Living well after cancer

When treatment ends, you may expect that life will soon return to normal. Or you may see the diagnosis as an opportunity to make changes to your life. Over time, cancer survivors often find a new way of living. This process is commonly called finding a new normal and it may take months or years.

Most people say cancer is a life-changing experience. Although having cancer can be very challenging, some people find positive aspects. They may discover an inner strength they didn’t know they had, develop new friendships during treatment or find other sources of support.

Cancer may prompt you to reconsider your outlook on life. This shift is often gradual; even positive change can take time. You may:

• place more value on spending time with family or friends and choose to focus on the more meaningful relationships in your life
• spend more time doing activities you enjoy, start new activities or visit new places
• reconsider your career goals and work values, and decide to work fewer hours or take on a different role
• have a new focus on healthy living.

The cancer experience doesn’t stop when treatment ends. Give yourself time to adjust to life after treatment. It can be helpful to take each day as it comes and accept that you may have both good and bad days. Everyone is different, but you may find some of the following suggestions useful.

Reflect on your life

Think about your goals and priorities. It may be helpful to write down how you’re feeling in a journal or to ask yourself:

• What makes me feel fulfilled?
• What makes me feel happy?
• What gives my life meaning?
• What is most important?

Look after yourself

Take the time you need to get used to any changes in your body. Do things at your own pace and rest between activities. Remember, your body is still healing and adjusting. If you are worried about going out, ask someone to go with you.

Take time for yourself

Make time each day to do something you find relaxing or enjoyable. This could be reading, listening to music, spending time in nature or taking a bath.

Talk about your emotions

Acknowledge your feelings. It may help to share any concerns or worries with your family and friends, your doctor, a psychologist or counsellor.

Manage your wellness

Think about ways you can manage your own wellness and make changes to improve your quality of life. Eating healthy food and being physically active can help your body cope with physical and emotional stress, and make you feel as though you are doing something practical to help yourself.

Clear your mind

Complementary therapies, such as relaxation, yoga, mindfulness meditation and visualisation, may increase your sense of control, relieve stress and anxiety, and improve mood.

Seek support

Connecting with others who have been through a similar experience may be helpful. Join a support group, attend a survivorship program, listen to survivorship webinars or read stories from other survivors.

Manage side effects

You may have ongoing side effects after treatment. Talk to your health care team about ways to improve or manage any symptoms.

I should be back to normal – You may have thought you would just resume your life exactly where you left off before the cancer diagnosis. The reality is often more complex. Some cancer survivors find they can’t or don’t want to go back to how life was before their treatment. Others need time to recover from treatment before they return to their usual activities.

I should feel well – You may look healthy on the outside, but on the inside, you may still be recovering physically and emotionally. Many cancer survivors have ongoing health concerns because of the cancer or treatment side effects.

I should not need any more support – You may feel a bit lost when you stop seeing your treatment team, family and friends so often. Some survivors are surprised to find they need more support than ever after treatment ends.

I should feel grateful – Survivors can sometimes feel pressure to be grateful for having survived cancer. Instead, the impact of cancer on your life and future may make you feel upset, angry or resentful.

I should be celebrating – You may think that you should be happy because you survived the diagnosis and feel guilty or confused if you’re not happy all the time.

I should feel positive – Friends and family may pressure you to think positively all the time. Although it is unrealistic to think positively all the time, this can be a source of worry for survivors.

I should be the person I was before cancer – Many survivors say that cancer changes them. You may have a sense of loss for the person you once were or thought you’d be. It can also be difficult when the people around you expect you to return to how you were.

I should be making plans – You may feel both excited and anxious when treatment ends. Many survivors need time to reflect on what has happened before they can think about the future.

I should make big changes – You may feel guilty if you return to your pre-cancer way of life instead of making big changes to your way of life.

Relief – You might be relieved that treatment has finished and seems to have been successful. You may welcome the chance to focus on the things you like to do.

Isolation – You may feel lost or nervous when regular appointments with your health care team reduce or stop. This can feel like losing a safety net. You may also feel lonely if your relationships have changed or people don’t understand what you’ve been through.

Fear – You may worry that the cancer will come back.

Uncertainty – You may avoid making plans for the future because you feel uncertain about your health. This is very challenging, but you can learn to manage it effectively.

Frustration – You may feel frustrated because you think your family and friends expect too much from you. Or you may feel discouraged because you can’t do the things you want to do.

Hopeful – You may feel hopeful about the future, and happy to be getting back to your regular routine.

Survivor guilt – You may feel guilty or question why you survived cancer when others didn’t. This can be confronting.

Anxiety – You may be anxious before follow-up appointments and feel these appointments “bring it all back”. Waiting for test results can also be an anxious time.

Worry – You may be concerned about treatment side effects: how long they’ll last and whether they’ll affect your life. Many survivors are worried about their finances or being a burden to their family. Other survivors worry about returning to work and dealing with questions from colleagues.

Lack of confidence – You may feel differently about your body and health. You may not trust your body and think it has let you down. You may not be physically able to do some of the things you did before treatment. Or you may worry about the impact on your ability to remember things and process information. Many people feel vulnerable and self-conscious about their body image and sexuality.

Heightened emotions – You may become tearful or emotional very quickly, particularly when someone asks how you are. It is normal to feel like this.

Anger – You may be angry about your cancer experience and how it has affected your life.

Delayed emotions – You may find your emotions catch up with you now that treatment is over. Many people do not expect negative emotions once their treatment ends and find this confusing.

Acknowledging how you are feeling may help you to work through your emotions. Try to develop a sense of your personal coping style (the things that work best for you). Remembering how you have coped with difficult situations in the past may give you some clues about helpful ways to cope with your emotions. Most cancer survivors find that they do feel better over time.

Friends and family may advise you to “think positively”. It is almost impossible to be positive all the time; everyone has good and bad days, before and after a cancer diagnosis. There is no scientific evidence to suggest that positive thinking has any impact on surviving cancer. However, many survivors say that feeling hopeful helped them to cope with their illness and make positive changes, such as doing more exercise or improving their diet.

It is common to feel low or depressed after treatment ends. Cancer survivors often experience worry or periods of feeling down for months or even years after treatment.

Cancer survivors may feel sad or depressed because of the changes that cancer has caused, fear that the cancer will come back or worries about the future. Many people feel disconnected from their life before cancer. Others wonder if they will be able to work again and whether their family will cope if they can’t earn enough money. Sometimes you may feel down for no particular reason.

Support from family and friends, other cancer survivors or health professionals may help you manage these periods.

Warning signs of depression

At any stage after a cancer diagnosis, it is natural to have days when you feel sad or worried. Sometimes a person may begin to feel “stuck” in their distress and become depressed or anxious. Depression is more than feeling down for a few days. Seek help from your general
practitioner (GP) if you:

• find it difficult to function on a daily basis
• have lost the desire to do things that previously gave you pleasure
• feel very sad and low most of the day, nearly every day
• begin to rely on alcohol or drugs
• eat more or less than usual
• are sleeping too much or having a lot of trouble sleeping
• feel restless, agitated, worthless, guilty, anxious or upset
• think you are a burden to others
• worry that you might hurt someone
• think about self-harm or taking your own life.

Some of these symptoms can also be caused by other medical conditions. Talk to your doctor about how you are feeling and ask for help. Anxiety and depression are quite common among people who have had cancer, but there is no need to face this experience alone.

"After my treatment, a psychologist explained that it’s common to feel like you’ve had the rug pulled out from underneath you. It’s also
common to question your view of the world and your beliefs. Knowing that, and how normal it is, helped tremendously.” DAVID

Getting help with depression

Depression generally won’t go away by itself – specific treatment is needed. Treating depression early may mean that you can deal with the problem quickly and avoid symptoms becoming worse.

There are ways to treat depression that don’t necessarily involve medicines. Treatment may include therapy provided by a GP, psychologist, psychiatrist, social worker or counsellor. Some
people are able to get a Medicare rebate for these sessions under a mental health treatment plan. Ask your GP if you are eligible. You can also call 13 11 20 to find out more about Cancer Council SA’s free Counselling Service.

Some people find online programs or smartphone apps helpful in managing depression and anxiety. Examples include moodgym, myCompass or MentalHealthOnline.

For information about coping with depression and anxiety, visit Beyond Blue or call
1300 22 4636. For 24-hour crisis support, visit Lifeline or call 13 11 14.

"Although some people bounce right back, once treatment was over, I questioned my values and reasons for being here.” EMMA

If you are having intense thoughts about hurting yourself or others, seek immediate assistance by calling Lifeline 13 11 14. In an emergency, call Triple Zero (000).

• Take care of yourself. Eat a well-balanced diet, drink plenty of water and limit alcohol.
• Do some regular physical activity. This can help with feelings of anger, stress, anxiety and depression, manage fatigue and improve sleep. Even a short daily walk will help.
• Do things you enjoy and connect with others who share your interests.
• Spend time with a pet.
• Share your fears and concerns with someone close to you. This can help you feel less alone.
• Spend time outside in the fresh air. A change of scenery might lift your spirits.
• List activities you would like to do and plan to do one of these activities each day.
• Establish a routine. Get up at the same time each morning. Make an effort to have a shower and get dressed.
• Write down your feelings or express yourself in painting, colouring, music or singing.
• Allow yourself a “low mood day” every now and again. You don’t have to be “up” every day.
• Practise letting your thoughts come and go without getting caught up in them. Try to focus on the present moment, rather than worrying about upcoming check-ups or tests. You may find Cancer Council’s Finding Calm During Cancer podcast helpful with this.
• Keep a record of positive things that happen each day. These don’t have to be big things, it could just be an encouraging smile from a neighbour.

• Talk to your treatment team about your risk of recurrence and how this might be managed. Ask about the symptoms to look out for and how to distinguish normal aches, pain or sickness from cancer symptoms.
• Focus on things you can control, such as being actively involved in your follow-up appointments and making positive changes to your lifestyle to reduce the risk of recurrence.
• Recognise the signs of stress and anxiety, such as a racing heartbeat or sleeplessness. Manage these in a healthy way, for example, you could try yoga, mindfulness meditation, taking slow, deep breaths or going for a walk.
• Speak with a counsellor or psychologist if the fear of recurrence is overwhelming. They may be able to teach you some strategies to help manage your fears.
• Joining a support group may help.
• Consider getting involved in a creative activity such as drawing, painting or writing. Some people find this helpful in working through their emotions.
• Side effects of treatment can make it harder to cope emotionally. Talk to your doctor about ways to manage any ongoing treatment side effects you are experiencing.

For more information, listen to our ‘Managing Fear’ podcast episode

"Once treatment was finished, it was quite daunting. I was fearful that the cancer would come back somewhere. Eight years later, it hasn’t come back, which is fantastic.” PETE

You may wonder how likely it is that the cancer will come back or how long people with the same type of cancer live. Cancer is most likely to recur in the first five years after treatment ends. Generally, the more time that goes by, the less likely it is that the cancer will come back.

The risk of cancer coming back is different for each person and depends on many things, including the type and stage of cancer, genetic factors, type of treatment and time since treatment. Your specialist can discuss your risk with you.

Even when there is no evidence of active cancer in the body, many doctors are wary of using the term “cure” because undetected cancer cells can remain in the body after treatment, causing the cancer to return. Instead they may talk about the “five-year survival rate”. The survival rates for cancer in Australia are among the best in the world.

The five-year survival rate is determined by the percentage of people alive five years after diagnosis. It does not mean you will only survive for five years. For example, about 92 out of 100 people (92%) with breast cancer will be alive five years after they are diagnosed. Many of these people live much longer than five years after diagnosis.

How accurate are the statistics?

Five-year cancer survival rates are a guide only. They generally include everyone with a particular type of cancer, at all stages and grades of the disease. For most cancers, people diagnosed with early-stage disease (cancer that is small and has not spread) are likely to have a much better outlook than people diagnosed with advanced disease (cancer that has spread to other parts of the body). With cancer treatments improving all the time, your outcome (prognosis) is likely to be better than the statistics currently available as they take many years to obtain.

Some survivors develop a second cancer that is different to the first cancer. The following things may increase your risk of developing another type of cancer:

• past or continuing exposure to cigarette smoke or other cancer-causing agents (including  asbestos, heavy metals, diesel engine exhaust, solvents and pesticides)
• skin damage caused by exposure to ultraviolet (UV) radiation from the sun or solariums
• getting older
• being born with an inherited gene that increases the chance of developing some cancers (about 5% of cancers)
• having some forms of cancer treatment, particularly as a child
• lifestyle factors such as eating an unhealthy diet, drinking too much alcohol, being overweight, and not getting enough exercise.

Some of these things you can change and others you can’t. Talk to your doctor if you are concerned about any risk factor. 

"I’m more aware of my own body and the need to get any changes checked out straightaway.” SAM

For some people, cancer does come back after treatment. Advanced cancer usually can’t be
cured, but it can often be controlled. Sometimes treatment can shrink the cancer, stop or slow the spread of advanced cancer, or relieve side effects. This can help maintain quality of life for several years. Many of the issues explored on these pages will be relevant for people with advanced cancer.

Download our booklet ‘Living with Advanced Cancer’

Listen to ‘The Thing About Advanced Cancer podcast’ 

It’s important to know what is normal for you. If you notice any unusual changes in your body or have any concerns, see your GP as soon as possible. Don’t wait until your next scheduled check-up.

The main signs and symptoms to look out for include:

• a lump, sore or ulcer that doesn’t heal
• a mole that bleeds or has changed shape, size or colour
• a cough or hoarseness that doesn’t go away, or a cough that produces blood
• a change in bowel habits, such as blood in your bowel movements, or diarrhoea or constipation that lasts for more than a week
• problems or changes with urinating
• persistent indigestion or difficulty swallowing
• abnormal bleeding or bruising
• changes in the breasts or testicles, such as a lump or swelling
• abdominal (belly) pain or bloating that doesn’t go away
• unexplained changes in your general health, such as weight loss or gain, night sweats, loss of appetite and loss of energy (fatigue).

Take part in cancer screening

Screening is organised testing to find cancer in people before symptoms appear. Australia has national screening programs for bowel, breast and cervical cancers. These programs are free for some people in certain age groups. From mid-2025, some people will be eligible for lung cancer screening. Screening programs for other cancers are being trialled.

Whether these screening programs are still appropriate for you will depend on the type of cancer treatment you had. Talk to your GP about this, or call Cancer Council 13 11 20. For details about screening programs, visit the Department of Health and Aged Care.

Join a clinical trial

Doctors and other health professionals conduct clinical trials to look at ways to improve the care and quality of life of cancer survivors. Areas studied include:

• how to best support the mental health of cancer survivors and deal with the fear of recurrence
• wellbeing and healthy lifestyle programs for survivors
• how to best treat common side effects such as fatigue, early menopause and lymphoedema
• understanding more about the causes of common side effects
• improving follow-up care for survivors.

You may want to consider joining a clinical trial when your cancer treatment finishes. Over the years, clinical trials have improved treatments and led to better outcomes for cancer survivors. You may find it helpful to talk to your specialist, treatment team or GP, or to get a second opinion. If you decide to take part in a clinical trial, you can withdraw at any time.

For more information and to find a list of current trials, visit the Australian New Zealand Clinical Trial Registry.

Download our booklet ‘Understanding Clinical Trials and Research’

Ask your cancer specialist or nurse for a written summary of your cancer and treatment. They should also send a copy to your GP and other health care providers. This summary should include:

• the cancer type and features
• date of diagnosis
• test results and staging information
• overview of cancer treatment (types and dates).

Some treatment centres now develop survivorship care plans for people as they approach the end of treatment. These plans usually:

• provide a cancer treatment summary
• set out a clear schedule for follow-up appointments and screening tests, including contact details for the health professionals involved in your treatment and ongoing care
• list any symptoms to watch out for and possible long-term side effects
• identify your medical, emotional, psychological or social needs after treatment and ways to manage them
• explain the roles and responsibilities of different members of your health care team and who to contact if you are worried
• suggest ways to adopt a healthy lifestyle after treatment.

A survivorship care plan can help improve communication between you, your family and all the health professionals involved in your care. The plan is not a fixed document; it should be reviewed regularly as your needs change. You can ask your health professionals to update your plan during consultations.

If you have not been given a survivorship care plan, ask your treatment team if they can prepare one for you. Another option is to develop your own plan and review it with your treatment team. The Australian Cancer Survivorship Centre provides a survivorship care plan template you can download and fill out.

If you’ve been treated for early breast, bowel or prostate cancer, melanoma, cancer of the uterus or non-Hodgkin lymphoma, visit myCarePlan to generate your own survivorship care plan.

How often do I need check-ups?

This is different for everyone. Your follow-up schedule depends on the type of cancer and treatment, the side effects experienced, and any other health conditions you are managing.

Some people have check-ups every 3–6 months for the first few years after treatment, then less often after that. Talk to your doctors about what to expect and ask if Australian guidelines or optimal care pathways exist for your follow-up care. For information about what to expect at every stage of cancer care visit Cancer Council’s guides to best cancer care.

If you are worried or notice any new symptoms between appointments, contact your GP right away. Don’t wait until your next scheduled appointment with the specialist.

What happens at follow-up appointments?

During check-ups your doctor or nurse may:

• assess your recovery
• ask how you’re feeling and coping with life after cancer
• do a physical examination
• monitor and treat any ongoing side effects and talk to you about any late side effects of treatment to watch out for
• look for any signs that the cancer may be coming back
• check any new symptoms
• ask if you have any concerns or questions
• discuss your general health and give healthy lifestyle advice
• outline how the cancer and its treatment might interact with any other health problems
• refer you to other health professionals and services, as necessary.

If you are on maintenance treatment (such as hormone therapy for breast or prostate cancer), talk to your treatment team about how long the therapy will continue and side effects to look out for.

Some people may need blood tests and scans, for example, mammograms for women treated for breast cancer, or prostate specific antigen (PSA) tests for men treated for prostate cancer. If you live a long way from your treatment centre, ask if you can have the tests in your local area. Not everyone will need or benefit from ongoing tests and scans. For many cancer types, having blood tests for tumour markers and imaging scans has not been shown to help identify a return of cancer.

It is important to tell your doctors about any new or ongoing symptoms so that they can help you manage them. For example, tell them if you feel low in mood or energy, aren’t sleeping, have a reaction to any medicines, or have pain or fatigue.

Managing your own health is an important part of survivorship. With the support of your health care team, there are many steps you can take to look after your own wellness, including
monitoring your body for any signs that the cancer has returned, managing any side effects and making healthy lifestyle choices.

"I now realise how important it is to build a relationship with my health care professionals and to actively look after my health.” EMMA

Who do I see for follow-up care?

You may have follow-up appointments with your cancer specialist, cancer nurse, GP or a combination. If you continue to see your specialist, you will still need to see your GP for regular health checks (e.g. blood pressure, cholesterol levels and weight). People treated for cancer may have a higher risk of other illnesses, such as heart disease and stroke, compared with the general population. Having a regular GP can help you manage your overall health and ensure you receive the support you need.

Your GP or specialist can refer you to a range of allied health professionals to help you manage some of the side effects of treatment and improve your quality of life. Ask for a referral to a professional with experience working with cancer survivors. Some people also find complementary therapies helpful.

If you have ongoing side effects after cancer treatment, talk to your GP about developing a chronic disease management plan to help you manage the condition. This means you may be eligible for a Medicare rebate for up to five visits each calendar year to allied health professionals.

The Australian Cancer Survivorship Centre provides resources on survivorship care plans, dealing with common survivorship issues such as fatigue, and caring for a cancer survivor.

Other health professionals who can help

general practitioner (GP) – helps manage treatment side effects and may manage some surveillance tests; conducts regular health checks; provides advice about healthy lifestyle
choices; manages any other physical or mental health issues you may have.

cancer nurse specialist – provides care, information and support throughout treatment and recovery; helps with symptom management and wellbeing after treatment; liaises with other members of the treatment team.

continence nurse – assesses and educates people about bladder and bowel control.

counsellor, psychologist – help you manage your emotional response to treatment and recovery; can provide strategies to help you make any desired changes to your life.

dietitian – helps with nutritional concerns, any ongoing problems with food and eating, or supervised weight loss or gain.

lymphoedema practitioner – educates people about prevention and management of lymphoedema; provides lymphoedema treatment.

occupational therapist – assists in adapting your living and working environment to help you resume usual activities after treatment.

physiotherapist/exercise physiologist – help restore movement and mobility, and improve
fitness and wellbeing.

sex therapist – helps you and your partner with sexuality issues after treatment.

social worker – links you to support services and helps you with emotional, practical and financial issues.

speech pathologist – helps with communication and swallowing issues; can give you strategies to help you eat and drink safely.

Ask questions – It may help to write down any questions you have and take this list with you to your appointments. If your doctor uses medical terms you don’t understand, ask them to explain them in plain English. If you have several questions, ask for a longer appointment when booking.

Record the details – Taking notes can help you remember what was discussed. If you would like to record the discussion, ask your doctor first. It is a good idea to have a family member or friend go with you to appointments for emotional support or to take part in the discussion. You may wish to ask them to make notes or simply listen.

Report on health issues – Tell your doctor or nurse if you have:

• difficulty doing everyday activities
• any new symptoms or new aches or pains that seem unrelated to an injury, or existing aches or pains that have become worse
• changes in weight or appetite
• feelings of anxiety or depression
• other health problems, such as heart disease, diabetes or arthritis
• started taking any new medicines or using complementary or alternative treatments.

Discuss other issues – You may want to talk to your health care team about other issues, such as changes to your sex life, how cancer has affected your relationships, returning to work or financial difficulties.

Treatment history – Give each health professional you see a copy of your survivorship care plan or treatment summary. If you don’t have one of these, tell them about your cancer diagnosis, treatment and any ongoing side effects, as this may affect the treatment they give you.

Many cancer survivors say they feel worried before routine check-ups. Anxiety, poor appetite, sleeping problems, mood swings and increased aches or pains are also common. These things may happen because:

• you fear you’ll be told the cancer has come back
• going back to hospital brings back bad memories
• you feel vulnerable just when you were starting to feel more in control
• friends or family make comments that upset you.

Check-ups may feel easier once you’ve had a few and things are going okay. In the meantime, finding ways to cope with your anxiety before check-ups may help.

Coping with check-ups

• Share your concerns with people close to you so they can provide support.
• Plan to do something special after the check-up.
• Allow extra travel time so you don’t feel rushed. This can help you to feel calm and focused.
• Try to see your check-ups as a positive way you can care for yourself.
• Learn mindfulness and meditation skills, or practise deep breathing to help manage stress and anxiety.
• Book the first appointment of the day or plan another activity beforehand so you are busy and don’t have time to dwell on the appointment.
• Ask if you can go to the doctor’s consulting rooms if you are not comfortable going to the hospital or treatment centre.
• Try to book tests about a week before your next doctor’s appointment so you don’t have to wait a long time for the results.

If you’ve had cancer, it doesn’t mean that your children will also get it. Most cancers are caused by a build-up of abnormal cells. These cell changes cannot be passed on to your children, so they won’t have a higher than normal risk of developing cancer.

However, having a strong family history of cancer may increase the risk of developing some cancers. This may be caused by inheriting a faulty gene linked to cancer, or by shared
environmental or lifestyle factors. A family history of cancer means that there are a number of closely related family members diagnosed with the same cancer or with more than one
cancer, often at a younger age.

Only about 5% of all cancers are linked to inherited faulty genes. If you are concerned about this, talk to your doctor. They may refer you to a family cancer clinic or genetic counselling service.

After treatment finishes, your family and friends may not fully understand what you’ve been through. They may expect you to act the same as you did before the cancer. If your outlook and priorities have changed, people close to you may be confused, disappointed, worried or frustrated. Family roles and responsibilities may have changed during treatment, and you may need to discuss these changes.

Friends and family may say things like “but you look fine” and “the cancer has gone, hasn’t it?” It’s natural for them to want the distress and disruption of cancer to go away.

Your family and friends may have difficulty accepting that you still need support or that some treatment side effects can persist for a long time or never go away. They care about you and want you to be well. However, if you find their reactions difficult to handle, you might like to talk to them about how you’re feeling. Ask for their support and patience. It may help to tell them that your recovery is ongoing, and that you need time to adjust to what you’ve been through and work out the next steps.

Like many adults, children may struggle with the changes to family life after a cancer diagnosis. They may worry about the future or find it difficult to understand why life can’t go back to the way it was.

Children’s reactions and needs will vary depending on their age. But most young people find honest discussions reassuring.

Tips for talking with children

• Try to be as open and honest as possible.
• Acknowledge the impact of cancer on your family. This is particularly important for teenagers. Canteen can help young people aged 12–25 cope with life after a cancer diagnosis in the family.
• Be open about how you feel, so the children understand if you’re not bouncing back.
• Spend time together doing things they enjoy.
• Explain any changes made to your family’s lifestyle. Let your children know if these are going to be permanent.
• Depending on the age and understanding of the children, talk to them about your fears (e.g. anxiety before a follow-up visit). This may encourage children to talk about their own fears.
• If your child (aged 18 or under) has had cancer, visit Cancer Hub to or call them on
  1800 431 312.

Download our booklet ‘Talking to Kids About Cancer’ 

Listen to our podcast episode ‘Explaining Cancer to Kids’

Some treatment side effects go away quickly; 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.

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.
• Speak with your GP about whether counselling or cognitive behaviour therapy (CBT) would help.
• 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.

Listen to our ‘Sleep and Cancer’ podcast episode

Now that treatment is over, you may think you should be full of energy, but this often isn’t the case. Feeling very tired and lacking energy for daily activities (fatigue) is a common side effect of cancer and its treatment. You may have muscle aches and pains, get worn out quickly, have trouble concentrating or find it difficult to do daily activities. Cancer-related fatigue is different from tiredness, as it doesn’t always go away with rest or sleep.

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.

Causes of fatigue

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), changes in hormone levels,
loss of muscle strength and fitness, 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).

How to manage fatigue

• Be realistic about what you can do. Your body is still recovering and it will take time for your energy levels to return.
• Exercise regularly to help boost your energy levels, restore muscle mass and reduce fatigue.
  Consider seeing an exercise physiologist or physiotherapist so they can develop a tailored
  exercise program for you.
• Break tasks up into smaller, more manageable pieces. Focus on doing a little bit each day rather than a lot all at once.
• Plan your day. Set small manageable goals and take regular breaks. Leave plenty of time to
  get to appointments.
• Adapt your activities. 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 activities.
• If you have children or grandchildren, sit down to play. Try activities like reading, board games, colouring, puzzles and drawing.
• Ask for, and accept, offers of help. Family and friends can help with shopping, school pick-ups or mowing the lawn.
• Say no to things you don’t feel like doing. If you have trouble saying no, ask someone to do it for you.
• Eat nutritious foods and limit alcohol. Aim to eat a healthy, well-balanced diet and drink plenty of water.
• Take regular short breaks throughout the day. Rest when you need to.

“I do become tired and I have to be careful, but if I pace myself, I can achieve what I want to achieve.” SUE

Download our fact sheet ‘Fatigue and Cancer’

Listen to our podcast ‘Managing Cancer Fatigue’ 

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 (peripheral neuropathy)
• 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.

If your pain is not well controlled, ask your doctor about referring you to a pain management specialist in a multidisciplinary pain clinic.

Ways to relieve pain

• Do some daily stretching and walking to help you deal with the pain. It is important to pace your activities throughout the day, and include rest or stretch breaks.
• See a physiotherapist or exercise physiologist. They can develop a program to improve muscle strength and increase your ability to function, which may help relieve pain.
• Talk to a physiotherapist or occupational therapist. They can suggest ways to address physical or practical problems that are causing pain.
• Learn different ways to think about the pain so it has less impact. Some types of talking therapies provided by psychologists and counsellors can help.
• Cognitive behaviour therapy (CBT) has been shown to improve mood, and decrease stress and anxiety.
• Try relaxation techniques, such as deep breathing, hypnotherapy, meditation or listening to music. They may improve how well other pain-relief methods work, help you sleep, and focus your attention on something other than the pain.
• Use massage or hot packs to relieve muscle spasms, stiffness and contractions. Cold packs may be used to numb the pain.
• Acupuncture may help by stimulating nerves to release the body’s natural chemicals, which help reduce pain.
• Try creative therapies such as art therapy or journal writing. These can help you express your feelings and work through the pain.
• Medicines that are normally used for other conditions can help relieve some types of chronic pain. They include antidepressants and steroids.

Download our booklet ‘Understanding Cancer Pain’

Listen to our podcast ‘Managing Cancer Pain’ 

When lymph fluid builds up in the tissues under the skin, it can cause swelling (oedema). 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.

Symptoms of lymphoedema

Having lymphoedema can make movement and some types of activity difficult. Swelling usually happens in an arm or leg, but it can also affect other areas of the body. The main signs of lymphoedema include:

• visible swelling
• aching, tingling or feelings of tightness or heaviness
• not being able to fully move the affected limb
• clothing, shoes or jewellery feeling tighter than usual
• pitting of the skin (when gentle pressure leaves a small dent).

How to find a lymphoedema professional

To find a health professional who specialises in the management of lymphoedema, visit the Australasian Lymphology Association. This may be an occupational therapist, physiotherapist or nurse with special training.

How to prevent or manage lymphoedema

• Treat lymphoedema early so you can deal with the problem quickly and avoid symptoms becoming worse.
• If you are at risk of developing lymphoedema, see a lymphoedema practitioner for regular
  check-ups rather than waiting for signs to appear. They may monitor the amount of fluid in your body using a painless electric charge (bioimpedance spectroscopy).
• Keep physically active to help the lymph fluid flow. Do regular exercise such as swimming, cycling or using light weights.
• Keep the skin healthy and unbroken to reduce the risk of infection. Avoid cuts, scratches, bites and injections in the affected area. If you shave, use an electric razor to minimise cutting the skin.
• Moisturise your skin daily to prevent dry, irritated skin. If you have lymphoedema, ask your lymphoedema practitioner about suitable creams and lotions.
• Protect your skin from the sun.
• Maintain a healthy body weight. Being overweight can be a risk factor for developing lymphoedema.
• Avoid wearing jewellery or clothing that puts pressure on the affected area or leaves marks on your skin.
• Take care cutting your toenails or see a podiatrist to look after your feet.
• Wear a professionally fitted compression garment, if advised by your lymphoedema practitioner.
• Seek medical help urgently if you think you have an infection in the affected area.

"Although I’d had lots of lymphoedema education, I missed the signs and didn’t realise I had it until I developed a skin infection called cellulitis.” SUZANNE

Download our fact sheet ‘Understanding Lymphoedema’

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

Managing changes in thinking and memory

• Get plenty of sleep. Deep sleep is important for memory and concentration.
• Use a diary or online calendar to keep track of appointments or set reminders on your phone.
• Carry a small notepad or download an app to your phone so you can jot down things you need to remember.
• Use your brain as much as you can – learn a language or musical instrument, do crosswords and puzzles, take up a new hobby.
• Do some gentle exercise each day. This can help you feel more alert.
• Do tasks one at a time rather than multi-tasking. Use a whiteboard to help plan your day.
• Put personal items (e.g. wallet, keys) in a dedicated place at home and at work so you can find them easily.

Download our fact sheet ‘Understanding Changes in Thinking and Memory’

Listen to our podcast ‘Brain Fog and Cancer’

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.

Taking care with numb hands or feet

• See a physiotherapist or occupational therapist for exercises to help you carry out your daily activities.
• Test the water temperature with your elbow before putting your hands or feet in to avoid burns.
• Use gloves while doing housework or gardening, a thimble when sewing and oven mitts when cooking.
• Wear well-fitting shoes with non-slippery soles.
• Clear walkways of hazards and remove loose rugs.
• Use non-slip rubber mats in the shower and bath.
• Be careful carrying things as you may have a greater risk of dropping them.
• 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.

Download our fact sheet ‘Understanding Peripheral Neuropathy and Cancer’

Cancer survivors can experience a range of other physical issues after treatment. Some common side effects are discussed below. If you would like more information about managing these or any other issues, 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 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. 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.

Incontinence – This 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. There are ways to better manage or perhaps even cure incontinence, for example, a physiotherapist can teach you exercises to strengthen your pelvic floor muscles. For more information and support, visit the National Continence Helpline or call them on
1800 33 00 66.

Radiation proctitis – Radiation therapy to the pelvic area can damage the lining of the rectum, causing inflammation and swelling known as radiation proctitis. Your treatment team will try to reduce the risk of developing radiation proctitis. It is usually a short-term side effect
but may be ongoing in some people. Radiation proctitis can cause a range of symptoms including blood in bowel motions; frequent passing of loose, watery faeces (diarrhoea); the need to empty the bowels urgently; and loss of control over the bowels (faecal incontinence).

The risk of developing radiation proctitis is low, but you may develop some of these symptoms for other reasons. Let your treatment team know if you develop any of these symptoms. They can refer you to a bowel care nurse for support. If you have ongoing bowel problems, your treatment team may refer you to a gastroenterologist.

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 (wee) or faeces (poo), 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 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; 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, 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. For more information, visit Healthy Bones Australia or call them on 1800 242 141.

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.

Download our fact sheet ‘Mouth Health and Cancer Treatment’

Side effects of androgen deprivation therapy

Males who have androgen deprivation therapy (ADT) to treat prostate cancer may experience side effects such as hot flushes, erection problems, mood changes, fatigue, loss of muscle strength, loss of bone density (osteoporosis), high cholesterol and weight gain.

Studies show that regular exercise can help manage the side effects of ADT. Our ‘Exercise for People Living with Cancer booklet‘ includes examples of aerobic, flexibility and strength-training exercises. It may also help to speak to a dietitian for advice on healthy eating.

For more information, talk to your specialist, GP or a sex therapist.

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.

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 love and care for 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. It may help to talk to someone who has had a similar experience. Call Cancer Council 13 11 20 for information on peer support programs.

Adjusting to changes in appearance

• Be gentle with yourself and acknowledge your feelings.
• Give yourself time to get used to any physical changes. Some changes may improve with time.
• 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. You can also book by calling them on
  1800 650 960.
• If you are finding it hard to adjust to changes in your appearance, help is available. Call Cancer Council 13 11 20 or talk to your GP.

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.

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.

If you have a partner, it can be helpful for them to understand the reasons why your libido has changed. They may feel confused or uncertain about how to react. Talking openly with your partner about how you’re feeling can be difficult, but it is often very helpful.

Ask your partner how they’re feeling too – some partners may feel concerned about having sex. They may be worried about hurting you or appearing too eager. You may want to talk to your partner about other ways of being intimate. Even if some sexual activities are not always
possible, there are many ways to express closeness.

Some people worry that they will never be able to enjoy sex again, but most people can have a fulfilling sex life after cancer. It’s important to take time to adapt to any changes. Some people say that because they try new things, their sex lives actually end up being better after cancer.

If you’re worried about changes to how you feel about yourself, your relationship or sexual functioning, you may find talking to a psychologist or counsellor helpful.

Managing changes in your sex life

• Seek professional advice and support. Talk to your doctor or nurse or ask for a referral to a sex therapist or counsellor. They can suggest ways to manage changes that affect your sex life.
• Try hormone creams and vaginal moisturisers to help relieve vaginal discomfort and dryness.
• Ask your doctor about medicines to help with erection problems.
• If surgery or radiation therapy has narrowed or shortened the vagina, you may be advised to use vaginal dilators to help keep the walls of the vagina open and supple. Using dilators can be challenging. Your doctor, nurse or physiotherapist can tell you where to get dilators and how to use them.
• Show affection by touching, hugging, massaging, talking and holding hands.
• Be intimate at the best time for you (e.g. when your pain is low or energy levels high).
• Talk to your GP if your low libido might be related to depression.
• Spend more time on foreplay and try different ways of getting aroused. Do whatever makes you and your partner feel good.
• Use a water-based 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 and to control penetration.
• If sexual penetration is painful or difficult, explore other ways to feel pleasure.
• If you feel comfortable, stimulate yourself. This may reassure you that you can still feel aroused.

How cancer treatment can affect your sex life

General

• reduced interest in sex (low libido)
• tiredness and fatigue
• changed body image
• feeling sexually unattractive
• incontinence
• painful intercourse
• depression or anxiety
• strain on or changes to your relationships

Females

• trouble reaching orgasm
• vaginal dryness
• shorter and narrower vagina
• loss of sensation
• pelvic pain
• menopausal symptoms

Males

• trouble getting or keeping an erection (erectile dysfunction or impotence)
• changes in ejaculation, such as dry orgasm

Download our booklet ‘Sexuality, Intimacy and Cancer’ 

Listen to our podcast episode ‘Sex and Cancer’

Menopause means the ovaries no longer produce eggs and periods stop. Menopause is a natural and gradual process that usually starts between the ages of 45 and 55. Some cancer treatments, including certain chemotherapy drugs, radiation therapy to the pelvic area, hormone therapy and surgery to remove the ovaries (oophorectomy), can cause early menopause.

If you are younger, reaching menopause much earlier than expected may affect your sense of identity and your plans to start a family or have more children. 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.

Symptoms of 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.

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.

Ways to manage menopause symptoms

• Meditation and relaxation techniques may help reduce stress and lessen symptoms. Listen to our Finding Calm During Cancer podcast for some exercises.
• Maintain a healthy weight and eat a healthy diet with lots of fresh fruit, vegetables and wholegrains.
• Regular exercise can help improve mood, heart health, bone and muscle strength, and energy levels.
• Try cognitive behaviour therapy (CBT). This has been shown to improve menopausal symptoms, including anxiety, sleep, hot flushes and sexual issues.
• Check your cholesterol levels as they can rise after menopause, increasing your risk of stroke and heart disease. If your levels are high, talk to your doctor about lifestyle changes or cholesterol-lowering drugs.
• Menopause can increase your risk of developing thinning of the bones (osteoporosis).
• Menopausal hormone therapy (MHT) can help reduce symptoms of menopause, but may not be recommended for some women who had hormone dependent cancers, such as breast or ovarian cancer. Talk to your doctor about the risks and benefits of MHT for your situation.
• If you need to avoid products containing oestrogen, talk to your doctor about non-hormonal medicines that may help with menopausal symptoms such as hot flushes and night sweats.
• If vaginal dryness is a problem, take more time before and during sex to become aroused and for the vagina to become more lubricated. Use a water-based or silicone-based lubricant that has no added perfumes or colouring.
• For more information, talk to your doctor, ask for a referral to a specialist menopause clinic or visit the Australasian Menopause Society.

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 by storing eggs, sperm or embryos.

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 do become pregnant soon after cancer treatment, 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 you thought your family was 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. You might want to consider other ways to become a parent, including adoption or fostering. Talking to a psychologist or fertility counsellor about how you are feeling might help.

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. 

Download our booklet ‘Fertility and Cancer’

Smoking is the biggest preventable cause of cancer. It increases the risk of developing many types of cancer, including lung, bowel, ovarian, bladder, kidney, liver, oesophageal, pancreatic and stomach cancers.

If you smoke, Cancer Council strongly recommends that you quit. Stopping smoking has been shown to increase your expected survival time and reduce your risk of developing another type of cancer.

Choosing to quit smoking at any age will benefit your health. It can also improve your ability to be more physically active and help reduce alcohol consumption, both of which can help you maintain a healthy weight. Many people who smoke find it hard to stop. Seek support and don’t be put off if it takes several attempts before you’re able to quit for good.

What about electronic cigarettes (vapes)?

E-cigarettes are battery-operated devices that heat a flavoured liquid to produce a vapour that users inhale into their lungs. The liquid can contain a wide variety of substances, including cancer-causing chemicals. There is growing evidence that e-cigarettes are not safe, and can lead to serious health problems. In Australia, people aged 18 years and over can buy e-cigarettes without a prescription from pharmacies. People under 18 years need a prescription to buy e-cigarettes. For up-to-date information about e-cigarettes, visit the Department of Health and Aged Care.

How to quit smoking

• Call Quitline on 13 7848 to talk to an advisor and request a free Quit Kit.
• Ask your doctor for advice about nicotine replacement therapy or prescription medicines to help you quit.
• Set a date to quit. Tell your family and friends so they can support you.
• Think of other attempts to quit as practice. Learn from what did and didn’t help.
• Make your home and car a smoke-free zone.
• Keep a list of all the reasons you want to quit.
• Do something else if you feel tempted to smoke (e.g. go for a walk, listen to music).
• Download an app such as My QuitBuddy from the App Store or Google Play. This can help you track your progress.

Skin cancer is the most common cancer in Australia and one of the most preventable. Most skin cancers are caused by exposure to the sun’s ultraviolet (UV) radiation. Using sun protection will reduce your risk of skin cancer. It’s also important to check your skin regularly and to ask your doctor how often you need a full skin check.

UV radiation from the sun causes skin cancer, but it is also the best source of vitamin D, which is needed for healthy bones. Most people get enough vitamin D throughout the day – even when using sun protection. When the UV Index is 3 or above, you may need only a few minutes outdoors on most days to get enough vitamin D (depending on your skin colour, where you live and the time of year). The body can absorb only a set amount of vitamin D at a time. Getting more sun won’t always increase your vitamin D levels, but it will increase your skin cancer risk.

People who’ve had skin cancer have a higher risk of developing more skin cancers. Talk to your doctor about how to protect your skin from the sun, check for new skin cancers, and maintain your vitamin D levels.

How to protect your skin

The UV Index shows the intensity of the sun’s UV radiation. An index of 3 or above means that UV levels are high enough to damage unprotected skin, so sun protection is recommended. Use a combination of the following measures to protect your skin. Make sun protection a part of your everyday routine.

Slip on clothing – Wear clothing that covers your shoulders, neck, arms, legs and body. Choose fabric with a tight weave or with a high ultraviolet protection factor (UPF) rating and darker
fabrics where possible.

Slop on sunscreen – Use an SPF 50 or SPF 50+ broad-spectrum, water-resistant sunscreen.
Apply 20 minutes before going out and reapply every two hours, or after swimming, sweating or any activity that causes you to rub it off. For an adult, the recommended amount is 1 teaspoon for each arm, each leg, front of body, back of body, and the face, neck and ears – a
total of 7 teaspoons of sunscreen for one full body application.

Slap on a hat – Wear a hat that shades your face, neck and ears. This includes legionnaire,
broad-brimmed and bucket hats. Check to make sure the hat meets the Australian Standard. Choose fabric with a close weave that doesn’t let the light through. Baseball caps and sun
visors do not offer enough protection.

Seek shade – Use shade from trees, umbrellas, buildings or any type of canopy. UV radiation is reflective and can bounce off surfaces, such as concrete, water, sand and snow, so shade should never be the only form of sun protection used. If you can see the sky through the shade, even if the direct sun is blocked, the shade will not completely protect you from UV.

Slide on sunglasses – Protect your eyes with sunglasses that meet the Australian Standard.
Wraparound styles are best. Sunglasses should be worn all year round to protect both the eyes and the delicate skin around the eyes.

Check daily sun protection times – Each day, use the free SunSmart Global UV app to check the recommended sun protection times in your area. The times will vary according to where you
live and the time of year.

You can also find sun protection times at the Bureau of Meteorology, or the BOM Weather app, or in the weather section of daily newspapers.

Sensitive skin after treatment – Some cancer treatments may make your skin more sensitive to the sun, causing it to burn or be damaged by the sun more quickly or easily than before. Ask your treatment team if this applies to you, and if there are any extra things you should do to protect your skin or you need more frequent skin checks.

Some cancer treatments can affect your weight. People often expect to lose weight during cancer treatment, but for many people it can have the opposite effect. Weight gained during cancer treatment can be difficult to lose because of fatigue and other challenges. Whether you have lost or gained weight, it is important to work towards a healthy weight.

Being overweight or obese is a risk factor for many types of cancer (including cancer of the bowel, kidney, pancreas, oesophagus, uterus, liver and breast), heart disease and diabetes. Keeping your weight within the healthy range can help reduce the risk of cancer recurrence and improve survival. The health risk associated with your body weight can be estimated using your waist measurement and body mass index (BMI). To calculate your BMI, go to healthdirect.

Waist measurement and health risk

Having fat around the abdomen or waist, regardless of your body size, can increase your risk of developing cancer, heart disease and diabetes. Some cancer types are also associated with increased fat around the hips and buttocks. Knowing your waist measurement can help you work out your risk. Place a measuring tape around your waist at the narrowest point between the lower rib and the top of the hips. Make sure to breathe normally. Use the table below to determine your health risk.

Increased health risk

• Female waist – 80 cm or more
• Male waist – 94 cm or more

Greatly increased health risk

• Female waist – 88 cm or more
• Male waist – 102 cm or more

Physical activity is a broad term that covers any activity that moves your body and increases your breathing and heart rate. Physical activity has a range of benefits for cancer survivors. It can:

• reduce the risk of some cancers (but not all) coming back, including breast, bowel and endometrial (uterine) cancers
• help prevent weight gain – being overweight or obese is a risk factor for many cancers
• help with recovery from treatment (rehabilitation) by increasing energy levels, improving sleep, increasing muscle strength, improving mobility and balance, relieving stress, and decreasing fatigue, anxiety and depression
• reduce the risk of developing other health problems, such as heart disease, osteoporosis and type 2 diabetes.

Recommended amounts of activity

Once cancer treatment is finished and you return to your usual day-to-day activities, aim to be as physically active as your abilities allow. The Clinical Oncology Society of Australia recommends that people with cancer do:

• at least 150 minutes (2½ hours) of moderate intensity aerobic exercise or 75 minutes (1¼ hours) of vigorous intensity aerobic exercise every week
• 2–3 strength-training (resistance exercise) sessions a week to build muscle strength.

Australia’s Physical Activity and Sedentary Behaviour Guidelines encourage adults to aim to do 150–300 minutes (2½–5 hours) of moderate activity or 75–150 minutes (1¼–2½ hours) of vigorous activity every week. For maximum cancer prevention benefits, aim to gradually increase your activity to 60 minutes of moderate physical activity or 30 minutes of vigorous activity every day.

Many people lose muscle mass and strength during cancer treatment and find it harder to complete tasks of normal daily living. Strength training (resistance exercise) can help you regain physical strength and get back to your daily activities. It can be done at home, an exercise clinic or gym. Resistance-based exercises can be done using your own body weight or equipment such as resistance bands, hand and ankle weights, or gym-based machines.

Taking care when exercising

Before taking part in any exercise program, it is important to talk to your specialist or GP about any precautions you should take. Ask about the amount and type of exercise that is right for you.

Your doctor may refer you to an exercise physiologist or physiotherapist to develop an exercise program to meet your specific needs. You may be able to attend one-to-one or group-based sessions, or your exercise professional may develop a program for you to follow at home. They will also show you how to exercise safely and monitor the intensity of your exercise (e.g. by measuring your heart rate).

Moderate intensity aerobic exercise includes brisk walking, swimming, jogging, cycling and golf. Vigorous intensity aerobic exercise includes fast jogging, running, swimming or cycling
and playing team sport such as football or netball.

How to be more active

• Doing any physical activity is better than doing none. To avoid overexerting yourself, start physical activity slowly and build up gradually.
• Walk with a friend or pet, join a walking group or walk to the corner shop instead of driving. If you are exercising outdoors, remember to protect your skin.
• Break up long periods of sitting or screen time by standing up and moving every half-hour.
• Take the stairs instead of the lift or escalators.
• Do some vigorous housework and activities around the home each day, such as vacuuming,
  gardening or mowing the lawn.
• Get off the bus or train one stop earlier or park further away from your destination and walk the rest of the way.
• Record your activity or steps completed each day. This can help keep you motivated.
• Join a group class such as dancing, Pilates, yoga or tai chi.
• Take your children or grandchildren to the park or kick a ball around the backyard.
• Try short periods of aerobic-based exercise (e.g. walking, cycling or swimming), stretching, or resistance-based exercises (e.g. using hand weights, resistance bands or your own body weight).
• Join a cancer survivorship exercise program or a local gym. Call Cancer Council 13 11 20 to find out about survivorship programs in your area.
• For some simple exercises to do at home, see our information ‘Exercise and Cancer‘ or Cancer Council NSW’s free online exercise videos.

"I was not as active before cancer as I am now. I walk three or four times a week. It gives me extra energy and helps clear my mind.” RIMA

Drinking alcohol increases the risk of developing some cancers, including cancer of the mouth and throat, oesophagus, bowel, stomach, liver and breast. Even drinking small amounts of alcohol can increase cancer risk, and the risk increases with every drink. Alcohol contains a lot of energy (kilojoules or calories), so it can contribute to weight gain. Drinking alcohol also increases the risk of other diseases, such as heart disease and type 2 diabetes.

Cancer Council recommends you limit how much you drink to reduce your cancer risk. If you choose to drink alcohol, stick to the National Health and Medical Research Council guidelines and have no more than 10 standard drinks a week and no more than 4 standard drinks in one day. One standard drink has 10 grams of alcohol, but remember that drinks served at home and bars are often more than a standard drink.

Ways to reduce your alcohol intake

• Choose a non-alcoholic drink such as sparkling mineral water with fresh lemon or lime slices.
• Alternate alcoholic drinks with a glass of water.
• Set yourself a limit and stop once you’ve reached it.
• Wait until your glass is empty before topping it up to keep count of your drinks.
• Explore alcohol-free beers, wines, spirits and mocktails.
• Have some alcohol-free days each week.
• Eat while you drink to slow your drinking pace.
• Catch up with friends over coffee or go for a walk.
• Download the Drinks Meter or Daybreak apps to help monitor your drinking.
• For information and support, visit the National Alcohol and Other Drug Hotline or call
  1800 250 015.

It is important to eat a balanced diet from the five food groups – fruit, vegetables and legumes, wholegrains, meat (or alternatives) and dairy (or alternatives). Limit foods containing saturated fat, added salt and added sugars, and avoid sugary drinks.

Fruit, vegetables and legumes

Eating fruit, vegetables and legumes (e.g. beans, lentils, peas) is important for your health. They are a great source of fibre, vitamins and minerals. Fruit and vegetables also contain natural substances, such as antioxidants and phytochemicals, which can protect cells in the
body from damage that may lead to cancer. Eating fruit, vegetables and legumes can help you achieve and maintain a healthy weight because they are low in kilojoules and high in fibre.

The Australian Dietary Guidelines recommend eating at least two serves of fruit and five serves of vegetables or legumes daily. Aim to eat a variety of different-coloured fresh fruit and vegetables. They are best eaten whole (not juiced), and it’s good to eat both cooked and raw vegetables. Frozen and tinned vegetables are just as nutritious and are a good alternative to fresh produce – look for varieties without added sugars, salt or fats.

Wholegrain, wholemeal and high-fibre foods

Dietary fibre can help to ensure a healthy digestive system and reduce the risk of bowel cancer. Eating a diet high in fibre and wholegrain foods can also lower your risk of developing type 2 diabetes and heart disease, and help you maintain a healthy body weight.

The Australian Dietary Guidelines recommend that most adults eat at least four serves of cereal or grain foods each day, with at least two-thirds of these being wholegrain or wholemeal varieties. Wholegrain foods include wholemeal breads, rolled oats, wholemeal pasta, brown rice, barley, popping corn, cracked wheat (burghul) and quinoa. Wholegrain foods contain the outer layer of the grain, which contains fibre, vitamins, minerals and phytochemicals. Wholemeal foods are made from wholegrains that have been crushed to a finer texture. Nutritionally, wholemeal and wholegrain foods are very similar.

Some people continue to have bowel problems after cancer treatment. If you find that dietary fibre makes any bowel problems worse, you may need to eat low-fibre foods. A dietitian can recommend suitable foods for your situation.

How much is a serve?

Fruit, vegetables, legumes

• 1 medium-sized piece of fruit
• 2 smaller fruits (e.g. plum, apricot)
• 1 cup diced fruit
• ½ cup cooked vegetables
• ½ cup legumes
• 1 cup raw salad vegetables

Wholegrain foods 

• 1 slice of wholegrain bread
• ½ cup cooked brown rice or wholemeal pasta
• 2/3 cup wholegrain breakfast cereal
• ½ cup cooked porridge

Meat (raw) 

• 100 g lamb loin chop
• 100 g steak
• 1/2 cup diced red meat
• 1/2 cup mince

Red meat and processed meat

Red meat includes beef, lamb, pork, veal, goat, venison and kangaroo. Lean red meat is an important source of dietary iron, zinc, vitamin B12 and protein. But eating too much red meat increases your risk of bowel cancer. To reduce this risk, Cancer Council recommends eating no more than 455 g cooked (700 g raw) lean red meat per week. This means you could have a small serve of lean red meat (65 g cooked) every day, or a larger serve in 3–4 meals a week.

There is strong evidence that eating processed meats (e.g. ham, bacon, salami) is linked with an increased risk of bowel cancer. Processed meats are high in energy (kilojoules), saturated fat and sodium, and they don’t provide the essential nutrients our bodies need.

There is no conclusive evidence that a vegetarian diet improves survival after cancer treatment. However, eating more fruit, vegetables, legumes and wholegrain foods will probably boost the quality of your diet.

Ways to eat well after cancer

• Eat a variety of nutritious foods every day.
• Add vegetables, legumes, fruit, wholegrain and high fibre foods to your meals.
• Limit your intake of red meat.
• Choose lean cuts of meat and trim as much fat as possible before cooking.
• Swap a serve of red meat for another variety of protein. Sources of protein include fish, chicken, eggs, legumes, tofu, nuts, wholegrains, soya and dairy products.
• Avoid processed meats like ham, bacon and deli meats or eat only occasionally.
• Try reduced-fat milk, yoghurt and cheese. Choose varieties that are also low in added sugars or salt.
• Eat fish a couple of times a week.
• Add fruit and yoghurt to wholegrain cereal or serve some vegetables such as mushrooms with your eggs and wholegrain toast.
• Adapt your recipes to include more vegetables and legumes (e.g. add grated carrot and zucchini, celery, capsicum, beans or lentils to pasta sauces).
• Limit the portion size of your meals and snacks.
• Fill half your dinner plate with vegetables.
• Swap sugary drinks for water.
• Avoid snacks that are high in added fats, sugars and salt, such as chips, biscuits and chocolate. Replace them with nuts, fruit, yoghurt or cheese.
• Limit takeaway foods that are high in fat, sugar, salt and kilojoules.
• Don’t add salt to food during cooking or before eating. Add flavour with herbs and spices.
• Grill, poach, slow roast and stir-fry rather than deep fry.
• Steam or microwave vegetables to maintain their nutritional goodness.

Managing dietary changes

Treatment for some cancers can affect how you eat, swallow, digest food and absorb essential nutrients. You may need to try different foods and ways of eating.

A dietitian can help tailor an eating plan to manage any ongoing issues. They can also provide advice about suitable nutritional supplements to help maintain your strength.

It may take time and support to adapt to your new way of eating. You may worry about eating in public or with friends. These reactions are natural.

It may help to talk about how you feel with your family and friends, your GP, a counsellor or someone who has been through a similar experience.

Download our booklet ‘Nutrition for People Living with Cancer’

For many people, cancer treatment can be a financial strain. This could be caused by extra costs you may have during and after treatment, or loss of income. Financial support and advice is available:

• Call your local Cancer Council on 13 11 20 to find out what support services are available. Depending on where you live, Cancer Council may be able to provide financial counselling support (if you are struggling with debts and everyday expenses) or refer you to a financial planner (for advice on income and asset management).
• Call the National Debt Helpline on 1800 007 007 for free, confidential and independent financial counselling.
• Ask your social worker if any financial or practical assistance is available to you. If you have to travel for follow-up appointments, ask about patient travel assistance.
• Ask your utility company, loan provider or local council how they can help you manage payment of your bills (e.g. electricity, water, gas, internet, phone bills), loans or rates. Check if you qualify for any rebates, concessions or hardship programs.
• Ask your superannuation fund if you are eligible for early access to your super or any attached insurance policies. Talk to a financial counsellor or planner about how this will affect your long-term financial situation.

Download our booklet ‘Cancer and Your Finances’

Download our fact sheet ‘Superannuation and Cancer’

Applying for new insurance (life, income protection or travel) may be harder because you have had cancer. You are generally required to provide your medical history, including any diagnosis of cancer. In general, you should be able to buy insurance for things that are not cancer-related (like travel insurance for lost luggage or life insurance for accidental death).

It may be difficult to buy travel insurance that covers medical problems that are related to cancer, but you should be able to get coverage for non-cancer-related medical costs. It is a good idea to check exactly what is covered before buying a new insurance policy.

If you need legal advice about an insurance policy, you can contact the Insurance Law Service at the Financial Rights Legal Centre or call them on 1300 663 464.

Download our fact sheet ‘Insurance and Cancer’

Depending on where you live and your financial situation, Cancer Council may be able to connect you with a lawyer for free advice about legal issues that may arise as a result of cancer. Call 13 11 20 to find out more. You can also contact Community Legal Centres Australia or the law society in your state or territory.

Find out more about our ‘Legal Referral Service’

Having a job is an important part of life for many people. Aside from income, work can provide satisfaction, social contact, a sense of normality, and a way of maintaining self-esteem. If you took time off work for treatment and are returning to an existing job, talk to your employer about a return-to-work plan.

It’s a good idea to speak with your doctor about your ability to perform your usual tasks. For some people, returning to the same job may not be possible due to changes in ability and length of time away. The desire to reduce work-related stress or seek more meaningful work may also motivate people to change jobs.

Do I have a right to return to my job?

Australian laws require an employer to take reasonable steps to accommodate the effects of an employee’s illness. This may mean, for example, that your employer is flexible with start/finish times, gives you time off to attend medical appointments or allows you to return to work in stages. If you are unable to carry out your previous role, your employer doesn’t have to offer you a different job unless your cancer is work-related.

Must I say I had cancer in job applications?

While some people may want to tell a potential employer that they have had cancer, you don’t need to unless it may impact on your ability to do the job. If you are asked about a gap in your résumé, you can say that you had a health issue and it’s now resolved. A prospective employer is permitted to ask you about your ability to perform tasks that are an essential part of the job (e.g. lifting heavy boxes). If some tasks are a problem for you because of the cancer or treatment, it’s best to mention this at the interview.

What if I can no longer work?

If cancer or its treatment has made it impossible for you to return to your previous work, then rehabilitation and retraining programs can prepare you for another job. Discuss this with your employer or GP.

If you are permanently unable to return to work, you may be able to access your superannuation under the permanent incapacity condition. If you have total and permanent disability (TDP) insurance or income protection insurance, you may also be able to make a claim. If you are unable to return to work, visit Centrelink or call 132 717 to see if you are
eligible for the Disability Support Pension or other payments.

I had planned to work beyond 65, but now I’m thinking I’ll retire sooner. I have different priorities now. I’ve been given a second chance.” JULIE

Discrimination at work

A lack of knowledge about cancer may mean some people are treated differently at work after a cancer diagnosis. Employers and colleagues may think you need more time off or wonder about your ability to perform your usual role.

Anyone who has had cancer is protected by the Commonwealth Disability Discrimination Act 1992, which prevents employers from discriminating against people with disabilities in the workplace. For details: contact your state or territory anti-discrimination body; visit the Australian Human Rights Commission; or visit the Fair Work Ombudsman.

Download our booklet ‘Cancer, Work and You’

Download our workplace fact sheets