Adjusting after cancer treatment

Expert reviewer, Mr Giles Davies, Consultant Oncoplastic Breast Surgeon
Next review due February 2023

Although it can feel like a huge relief when your cancer treatment finishes, it’s not uncommon to feel a little lost too. Cancer is a life-changing experience and it’s likely to take time to recover, both physically and emotionally.

Here, we talk about what you might expect from life after cancer treatment and how you can get any support you need.

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Follow-up appointments after cancer treatment

You’re likely to have regular check-ups with your doctor or nurse when you first finish cancer treatment. They’ll want to find out how you are and if you have any symptoms or concerns. These will usually be every few months to begin with. Over time, appointments will become less frequent and eventually you may not need to see your doctor or nurse at all anymore.

You might feel anxious about going to follow-up appointments. But it’s important to go so your doctor can make sure you’re ok and give you the best possible care. 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.

Your GP may also follow up to see how you’re getting on. Your GP will be able to help with your general health and advise you on your recovery and making healthy lifestyle changes. They can also help to arrange any care that you need.

How you might feel after treatment

You’re likely to feel a range of emotions after your treatment has finished. Although you may be relieved, you might also be worried about the future, angry about what you’ve been through or just generally feeling low. It’s also common to have fatigue – where you feel physically or mentally exhausted. One of the hardest things for many people is coping with the fear of cancer coming back. Joining a support group or speaking to a counsellor or psychologist may help.

It’s also worth talking to your healthcare team if you continue to feel anxious or depressed. They can talk to you about strategies for coping and may refer you for counselling or prescribe medication if they think it will help.

If you’ve been away from work or social groups for some time, you might be feeling a bit isolated. Some people decide to go back to work as soon as possible, either for financial reasons or to try to regain a sense of normality. For others though, it can take longer to feel ready. There may be practical reasons that make it difficult to get back to work too. You might also find that your values and priorities have changed since you had cancer. The most important thing is to give yourself plenty of time to adjust and find out what works for you.

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Changes in your appearance

Cancer and cancer treatments can affect how you look in a number of ways, which can really affect your confidence when you’re starting to recover.

  • Chemotherapy and radiotherapy can both cause hair loss. Hair grows back a few months after chemotherapy – although it may be finer at first, and a different colour or texture. In the meantime, there are a number of options for covering up hair loss, including wigs, hats and scarves, that you may want to try.
  • Surgery may involve removing part of your body, for example, a breast removal (mastectomy). Or your appearance may have changed in other ways – such as leaving visible scars. If you feel self-conscious about scars, you could give camouflage make-up a try. If you’ve had surgery to remove a part of the body, you may be able to wear a prosthesis (for example, a false breast). Reconstructive surgery may also be an option.
  • You may have to get used to wearing a colostomy or stoma bag if you’ve had surgery on your bowel, like a colostomy or ileostomy. You’re likely to get better at managing this as time goes on.
  • It’s common to lose weight when you have cancer. Your healthcare team can advise you on how to eat well and gain weight. Cancer treatments can also cause you to put weight on, and your healthcare team can advise you the best way to lose weight after cancer treatment.
  • Some biological therapies that you take for a long time can cause skin rashes and changes in your skin colouring.

With time, you might start to feel less conscious about any changes in your appearance and more positive about your body image. If you’re having trouble coming to terms with changes in your appearance, talk to your doctor. They may be able to refer you to a psychologist or counsellor.

Fatigue after cancer

It’s common for people who have had cancer to have fatigue – sometimes for several months after treatment has finished. Fatigue is very different from normal tiredness – it means you lack energy and feel physically or mentally exhausted. Having fatigue can be frustrating because it can really impact on your daily life. Making sure you’re eating and sleeping well and keeping active can help. Have a think about changes you can make at home. For example, getting help with shopping or childcare, and keeping stocked up with ready-meals for when you’re most tired.

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

Memory and concentration problems

After cancer treatment, you may have trouble remembering things, concentrating or managing mental tasks that you didn’t have difficulty with before. This is often called ‘chemo brain’ because it was first linked to chemotherapy but it’s now known that these problems can affect anyone who’s had cancer.

These difficulties usually get better after treatment has finished, but they may carry on for months afterwards. Talk to your doctor if you are having problems.

There are many things you can do to help yourself.

  • Plan your day so that you do the most 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’re getting enough rest and sleep at night.
  • Try doing some mental exercise such as crosswords or puzzles to help improve your concentration.
  • Keep active – physical exercise can clear your mind and help you to feel more alert.

Fertility and sexual problems

Cancer and its treatment can affect fertility in both women and men. This means it may be more difficult for you to become pregnant or to father a child. Your doctor will discuss this with you before your treatment, so you can plan for the future.

As well as problems with your fertility, some treatments might affect your ability to have sex. Or you might find you have a lower sex drive or feel too anxious or tired to have sex. If you have changes to your appearance, this can also knock your confidence. Try to have open conversations with your partner about how you’re feeling and let your doctor or nurse know if you’re having problems.

Fertility problems in men

Some cancer treatments can lower sperm count in men. With chemotherapy, this is usually a temporary problem, but it can be permanent with certain chemotherapy drugs or high doses of treatment. Radiotherapy to your pelvis can also affect production of sperm.

Your doctor may advise you to bank some sperm before your treatment as a precaution – even if your chances of becoming infertile are low. If necessary, 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 hormone therapy, this might only last while you’re on treatment; with radiotherapy, it can be permanent. There are many different ways to deal with erection problems, including medicines, creams and devices. Talk to your doctor or cancer nurse if you’re having any problems.

Fertility problems in women

Chemotherapy, surgery on your pelvis and radiotherapy on your abdomen or pelvis can all affect fertility in women. Your periods may stop temporarily or permanently following treatment (early menopause). The symptoms of menopause can be difficult to cope with, but there are a number of treatments, complementary therapies and practical things you can do to help. Take the time to discuss these with your doctor or nurse.

Your doctor will talk to you about the possible effects on your fertility when your cancer is diagnosed. They may be able to avoid particular treatments if they know you’d still like to have children. They may also refer you to a fertility clinic to talk about possible options for preserving your fertility. These include freezing your eggs, embryos (created through IVF) or ovarian tissue. Other possible options include egg donation and surrogacy (when another woman carries a baby for you).

Managing other long-term side-effects

  • Pain. You may have pain after your treatment from damaged nerves or surgical scars. If you have any kind of pain, tell your doctor or nurse. They may prescribe painkillers or refer you to a pain specialist, physiotherapist or occupational therapist as necessary.
  • Problems with feeling and sensation. You may have ongoing numbness, pins and needles and tingling, especially in your hands and feet. This is more common after chemotherapy. It tends to gradually improve over time; but your doctor may prescribe medicines to help control your symptoms.
  • Difficulty eating. If you’ve had surgery to your digestive system, you may need to make permanent changes to how you eat and drink. You may also have ongoing problems with indigestion or heartburn (reflux). Your doctor or nurse may be able to give you some advice to help with your diet, but do ask to see a dietician if you need further support.
  • Bowel and bladder problems. Radiotherapy to your pelvis can sometimes cause long-term bowel and bladder problems. These include diarrhoea or trouble controlling your pee or poo (incontinence). You might feel embarrassed about this, but it happens to lots of people. There are treatments that can help, so do tell your doctor.
  • Damage or changes to other parts of your body. Cancer treatments can sometimes have a lasting effect on different parts of your body. These may include your heart, liver or kidneys. Your doctor will monitor you for these problems and treat them as necessary.
  • Second cancers. Some treatments for cancer may slightly increase the risk of developing a second cancer in the future. However, the benefits of having treatment should greatly outweigh any potential risk. Your doctor will be able to give you more information about this, and explain how it might affect you.

Side-effects from cancer treatments can continue for weeks or months after you’ve finished treatment. Some may only appear months or years later. We haven’t described all the possible side-effects you might experience here because this will depend on your particular circumstances. Your healthcare team will talk to you about what you might expect depending on the cancer and treatment you’ve had.

Healthy living after cancer treatment

There are several steps you can take that can help improve your overall health and wellbeing as you recover from cancer.

  • Keep active. Being physically active can help you return to full fitness, improve your mental wellbeing, reduce fatigue and even reduce the risk of cancer coming back. Your healthcare team will talk to you about the type and amount of exercise you can do. They may even be able to prescribe an exercise programme.
  • Try to eat a healthy, balanced diet and maintain a healthy weight. Eating well can help you to recover more quickly. If you need to lose or put on weight, your healthcare team can give you more advice specific to you.
  • If you smoke, try to give up. Smoking can increase your risk of developing new cancers, as well as heart disease and stroke. It can also make certain side-effects of treatment worse.
  • Be aware of any new symptoms or side-effects. Your healthcare team can tell you what symptoms to look out for. If you do notice any new symptoms, it’s important to let the team know. They can reassure you or arrange to see you if necessary.
  • Talk about how you feel. It can help to open up to loved ones. Many people also find support groups helpful because they can talk to people who have had similar experiences. If you think you’d benefit from talking to a counsellor, your GP or cancer team may be able to suggest someone.
  • Look at how you can reduce any stress in your life. Your healthcare team might be able to teach you some relaxation techniques, which can help with any stress or anxiety. Complementary therapies, such as meditation, mindfulness and yoga can also help with this.

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  • Reviewed by Pippa Coulter, Freelance Health Editor, February 2020
    Expert reviewer, Mr Giles Davies, Consultant Oncoplastic Breast Surgeon
    Next review due February 2023