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  • Physical side effects after cancer

    Reviewed March 2012

    Content

    It can take time to get over the side effects of treatment. Side effects vary depending on the type of cancer you had, its stage and the treatment you were given. The changes can be both physical and emotional.

    Fatigue

    Fatigue—or feeling exhausted and lacking energy for day-to-day activities—is the most common side effect of cancer treatment. It can be caused by the physical and emotional effects of diagnosis and treatment. Fatigue differs from normal tiredness as it often doesn’t go away with rest or sleep.

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

    Most people get their energy back six to twelve months after treatment. However some people lack energy for years after treatment and their energy levels may never fully recover.

    Symptoms of fatigue

    People living with cancer have described fatigue as overwhelming, unbelievable, debilitating and frustrating. Symptoms include:

    • a lack of energy— you may want to stay in bed most of day
    • difficulty sleeping (insomnia)
    • finding it hard to get up in the morning
    • feeling anxious or depressed particularly if fatigue persists
    • muscle pain—you may find it hard to walk or climb stairs
    • feeling breathless after light activity such as having a shower or making the bed
    • difficulty concentrating, even watching TV or talking to someone
    • finding it hard to think clearly or make decisions easily
    • little or no interest in sex (low libido).

    You may worry your friends or family won’t believe you or think you are complaining too much if you keep saying how tired you feel. They may not appreciate the long-term effects of fatigue. It’s common for relationships to change if people feel misunderstood. Talking to family and friends about how you feel may help them to understand.

    Fatigue and its symptoms may also sometimes be signs of depression. If you have a persistent low mood, talk to your doctor. Treating depression may help you feel less tired and give you more energy. Click here for more information about depression.

    Managing fatigue    

    Many cancer survivors don’t tell their doctor about fatigue because they think nothing can be done about it. However there may be things your treatment team can suggest that might help. For example if your fatigue is caused by low red blood cells or the side effects of drugs, your doctor may be able to treat the cause.

    • Have realistic expectations. As soon as treatment finishes don’t expect to be able to instantly do all the things you used to do before the cancer. Your body is still recovering and it will take time for your energy levels to return.
    • Set small, manageable goals. Focus on doing a little bit each day rather than a lot in one go.
    • Ask for help. Get friends or family to help with school pick-ups, shopping or running errands.
    • Plan your day so you can do the activities most important to you at the time of day when you have the most energy.
    • Take rest breaks between activities.
    • Do things slowly so you don’t use too much energy as you go.
    • Leave plenty of time to get to appointments so you don’t have to rush
    • Try activities to help you relax, reduce stress and take your mind off how tired you feel. For example you might walk on the beach, sit in a peaceful setting, do some light gardening, have a long bath or listen to some music.
    • Say no to things you don’t feel like doing. It’s okay not to please others all the time.
    • Do some regular, light exercise to boost energy levels, which may make you feel less tired. A short walk may help to restore your energy without exhausting you. Talk to your health care team about suitable activities.
    • Smoking can reduce your energy. If you smoke, talk to your doctor about quitting or call Quitline 13 7848.
    • Save your energy if you can. Sit down to talk on the phone or do chores such as cutting up vegetables or the ironing. Use a trolley to transport wet clothes to the clothesline.
    • Eating a nutritious snack during the day may help increase your energy if you are not having enough at meal times.
    • Go to the shops during quieter times or do your shopping online and having it delivered.
    • Consider joining a support group. Cancer Council 13 11 20 can talk to you about support groups that may suit you. Talking about your feelings may ease the burden of fatigue and you can hear how other people in similar situations have managed.

    Sleep difficulties

    Difficulty sleeping is common among people who have had cancer. Sleep can be affected by symptoms related to the cancer treatment as well as environmental, physical and psychological factors. People who have pre-existing sleep problems can have additional sleep difficulties after their cancer diagnosis.

    Tips to help you sleep

    • Only go to bed when tired.
    • Get up at the same time each morning, including weekends.
    • Try not to take daytime naps.
    • Exercise regularly.
    • Ensure the room is dark, quiet and a comfortable temperature.
    • Set up a pre-sleep routine to help you to relax.
    • Speak to your doctors if it doesn’t improve

    Pain

    Some people experience pain after cancer treatment. Pain can prevent you from doing the things you want to do which has a big impact on your life. Controlling the pain may allow you to return to many of the activities you enjoy.

    Chemotherapy and surgery can injure nerves and cause pain and numbness in certain areas of your body. Your skin may be very sensitive in the area you received radiotherapy; this can last for a few months. Scars from surgery can also hurt for a long time.

    Controlling the pain may allow you to return to many of the activities you enjoy. Discuss your pain with your doctor so the cause of the pain can be worked out and the best treatment plan developed. How you manage your pain depends on the type of pain you have. If your pain lasts for a long time or is constant, do something about it before it gets out of control.

    Taking medication regularly is often the best way to prevent pain from getting worse. Some people call this ‘staying on top of the pain’. It may mean you can use lower doses of pain relief than if you wait until the pain gets worse.

    Common pain-killing medications

    Pain-killing drugs, called analgesics, are available to treat different types and levels of pain:

    • mild pain—paracetamol or non-steroidal anti-inflammatory drugs
    • moderate pain—mild opioids such as codeine
    • strong pain—opioids such as morphine.

    Your doctor may also prescribe other drugs e.g. medications normally used to treat depression or epilepsy have been found to be helpful for some types of pain. Although you may not have depression or epilepsy, taking these drugs may make it possible to control the pain with a lower dose of opioids.

    Will I become addicted to pain-killers?

    People taking opioids at the levels necessary to relieve pain are not at risk of addiction unless they have had addiction problems in the past. However it is common to experience symptoms of withdrawal when you stop taking a drug. For this reason your doctor will gradually reduce your dosage. If you are concerned about drug dependence talk to your doctor.

    Will the pain-killers make me drowsy?

    This is unlikely if you take the medication as your doctor prescribes. You may feel drowsy at first but this usually wears off within a couple of days. If it doesn’t talk to your doctor. Your dosage may need to be adjusted.

    Other methods of pain relief

    For some people pain can be relieved without taking tablets. Some people have surgery or have an anaesthetic injected into their body (nerve block). Doctors usually use these methods if nothing else is effective.

    Seeing a physiotherapist or occupational therapist may help you address physical or practical problems that are making you uncomfortable.

    Some people use complementary therapies. These therapies may enhance your general well-being and help you cope better with pain. They may also increase your sense of control over the pain, improve your mood and decrease your stress and anxiety.

    • Relaxation techniques - such as deep breathing, meditation or listening to your favourite music - may help you sleep at night, give you more energy, reduce your anxiety and make other pain-relief methods work better.
    • Mindfulness and meditation use breathing techniques to quieten the mind. This may help you to focus on the present.
    • A relaxing massage may relieve muscle spasms and contractions.
    • Applying hot or cold packs to areas may provide good relief.
    • Distraction involves focusing your attention on something other than the pain. For example you can listen to music or do something creative such as craft activities or painting.
    • Other therapies, such as acupuncture, may stimulate the release of the body’s own natural chemicals which may help reduce your pain and help you relax.

    Loss of self-esteem due to physical changes

    Treatment for cancer can change the way your body looks and how it works. This may affect how you feel about your body.

    Your self-esteem may be affected by:

    • speech difficulties
    • eating and drinking problems
    • breathing changes
    • weight loss or gain
    • changes to your appearance (e.g. mastectomy, loss of a limb or oral surgery)
    • hair loss or hair growing back differently
    • bladder and bowel changes (e.g. colostomy or ileostomy)
    • intimacy and sex life difficulties
    • infertility .

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

    It is natural to worry about how your family and friends will react, and whether your partner or a potential partner finds you physically attractive.

    It may help to let others know how you are feeling. They probably want to support you and reassure you they still love you and see you in the same way as they did before the diagnosis. Hearing what they have to say may boost your confidence.

    If you don’t feel comfortable talking to friends or family about how you feel, consider speaking to your health care team or a professional counsellor. You may also find it valuable to talk to someone who has had a similar experience. Call Cancer Council 13 11 20 for information on support services.

    Sexuality and intimacy

    Cancer and its treatment may affect your sexuality and intimacy in physical and emotional ways. Some people don’t feel any differently sexually after treatment but if you do, it can be hard to deal with. These changes may be temporary or ongoing.

    Anyone who has had cancer treatment may have sexual concerns but those most likely to experience long-term problems include:

    • women treated for breast or gynaecological cancers
    • women who experience early menopause
    • men treated for testicular or prostate cancer
    • people treated for rectal or lower bowel cancer
    • people who have a stoma because of their treatment.

    Types of problems you may have

    Cancer and its treatment may change your appearance and your sexual response.

    Hormone levels or the nerves supplying the genital area may have been affected causing physical problems such as vaginal dryness or erectile dysfunction. This can affect your desire for sex.

    You may feel less sexual because you look different or feel less attractive. Some people feel embarrassed and upset by changes to their body and don’t want their partner to see them naked.

    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, in fear that it may lead to sex when they don’t want it. Some people worry that they will never be able to have an intimate relationship again.

    If the cancer treatment has affected your ability to have children this may also change the way you feel about having sex.

    • Plan sexual activity for the time of day when your pain is at its lowest. To be most effective pain medication should be taken shortly before sex.
    • Show affection by touching, hugging, massaging, talking and holding hands.
    • Talk to your partner if you have little or no interest in sex (low libido). They may be able to help you get in the mood. They may also need to accept that you may not be able to get in the mood for some time.
    • Try different ways of getting aroused: shower together, have a weekend away, wear something sexy—whatever makes you feel relaxed and good about yourself.
    • If you have vaginal dryness or tightness, try a water based lubricant, vaginal moisturiser or cream during sex. Some women who have had radiotherapy or surgery may be advised to use a dilator to keep their vagina open and supple.
    • Change position during sex to work out which position is the most comfortable for you.
    • Ask your doctor if any medications can help with sexual problems such as difficulties getting or maintaining an erection.

    You may not even be aware you aren’t taking an interest in sex or being as intimate as you were before. If you have a partner this can be confusing for them and it may make them feel uncertain about how to react.

    Talking to your partner about how you’re feeling can help. Let them know why you don’t want sex, but reassure them that you love them. Most partners will be happy to do things at your pace.

    • Spend more time on foreplay: watch a romantic movie, look at erotic magazines or DVDs, create a sexy atmosphere with dim lighting, music or candles.
    • Physical activity can stimulate sexual desire by increasing energy and lifting your mood.
    • Dancing is not only great exercise but it can also arouse your sexual desire as you get physically close to your partner.
    • Be intimate at the time of day best for you (e.g. in the morning when you feel refreshed) and have shorter lovemaking sessions.
    • If you feel comfortable, stimulate yourself. This may give you the reassurance that you can still enjoy sex. Or you may want to stimulate your partner and help them reach orgasm even if you don’t want this yourself.
    • Health professionals with specialised training can help you cope with specific sexual problems. It can be helpful to get advice and support rather than ‘put up with it’. Talk to your doctor—either with your partner or separately—and ask for a referral.

    Rekindle is a personalised online resource that addresses sexual concerns for all adults affected by cancer.

    Erectile dysfunction

    When a man has trouble getting or keeping an erection firm enough for intercourse it is called erectile dysfunction or impotence.

    Erection problems are common in men who have had treatment for prostate, bladder or rectal cancer particularly if they’ve had radiotherapy or surgery. Cancer treatment may add to existing erection difficulties or it may be the sole cause of them.

    The body needs time to heal after treatment but generally there is a gradual recovery, with men noticing continued improvement for up to three years after treatment finishes.

    Surgery

    The most common way surgery affects erectile function is by removing or injuring the nerves or blood vessels that are needed for an erection.

    Radiation

    The higher the total dose of radiation and the wider the section of the pelvis treated, the greater the chance of an erection problem later. This change most often develops slowly. Some men will still have full erections but lose them before reaching climax. Others no longer get firm erections at all.

    Hormone therapy

    Hormone therapy—or androgen deprivation therapy—used for treatment of prostate cancer to prevent the cancer from growing will often affect erectile function.

    Prostate cancer

    While the prostate doesn’t contribute to a man’s ability to have an erection, it lies close to nerves and blood vessels that are important for erectile function.

    Speak to your specialist if you have concerns about erectile dysfunction. There are several options available including tablets, injections, vacuum pumps and penile implants.

    There is increasing evidence that early sexual rehabilitation after surgery and radiotherapy helps recovery.

    Menopause

    Menopause means a woman’s ovaries no longer produce eggs and her periods stop. The average age for a woman to experience natural menopause is 52.

    Menopause after treatment for cancer may be temporary or permanent. Whether your periods stop temporarily or permanently, you may experience menopausal symptoms.

    Cancer treatments that can cause menopause include certain chemotherapies, radiotherapy to the pelvic area, hormone treatment and surgery to remove the ovaries (oophorectomy).

    For women who want children menopause can be devastating. Even if your family is complete or you didn’t want children you may have mixed emotions and worry about the impact on your relationship.

    Some women find menopause difficult because they feel it has taken away a part of their identity as a woman.

    Symptoms

    While natural menopause can be a difficult time for a woman it may be more difficult if menopause happens suddenly because of cancer treatment.

    Symptoms may be severe because the body hasn’t had time to get used to the gradual decrease in hormone levels. You may experience hot flushes, mood swings, trouble sleeping, tiredness and vaginal dryness. Many of these symptoms will eventually pass though it can take months or a few years.

    You are also at risk of developing weak and brittle bones (osteoporosis). Ask your doctor how to manage this condition.

    Some things that may help

    Hormone replacement therapy (HRT) can help reduce symptoms. However this may not be recommended because studies have shown that using HRT with oestrogen and progestogen for longer than five years can increase the risk of some diseases, such as breast cancer.

    • Talk to your doctor about non-hormone medications that might help with symptoms such as hot flushes.
    • Ask your doctor whether you would be suitable to use creams or pessaries that contain oestrogen, to relieve vaginal dryness. Moisturisers without oestrogen can also be used.
    • Eat a healthy diet with lots of fresh fruits and vegetables, and wholegrains. Ask your doctor if you want advice about diet modifications or herbal remedies.
    • Extra lubrication may make intercourse more comfortable. Choose a water or silicone-based gel without perfumes or colouring to reduce irritation (e.g. Sylk® or Pjur®).
    • Take more time before and during penetration to help the vagina relax and become more lubricated.

    Fertility problems

    Some cancer treatments can cause temporary or permanent infertility (inability to conceive a child).

    Although chemotherapy and radiotherapy reduce fertility, it may still be possible for women to become pregnant after treatment or for men who have had treatment to father a child.

    Your doctor may suggest you wait a certain period of time before trying to conceive. For example some people wait for a year or two to give their body time to recover and allow eggs and sperm to become healthy again. Some form of contraception must be used during this time.

    If you are told you’ll be permanently infertile you may feel a great sense of loss and grief. You might be devastated you won’t have your own children or additional children and you may worry about the impact of infertility on your relationship. Even if your family is complete, you may be distressed.

    Infertility may make you feel you have lost control of what you wanted in your life. You may feel very angry, sad or anxious that the cancer and its treatment caused these changes to your body. Talking to a counsellor about how you are feeling might help.

    Lymphoedema

    Lymphoedema is swelling that occurs in soft tissue, usually a limb such as the arm or leg, after lymph nodes have been removed during surgery, or damaged by infection, injury or other treatment such as radiotherapy. The likelihood of developing lymphoedema after treatment depends on the extent of the surgery, your cancer treatment and your body weight. Lymphoedema may be permanent but it can usually be managed especially if treated early.

    Signs of lymphoedema include persistent swelling which may be associated with new feelings of heaviness, tightness, aches, or pins and needles.

    Some hospitals have specialist lymphoedema physiotherapists or occupational therapists who can help to manage lymphoedema. They can provide advice on lymphatic drainage massage and exercises and can teach you simple exercises to reduce your risk.

    Managing your lymphoedema risk:

    • avoid cuts, scratches, bites and injections in your affected limb
    • use sunscreen to protect your skin from sunburn
    • regularly moisturise your skin to prevent dryness and irritation which can lead to infection
    • avoid constrictions to your limb (i.e. don’t apply blood pressure cuffs to the affected limb)
    • avoid exposure to heat
    • maintain a normal body weight
    • take care cutting your toe nails or get a podiatrist to cut them
    • engage in activities like swimming, bike-riding or light weights to aid the flow of lymph fluid
    • wear a professionally fitted compression sleeve or stocking when travelling, if advised by your physiotherapist or occupational therapist
    • treat lymphoedema early so you can deal with the problem quickly and avoid symptoms becoming worse
    • lightly massage the affected area to help move fluid back towards the heart
    • raise your legs if watching TV and avoid sitting for long periods
    • seek medical help urgently if you have lymphoedema and experience redness, swelling, throbbing or pain in your limb as these can be signs of infection which requires urgent treatment.

    Remember lymphoedema can take months or years to develop and not everyone who is at risk will develop it.

    A directory of lymphoedema practitioners is available at www.nlpr.asn.au.

    For more information see the Lymphoedema Association of Australia website www.lymphoedema.org.au. You can also contact Cancer Australia for a copy of the booklet Lymphoedema – What You Need to Know. Call 1800 624 973 or download it from canceraustralia.nbocc.org.au.

    Cognitive problems

    Many cancer survivors say they have difficulty concentrating, focusing and remembering things. This is often called ‘chemo brain’, as it is common after chemotherapy. However some cancer survivors who did not have chemotherapy also report similar problems.

    These memory and cognitive problems can also be caused by:

    • fatigue
    • emotional concerns such as stress, anxiety or depression
    • radiotherapy to the head, neck or whole body
    • hormone therapy
    • immunotherapy
    • other medications
    • infections
    • vitamin or mineral deficiencies such as iron, vitamin B or folic acid
    • other health problems including anaemia.

    ‘Chemo brain’ usually improves with time sometimes taking a year or more. Researchers still aren’t sure exactly what causes the memory and concentration problems experienced by some cancer survivors but there is ongoing research to try to find out.

    Hints for coping with memory changes

    • Use your mobile phone, a calendar or daily planner to keep track of tasks, appointments, social commitments, birthdays.
    • Plan your activities so you do things that require more concentration when you are more alert, e.g. mornings.
    • Set aside time each day to read and respond to emails.
    • If you are working and have your own office, close the door when you don’t want to be interrupted.
    • Put personal items (e.g. wallet, keys) in a dedicated place at home and at work so you don’t misplace them.
    • Let phone calls go through to your answering machine or voicemail. You can listen to them and think about how you will respond when you feel ready.
    • Make notes of things you have to remember, e.g. a shopping list or where you parked the car.
    • Do tasks one at a time rather than multi-tasking.
    • Get plenty of sleep and exercise. Deep sleep is important for memory and concentration, and getting some physical activity every day will help you sleep better.

    Problems eating and drinking

    Difficulty swallowing

    Some people with cancer have trouble swallowing (dysphagia) after treatment. Radiotherapy can cause dryness, pain and changes to the strength of the muscles used in swallowing.

    Surgery may also reduce your ability to swallow. If you feel you have too much saliva rather than too little this may be a sign of swallowing difficulties.

    If swallowing is painful ask your doctor about medications that might help. You may also be able to use other types of soothing agents to prevent your mouth and throat from becoming too irritated.

    If you find that drinks make you cough you should tell your doctor or specialist nurse as soon as possible.

    A speech pathologist can assess how you swallow and suggest changes to your diet and swallowing action to help reduce any discomfort or concerns of food going down the wrong way (aspiration).

    Dry mouth

    Salivary glands may be affected by certain treatments. Although they gradually recover after treatment finishes you may have less saliva than before and it may be thicker and sticky. Some people have a dry mouth permanently. There are medicines that can be prescribed to help you. Tell your cancer specialist if you’re having difficulties.

    Having a dry mouth can be uncomfortable and can affect eating, speaking and sleeping. It also makes you much more likely to get tooth decay so it’s really important to care for your teeth.

    Here are some things you can do to help ease symptoms of a dry mouth

    • Be aware of foods and drinks that can irritate a dry mouth such as spicy, salty or hard and crunchy foods. Add plenty of moisture and fat to make food easier to manage. Dry and starchy foods such as bread, biscuits, crackers and potatoes can be difficult to eat. Eat soft, moist foods such as casseroles, soup, melon, grapes and ice cream.
    • Alcohol (especially spirits) and caffeine can also irritate a dry mouth.
    • Cut down or stop smoking. Smoking dries and irritates the mouth.
    • Use a lip salve to protect your lips.
    • Try using a humidifier in your bedroom at night.

    Changes in taste, smell and appetite

    Treatment can affect your sense of taste and smell. It can take several months for your sense of taste to return to normal. Some people never regain their full sense of smell. Taste changes may make you lose your appetite. The following tips may help improve the taste of food.

    • Add lemon, ginger and vinegar to your cooking to add flavour and stimulate your digestive juices and appetite.
    • Use salt, lemon juice or coffee powder if food is too sweet; try sugar or honey if food tastes metallic or salty.
    • You can add flavour to food with spices, garlic, herbs, cheese or bacon.
    •  Use a drinking straw to bypass your taste buds.

    Weight gain

    People don’t usually expect to gain weight during cancer treatment but some treatments, side effects or even lifestyle changes can cause you to put on weight.

    Factors which may cause you to put on weight include:

    • treatments—some chemotherapy drugs, steroids and hormonal therapies can cause weight gain
    • tiredness due to the cancer or treatment—this can make you less physically active than usual which may cause you to gain weight
    • depression—for some people, natural feelings of sadness or worry about the cancer can develop into depression. Eating more and gaining weight may be symptoms of this
    • stopping smoking—this is the healthiest decision anyone who smokes can make but it can cause weight gain at first
    • comfort eating—some people turn to food for comfort when life is stressful, which can lead to weight gain.

    Don’t be too hard on yourself if you find you’ve put on weight. Sometimes knowing why it’s happened can help you think of ways to manage it.

    After treatment most people need time to recover. But as you gradually get better you may find that you’re ready to make some changes.

    If you think you’ve gained weight because you’re depressed talk to your GP. There are effective treatments for depression such as counselling and antidepressants.

    Doctors often prescribe hormonal therapy to reduce the chance of a cancer coming back. It’s very important not to stop taking this, even if you think it’s causing weight gain. Talk to your cancer doctor or nurse if you’re concerned about this. Eating healthily and being more physically active will help you manage your weight.

    Talk to your doctor

    Before trying to lose weight it’s important to speak to your GP or treating specialist. They can talk to you about the right approach for you based on your cancer and its treatment. They’ll also take into account your weight before diagnosis and any other medical conditions you may have.

    Weight loss

    During and after cancer treatment many people find it difficult to eat enough to maintain their weight. Some people lose weight as a result of the cancer or its treatment.

    There are lots of reasons for this: it can be related to the cancer itself or to the side effects of different treatments. Some people find they don’t feel hungry or that they feel full soon after starting a meal. Other people find food makes them feel sick or  their treatment makes some foods taste different.

    It can take a great deal of effort and persistence to overcome eating difficulties. If eating has been a struggle for a while you may no longer associate food with pleasure. Taste changes may reduce your desire for food and affect your appetite.

    Small, frequent meals or snacks are often better tolerated than large meals as long periods without food may result in nausea.

    Try to cook a variety of foods and keep a balance of sweet and savoury flavours.

    Many people will need to eat soft foods or liquid meals either because of physical problems such as a painful, dry mouth or swallowing difficulties, or simply lack of energy to chew food.

    You may need to see a dietitian. They can advise you on how to increase the energy and nutrients in your diet and may give you high-calorie supplements if you have lost weight.

    Bladder problems

    Bladder sensation or control may change after surgery or radiotherapy. Some people find they need to pass urine more often or feel that they need to go in a hurry. Others may lose urine when they cough, sneeze, strain or lift.

    For ways to manage involuntary or accidental loss of urine (urinary incontinence), contact the continence nurse or physiotherapist at your hospital. You can also contact the Continence Foundation of Australia (www.continence.org.au) on 1800 330 066.

    After radiotherapy the blood vessels in the bowel and bladder can become more fragile. This can cause blood to appear in your urine or bowel movements even months or years after treatment. Let your doctor know so the appropriate treatment can be given.

    Bowel problems

    After surgery, chemotherapy or radiotherapy, some people have altered bowel habits. You may experience constipation or diarrhoea or feel pain in your lower abdomen.

    You may be able to make simple changes in your lifestyle to decrease bowel problems. You can also talk to your doctor about making changes to your diet or taking medication.

    Constipation

    Constipation is bowel movements that come less often than normal for you, are painful or are hard to pass.

    • Let your doctor or nurse know if you experience constipation. Your medication may be changed or other medication given to relieve the constipation.
    • Eat more high-fibre foods such as wholegrain bread and pasta, bran, fruit, vegetables, nuts and seeds.
    • Drink plenty of fluids. This will help loosen the bowels. Warm and hot drinks such as coffee or tea may help.
    • Get some light exercise. Walking or riding an exercise bike are good options.
    • If you are taking laxatives containing fibre make sure you drink plenty of fluids.

    Diarrhoea

    Diarrhoea is frequent bowel movements that may be soft, formed, loose, watery or urgent.

    • Drink plenty of fluids to replace fluid lost. If the diarrhoea is severe it may cause dehydration.
    • Talk to your treatment team about medication to relieve the diarrhoea.
    • Avoid spicy foods, coarse wholegrain products, fatty or fried foods, rich gravies and sauces and raw fruit or vegetables with skins or seeds. Instead try snacking on clear broth and toast, biscuits and cheese or cooked rice.
    • Eat small, regular snacks instead of big meals.
    • It is important to let your medical team know about your diarrhoea particularly if it is ongoing. They may need to do extra tests to rule out other problems.
    • Ask for an appointment with an experienced dietician to discuss how to manage if this is a long-term problem.

    Peripheral neuropathy

    Tingling or numbness in the hands or feet (peripheral neuropathy) can be a side effect for people who have had chemotherapy and may last for some time after treatment finishes. Peripheral neuropathy can be annoying and frustrating, and may make it difficult for you to return to normal activities. It may help to talk to your GP or see an occupational therapist.

    The lack of feeling in your hands and feet can cause safety problems. For a few people this may lead to problems with balance and walking. A physiotherapist will be able to offer treatment and advice for these issues.

    Protect yourself

    If your hands and/or feet are affected it’s important to protect them as much as possible. If your balance, coordination or walking is affected it’s important to reduce your risk of accidents and falls.

    • Keep your hands/feet warm—wear gloves and warm socks in cold weather.
    • Wear well-fitting shoes or boots.
    • Wear gloves when working with your hands e.g. when doing household chores, gardening or DIY.
    • Use potholders and oven gloves to avoid burning your hands when cooking.
    • Avoid walking around barefoot and check your feet regularly for any problems.
    • Test the temperature of water to make sure that it isn’t too hot before baths or showers.
    • Make sure rooms are well lit and always put on a light if you get up during the night.
    • Keep areas you walk through, such as halls, free of clutter and make sure there aren’t things such as loose rugs that you could trip over.
    • Install rubber mats in showers and baths to prevent slipping.
    • Get advice from a physiotherapist about walking aids if your balance is affected.

    Heart problems

    Sometimes radiotherapy to the chest and heart area leads to an increased risk of heart problems after treatment.

    Risk factors for radiation-associated heart damage include:

    • radiotherapy combined with chemotherapy
    • younger age at treatment
    • diabetes
    • high blood pressure (hypertension)
    • obesity
    • smoking.

    If you have received radiotherapy to the chest or whole body, or combined radiotherapy and chemotherapy, talk to you doctor about your heart health.

    Hearing problems

    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.

    Tell your specialist or GP if you notice any change in your hearing or if these symptoms don’t go away.

    Last reviewed by: Dr Kate Webber, Cancer Survivorship Research Fellow and Medical Oncologist, NSW Cancer Survivors Centre; Kathy Chapman, Director, Health Strategies, Cancer Council NSW; Janine Deevy, Adolescent and Young Adult Cancer Care Coordinator, Royal Brisbane and Women’s Hospital, QLD; Dr Louisa Gianacas, Clinical Psychologist, Psycho-oncology Service, Calvary Mater Newcastle, NSW; Tina Gibson, Education and Support Officer, Cancer Council SA; A/Prof Michael Jefford, Senior Clinical Consultant at Cancer Council VIC, Consultant Medical Oncologist, Peter MacCallum Cancer Centre and Clinical Director, Australian Cancer Survivorship Centre, VIC; Annie Miller, Project Coordinator, Community Education Programs, Cancer Council NSW; Micah Peters, Project Officer, Education and Information, Cancer Council SA; Janine Porter-Steele, Clinical Nurse Manager, Kim Walters Choices, The Wesley Hospital, QLD; Ann Tocker, Cancer Voices; and A/Prof Jane Turner, Department of Psychiatry, University of Queensland.
     

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