bowel problems

Sometimes radiotherapy to your lower abdomen (the pelvis) can cause long-term bowel problems. You may have diarrhoea, constipation or wind. These may be quite mild but some people can have more troublesome symptoms and need help in managing them. Do tell your doctor. There are treatments that can help. Your doctor may refer you to a bowel specialist. It’s particularly important to tell your doctor if you have bleeding, need to open your bowels urgently, or lose control of your bowels (incontinence).

Breathing problems

Some cancer treatments can cause shortness of breath. This can happen after surgery or radiotherapy. It’s rare after chemotherapy these days. Radiotherapy can cause scarring of the lungs (fibrosis). Do tell your doctor if you feel breathless after radiotherapy. There are treatments you can have.

Early menopause

Cancer treatment can cause an early menopause for some women, which means your periods will stop and your ovaries will no longer produce oestrogen. Surgery to remove your ovaries or radiotherapy on your ovaries will cause permanent menopause. Chemotherapy may cause early menopause depending on the exact treatment you have. Chemotherapy and hormone therapy are more likely to cause permanent menopause if you’re close to the age at which your periods would stop naturally.

Sudden menopause can cause a number of symptoms including:

  • hot flushes and sweats
  • vaginal dryness
  • lowered sex drive (libido)
  • loss of confidence or self-esteem
  • low mood or depression
  • tiredness
  • bone thinning (osteoporosis)

With some types of cancer, you can’t take hormone replacement therapy to relieve your symptoms. But there are other ways to help with hot flushes and vaginal dryness, so do talk to your doctor or nurse.

Fertility

Cancer and its treatment can sometimes affect your ability to have children. Your doctor will discuss this with you before your treatment, so you can plan for the future. If you’d like more information, or have any questions, speak to your doctor. He or she will be happy to discuss your options with you.

Infertility means that you’re unable to conceive a child despite having regular, unprotected sex. This is sometimes temporary but it can also be permanent. Being told you’re infertile can be overwhelming, so it may be helpful to talk to someone about how you’re feeling.

Male infertility and impotence

Some cancer treatments can lower your sperm count. Chemotherapy may cause temporary infertility, although this is sometimes permanent with certain chemotherapy drugs or high doses of treatment.

If your treatment was likely to cause infertility, you may have been advised to bank some sperm before your treatment. This can be used for in vitro fertilisation (IVF) when you want to start a family.

Certain cancer treatments, such as radiotherapy and hormone therapy, can affect your ability to get an erection (erectile dysfunction or impotence). With radiotherapy, this is sometimes permanent and with hormone therapy will last as long as you’re on treatment.

There are many different ways to improve difficulties with getting an erection, including medicines, creams and devices, so do talk to your doctor or cancer nurse if you’re having problems. You can also learn more about these on our page: Male infertility.

Female infertility

Chemotherapy, surgery on your pelvis and radiotherapy on your abdomen or pelvis can all cause infertility in women. If your treatment causes infertility, you won’t be able to become pregnant after your treatment. With chemotherapy, temporary or permanent infertility depends on the particular chemotherapy medicines you have and your age. With pelvic radiotherapy or surgery, infertility will be permanent.

If you’re able to, speak to your doctor about this when your cancer is diagnosed. They may be able to avoid particular types of treatment if they know you would like to have children. Some women are able to have egg collection or ovarian tissue freezing, but sometimes, there isn’t always time to complete these before you need to start your cancer treatment. Other possible options are egg donation or surrogacy.

It can be extremely difficult and upsetting coming to terms with infertility, particularly after all the emotional turmoil of coping with your cancer diagnosis and treatment.

Speak to your doctor or nurse, who can put you in contact with support groups or a counsellor. Your partner, family and friends may also be able to offer support.

For more information, see our page: Female infertility.

Sex and relationships

Many people have changes in their sex life during and after cancer treatment. These changes are usually temporary but for some people they can be permanent. Sexual problems can be caused by:

  • how you see yourself (body image)
  • changes in how your body looks and functions
  • pain that you may be feeling
  • fatigue
  • emotions you may be having, such as anger, sadness and fear
  • how your partner responds to you

It’s important to let your partner know how you’re feeling so they don’t feel rejected. There are other things you can try if you’re having problems with your sex life. For example, being intimate in other ways such as hugging, kissing, and massaging. You could also try experimenting with other ways to help increase your sex drive. You may find it useful to speak to a sex and relationship therapist for more help and support.

Change to body organs

Cancer treatment can sometimes have a lasting effect on the way your body works. Treatments may cause changes to your heart, liver or kidneys. Often these changes go back to normal after your treatment is over but sometimes they are permanent. If this is a possibility with your treatment, however unlikely, your doctor will monitor you with tests before and after treatment. Do speak to your own doctor if you’re at all concerned.

Secondary cancers

Some types of cancer treatment can increase the risk of developing a second cancer. Doctors are aware of this, of course, and make every effort to minimise the risk.

The risk for chemotherapy depends on the drugs you’ve had. With radiotherapy, treatment has improved greatly over the past few years. There’s less normal body tissue damaged while destroying the cancer cells and lower doses are now often used. Both of these factors are likely to lower the risk of another cancer.

If you’re worried, it’s best to speak to your own doctor, who has all the information related to your treatment. Do remember that the risk of getting another cancer is likely to be much smaller than the risk to your health of the cancer you were, or are, being treated for.

Work

You may want to go back to work as soon as possible for financial reasons or to regain a sense of normality. For some people though, it can take several months to adjust to everything that has happened and get used to the physical and emotional changes. For more information and advice on returning to work see our page: Coping with cancer and work.

Developing a wellness plan

After your cancer treatment, you may decide that you want to live a healthier life. Your doctor can help you to develop a plan. Here are some suggestions.

  • Give up smoking – smoking increases the chances of you getting certain cancers.
  • Cut down on the amount of alcohol you drink. Drinking more than the recommended alcohol guidelines can increase the chance of you getting certain cancers.
  • Eat a healthy, balanced diet. A dietitian can give you practical advice and support on eating well and staying hydrated. For more information on what to eat after cancer, see our page: Eating well during and after cancer.
  • Exercise regularly. Staying active can provide mental and physical benefits. Find out how much exercise you should be doing and tips to help you get started on our page: Exercise – getting started.


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  • Reviewed by Laura Blanks, Specialist Heath Editor, Bupa Health Content Team, July 2017
    Expert reviewer Dr Adam Dangoor, Consultant Medical Oncologist
    Next review due July 2020



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