|
 |
This publication covers post-treatment issues such as follow-up
medical care, physical and emotional changes, changes in social relationships,
and workplace issues.
Part of the Facing Forward Series for cancer survivors, family members,
and medical professionals. The series is designed to educate and empower
cancer survivors as they face the challenges associated with life after
cancer treatment. |
You may also order
a print version1
of this publication. |
|
Table of Contents
Facing Forward Series: Life After Cancer Treatment
Introduction
 Download
a PDF version of the Introduction.
What Is "Normal" After Cancer Treatment?
Congratulations on Finishing Your Cancer Treatment!
Ending cancer treatment can be both exciting and challenging. Most
people are relieved to be finished with the demands of treatment, but many
also feel sadness and worry. Many are concerned about whether the cancer
will come back and what they should do after treatment. |
When treatment ends, people often expect life to return to the way it was
before they were diagnosed with cancer. This rarely happens. You may have
permanent scars on your body, or you may not be able to do some things
you once did easily. Others may think of you--or you may view yourself--as
being somehow different.
"While I was having chemo I just quit doing most anything
... so, the challenge for me was, what am I going to do now with my life?
What should I go back to doing?"
Len, colon cancer survivor, 60
|
One of the hardest things after treatment is not knowing what happens next.
"Because
the doctors and nurses never told me the range of what to expect, I had
expectations of wellness that were absolutely unrealistic," one woman
said, "and so did my family and friends. This . . . led to a great deal
of worry."
What is "normal" after cancer treatment? Those who have lived through
treatment talk about the first few months as a time of change. It is not
so much "getting back to normal" as it is finding out what is normal for
you now. You can also expect things to keep changing as you begin your
recovery. As one man put it, "I thought when I had finished treatment--when
they looked at my tests and they said it looked good--I thought, 'OK, this
is done'. . . [but] it is not over."
Your new "normal" may include making changes in the way you eat, the
activities you do, and your sources of support, all of which are discussed
in this document.
How to Use This Document
The information in this document is designed mainly for cancer survivors
who have recently completed their cancer treatment, but you may find the
information helpful even if you were treated a long time ago. The purpose
of this document is to give cancer survivors and their loved ones a better
idea of what to expect during the first few months after treatment ends.
Its five main sections cover what may happen with:
-
Your medical care
-
Your body
-
Your mind and your feelings
-
Your social relationships
-
Practical matters such as job and insurance issues
Do not feel you have to read the whole document at once. It is meant for
you to use over time. Flip through to see what may be helpful to you, or
check out topics as they come up in your life.
As you'll see, this document talks about many concerns of those who
have been through cancer treatment and offers suggestions that have helped
others move forward. As you read, you may find yourself saying, "That's
just how I feel."
Although this document describes issues that are important to many
survivors, each person has a unique response to having cancer. While some
of the issues covered in this document may reflect your experience well,
other issues may not concern you. Focus on finding what works for you.
The information in this document is not intended to be all-inclusive. Resources
are provided if you need more information on a given topic or one that
is not included. We encourage you to be active in getting the information
and support you need.
We use two symbols to help you find your way through this information:
 |
means that this section discusses medical approaches to addressing
this problem. |
 |
means that this section has helpful hints. |
Keep in Mind
|
| In this document, the term cancer survivor is used to include anyone
who has been diagnosed with cancer, from the time of diagnosis through
the rest of his or her life. You may not like the word, or you may feel
that it does not apply to you, but the word survivor helps many people
think about embracing their lives beyond their illness. |
Getting Medical Care After Cancer Treatment
Download a PDF version of Getting Medical Care After Cancer Treatment.
| It is natural for anyone who has finished cancer treatment to be concerned
about what the future holds. Many people worry about the way they look
and feel and about whether the cancer will come back. Others wonder what
they can do to keep cancer from coming back. Understanding what to expect
after cancer treatment can help survivors and their families plan for follow-up
care, make lifestyle changes, stay hopeful, and make important decisions. |
"You have to be in control--your body talks to you--and
you've got to use the doctor as a consultant. You've got to find out what
is wrong, because it is your life."
Mae, uterine cancer survivor, 54
|
"I didn't know what to ask. So I asked my doctor what I
needed to know."
Jack, bladder cancer survivor, 70
|
All cancer survivors should have follow-up care. But you may have a
lot of questions about getting the care you need now, such as:
-
Whether to tell the doctor about symptoms that worry you
-
Which doctors to see after treatment
-
How often to see the doctor
-
What specific tests you need
-
What you can do to relieve pain and other problems after treatment
-
How long it will take for you to recover from treatment and feel more like
yourself
Dealing with these issues can be a challenge. Yet many say that getting
involved in decisions about their future medical care and lifestyle was
a good way for them to regain some of the control they felt they lost during
cancer treatment. Research has shown that people who feel more in control
feel and function better than those who do not. Being an active partner
with your doctor and getting help from other members of your health care
team is the first step.
This section offers some guidance on working with the people who provide
care after treatment. It describes the kinds of help you may need and provides
tips for getting what you want out of your medical visits. Reading this
section can also help you create a plan of action for your recovery and
future health.
What Is Follow-up Care?
The main purpose of follow-up care is to check if your cancer has returned
(recurrence) or if it has spread to another part of your body (metastasis).
Follow-up care can also help in:
-
Finding other types of cancer
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Spotting side effects from treatment now or that can develop years after
treatment
Follow-up care means seeing a doctor to get regular medical checkups. At
these visits, your doctor will:
-
Review your medical history
-
Examine your body
Your doctor may run follow-up tests:
-
Imaging procedures (ways of producing pictures of areas inside the body)
-
Endoscopy (the use of a thin, lighted tube to examine organs inside the
body)
-
Blood tests
Follow-up care can also include home care, occupational or vocational therapy,
pain management, physical therapy, and support groups. (See Services
to Think About for a description of these services.)
Keep in Mind
|
| If you do not have health insurance, Medicare, or Medicaid, you may
feel that some of the information in this document will not be helpful
to you. You may have already struggled just to get treated and now see
getting follow-up care as another battle. It can be hard to get health
care if you don't have good health insurance, but you must make sure you
get the care you need--especially after treatment is over. |
| There may be resources in your community to help you get these services.
Talk with your doctor, social worker, or the business office at your local
hospital or clinic. There are also government and nonprofit organizations
listed in the resource
section2
of this document that may be able to help with health costs. |
Which Doctor Should I See Now?
How Often?
You will need to decide which doctor will provide your cancer follow-up
care and which one(s) will provide other medical care. For follow-up cancer
care, this may be the same doctor who provided your cancer treatment. For
other medical care, you can continue to see your family doctor or medical
specialist as needed.
Depending on where you live, it may make more sense to get cancer follow-up
care from your family doctor than to travel long distances to see an oncologist.
No matter whom you choose as a doctor, try to find doctors you feel comfortable
with.
At your first follow-up visit, ask your doctor to recommend a follow-up
schedule. In general, people who have been treated for cancer return to
the doctor every 3 to 4 months during the first 2 to 3 years after treatment,
and once or twice a year after that for follow-up appointments. Some medical
organizations also have follow-up guidelines for certain cancers and update
this information as researchers develop new approaches to follow-up care.
(See Organization
Guidelines for Follow-up Care3
for contact information.)
Follow-up care will be different for each person who has been treated for
cancer, depending on the type of cancer and treatment he or she had and
the person's general health. Researchers are still learning about the best
approaches to follow-up care. This is why it is important that your doctor
help determine what follow-up care plan is right for you. Lastly, it is
important to note that some insurance plans pay for follow-up care only
with certain doctors and for a set number of visits. In planning your follow-up
care schedule, you may want to check your health insurance plan to see
what restrictions, if any, apply to your follow-up care after cancer treatment.
Keep in Mind
|
Some people may suspect that their cancer has returned, or they notice
other changes in their bodies. It is important for you to be aware of any
changes in your health and report any problems to your doctor. Your doctor
can find out whether these problems are related to the cancer, the treatment
you had, or another health problem.
Even if you learn that your cancer has returned, there is no reason
to lose hope. Many people live good lives for many years with cancer that
has returned. |
Developing a Wellness Plan
After cancer treatment, many survivors want to find ways to reduce the
chances of their cancer coming back. Some worry that the way they eat,
the stress in their lives, or their exposure to chemicals may put them
at risk. Cancer survivors also find that this is a time when they take
a good look at how they take care of themselves and their health. This
is an important start to living a healthy life after cancer.
When you meet with your doctor about follow-up care, you should ask
about developing a wellness plan that includes ways you can take care of
your physical, emotional, social, and spiritual needs. You may not be used
to talking with your doctor as a partner in planning for your health, so
it may be hard for you at first, but it is very important that you do it.
The more you do it, the easier it will become. For tips on how to talk
to your doctor, see Do You Have Trouble Talking With
Your Doctor?.
Research is just beginning to show what people can do to lower their
risk of getting certain cancers. But we don't yet know why cancer comes
back in some people and not others.
Making changes in the way you eat, exercise, and live your life may
not prevent your cancer from coming back. However, making these changes
can help you feel better and may also lower your chances of developing
other health problems.
Changes you may want to think about:
-
Quitting smoking. Research shows that smoking can increase the chances
of developing cancer at the same site or another site. For help in quitting
smoking, see Smoking Cessation Programs.
-
Cutting down on how much alcohol you drink. Research shows that
drinking alcohol can increase your chances of developing certain cancers.
-
Eating well and exercising.
|
Eating Well After Cancer Treatment
-
Eat a variety of healthful foods, with an emphasis on foods from plant
sources.
-
Eat five or more servings of vegetables and fruits each day.
-
Choose whole grains--rather than processed (refined) grains and sugars.
-
Limit eating red meats, especially high fat or processed meats.
-
Choose foods that help you maintain a healthy weight.
-
Adopt a physically active lifestyle.
-
Maintain a healthy weight throughout the rest of your life.
-
Limit drinking alcohol, if you drink at all.
Source: American Cancer Society Recommendations for Nutrition and
Physical Activity for Cancer Prevention, 2002 |
Exercise After Cancer Treatment
Few studies have been done to find out whether physical activity affects
survival after cancer treatment. More research is needed to answer this
question, but studies have shown that moderate exercise (walking, biking,
swimming) for about 30 minutes every--or almost every--day can:
-
Reduce anxiety and depression
-
Improve mood
-
Boost self-esteem
-
Reduce symptoms of fatigue, nausea, pain, and diarrhea
During recovery, it is important to start an exercise program slowly and
increase activity over time, working with your doctor or a specialist (such
as a physical therapist) if needed. If you need to stay in bed during your
recovery, even small activities--like moving your arms or legs around--can
help you stay flexible, relieve muscle tension, and help you feel better.
Some survivors may need to take special care in exercising. Talk with your
doctor before you begin any exercise program. |
"The more you learn about your cancer, the more you realize
you have to speak up for yourself. And lots of times I would take information
to my doctor."
Ellen, stomach cancer survivor, 70
|
Do You Have Trouble Talking With Your Doctor?
It is not always easy to talk with your doctor. Sometimes, he or she uses
terms you do not know. When this happens, it is important to stop and ask
the doctor to explain what the words mean. You may be afraid of how you
will sound to the doctor, but having questions is perfectly normal.
Talking with your doctor is important. Both of you need information
to manage your care. Telling the doctor about your health and asking questions
helps both of you do your "jobs" well. Here are some points to cover.
At your first follow-up visit, ask your doctor/health care team
about:
-
The tests and follow-up care you need, and how often you will need them.
-
The kinds of physical problems you may have from your cancer treatment
and what you can do to prevent, reduce, or solve them.
-
The potential long-term effects of treatment and the warning signs that
you might have them.
-
The warning signs that cancer may be coming back and what to do if you
see them.
-
Fears you may have about follow-up care.
Keep in Mind
|
Many survivors want to learn about symptoms that may indicate their
cancer has come back, or recurred.
There are many types of symptoms that may show if cancer has returned,
and it depends on each person, the kind of cancer she/he was treated for,
and the kind of treatment he/she had.
It is for this reason that you should talk to your doctor about the
signs or symptoms that you should watch for and what you should do about
them. |
At each visit, tell your doctor/health care team about:
-
Symptoms that you think may be a sign of cancer's return.
-
Any pain that troubles you. (See Talking
to Your Doctor About Pain 5
for ways to describe your pain.)
-
Any physical problems that get in the way of your daily life or that bother
you, such as fatigue, trouble sleeping, loss of sex drive, or weight gain
or loss. (See Your
Body After Cancer Treatment 6.)
-
Other health problems you have, such as heart disease, diabetes, or arthritis.
-
Any medicines, vitamins, or herbs you are taking and any other treatments
you are using. (See Complementary and Alternative Medicine
below.)
-
Any emotional problems you may have, and any anxiety or depression you
have had in the past. (See Your
Mind and Your Feelings After Cancer Treatment 7.)
-
Any changes in your family medical history.
-
Things you want to know more about (such as new research or side effects).
Your health care team should be able to help you or refer you to someone
who can help with any side effects or problems you may have. You have a
right to get the help you need.
Complementary and Alternative Medicine
Complementary and alternative medicine includes many different healing
approaches that people use to prevent illness, reduce stress, prevent or
reduce side effects and symptoms, or control or cure disease. An approach
is generally called complementary when it is used in addition to treatments
prescribed by a doctor. An approach is often called alternative when it
is used instead of treatments prescribed by a doctor. Research has shown
that more than half of all people with cancer use one or more of these
approaches.
Some common approaches include: visualization or relaxation; acupressure
and massage; homeopathy; vitamins or herbal products; special diets; psychotherapy;
spiritual practices; and acupuncture.
Even though you have finished your cancer treatment, if you are thinking
about using these methods, discuss this decision with your doctor or nurse.
Some complementary and alternative therapies may interfere or be harmful
when used with treatments normally prescribed by a doctor.
|
Tips: Getting the Most From Your Follow-up Visits
|
How do you get the most from your doctor visits? Here are some ideas
that have helped others deal with their follow-up care:
-
Ask someone to come with you to your doctor visit. A friend or family member
can help you think about and understand what was said. He or she also may
think of new questions to ask.
-
Bring paper or a tape recorder to make note of the answers the doctor gives
you.
-
Ask your most important questions first in case the doctor runs out of
time.
-
Don't be afraid to ask the doctor if you can schedule more time when you
set up your next appointment. Or ask the doctor to suggest a time when
you could call and get answers to your questions.
-
Ask to talk with the doctor or nurse in a private room, with the door closed.
-
Express yourself clearly.
-
Describe your problem or concern briefly.
-
Tell the doctor how your problem or concern makes you feel.
-
Ask for what you want or need.
Example: "I am tired most of the time each day. I've tried napping,
but it does not help. My fatigue gets in the way of my daily life, which
makes me upset and angry. I would like you to help me treat this problem
or refer me to someone who can help."
-
Tell your doctor how much you want to know.
-
Tell him/her when you've heard enough or when you want more information.
-
Ask for booklets or other materials to read at home.
-
Make sure you understand the doctor's answers.
-
Repeat in your own words what you think the doctor meant.
-
Ask the doctor to explain what he or she said in terms you understand.
-
If you find you cannot get answers to your questions, let your doctor know
you're unhappy about it. If that does not get results, you may want to
try to find a new doctor. This can be hard to do, but getting the information
you need is important for your health.
-
Ask your pharmacist about how to take your medicines correctly or about
possible side effects.
-
Keep your own set of records about the follow-up care you get.
Tell any other doctor you see about your history of cancer. The type of
cancer you had and your treatment can affect decisions about your care
in the future. Other doctors you see may not know about your cancer and
its treatment unless you tell them.
Your Medical Records
|
Make sure to get a copy of your cancer treatment records or a summary.
(You may be charged for these.) By keeping your records up to date, you'll
have enough information to share with any new doctors you may see.
If you don't keep a copy, your records might be spread among many doctors'
offices, and key facts about your cancer history could be lost.
Here are the key types of records you'll want to keep:
-
The type of cancer you were treated for
-
When you were diagnosed
-
Details of all cancer treatment (including all surgeries; names and doses
of all drugs; sites and total amounts of radiation therapy; and places
and dates of treatment)
-
Key lab reports, pathology reports, and x-ray reports
-
Contact information for all health professionals involved in your treatment
and follow-up care
-
Any problems that occurred after treatment
-
Information on supportive care you had (such as special medications, emotional
support, and nutritional supplements)
|
Services to Think About
People who have had cancer agree that no one should have to go it alone
after treatment. Your friends and family can help. Ask your doctor, nurse,
social worker, or local cancer organization how to find services in your
area like the ones listed below.
Professional Support Services You May Need
| Service |
How It Can Help You |
| Clergy-- Spiritual Counseling |
Some members of the clergy are trained to help you deal with cancer
concerns such as feeling alone, fear of death, searching for meaning, and
doubts about faith. |
| Couples Counseling |
You and your partner can work with trained specialists who can help
you talk about problems, learn about each other's needs, and find ways
to cope. Counseling may include issues related to sex and intimacy. |
| Family Support Programs |
Your whole family may be involved in the healing process. In these
programs, you and your family members participate in therapy sessions with
trained specialists who can help you talk about problems, learn about each
other's needs, and find answers. |
| Genetic Counseling |
Trained specialists advise on whether to have gene testing for cancer
and how to deal with the results. It can be helpful for you and for family
members who have concerns for their own health. (See Genetic
Counseling8for
ways to find genetic counselors.) |
| Home Care Services |
State and local governments offer many services useful after cancer
treatment. A nurse or physical therapist may be able to come to your home.
You also may be able to get help with housework or cooking. The phone book
has contact numbers under Social Services, Health Services, or Aging Services--both
nonprofit and for-profit. |
| Individual Counseling |
Trained mental health specialists help you deal with your feelings,
such as anger, sadness, and concern for your future. |
| Long-Term Follow-up Clinics |
All doctors can offer follow-up care, but there are a few clinics that
specialize in long-term follow-up after cancer. These clinics most often
see people who are no longer being treated by an oncologist and who are
considered disease-free. You may want to ask your doctor if there are follow-up
cancer clinics in your area. |
| Nutritionists/Dietitians |
They can help you with gaining or losing weight and with healthy eating. |
| Occupational Therapists |
They can help you regain, develop, and build skills that are important
for independent living. They can help you relearn how to do daily activities
such as bathing, dressing, or feeding yourself after cancer treatment. |
| Oncology Social Workers |
These professionals are trained to counsel you about ways to cope with
treatment issues and family problems related to your cancer. They can tell
you about resources and connect you with services in your area. |
| Pain Clinics (also called Pain and Palliative Care Services) |
These are centers with professionals from many different fields who
are specially trained in helping people get relief from pain. |
| Physical Therapists |
Physical therapists are trained in the way that the body parts interact
and work. They can teach you about proper exercises and body motions that
can help you gain strength and mobility after treatment. They can also
advise you about proper postures that help prevent injuries. |
| Smoking Cessation Services |
Research shows that the more support you have in quitting smoking,
the greater your chance for success. Many communities have "quit smoking"
programs. Ask your doctor, nurse, social worker, or local hospital about
what is available, or call 1-800-4-CANCER (1-800-422-6237). |
| Speech Therapists |
Speech therapists can evaluate and treat any speech, language, or swallowing
problems you may have after treatment. |
| Stress Management Programs |
These programs teach ways to help you relax and take more control over
stress. Hospitals, clinics, or local cancer organizations may offer such
programs and classes. |
| Support Groups for Survivors |
In-person and online groups enable survivors to interact with others
in similar situations. (See Joining
a Support Group9.) |
| Vocational Rehabilitation Specialists |
If you have disabilities or other special needs after treatment, these
services can help you find suitable jobs. Such services include counseling,
education and skills training, and help in obtaining and using assistive
technology and tools. |
Your Body After Cancer Treatment
Download a PDF version of Your Body After Cancer Treatment.
Although your treatment has ended, you are still coping with how it
affects your body. It can take time to get over the effects of cancer treatment.
Each person's schedule is different. You may wonder how your body should
feel during this time and what may be a sign that cancer is coming back.
This section talks about some of the problems that can occur when treatment
is over. Some of the most common effects people report are:
-
Fatigue
-
Pain
-
Lymphedema, or swelling
-
Problems with their mouth or teeth
-
Problems with weight and eating
-
Loss of bladder or bowel control
-
Menopause symptoms
-
Changes in their sex lives
|
"If I could get over the physical part, if it would stop
hurting, I think I would be fine."
Rose, lung cancer survivor, 70
|
What you experience may be related to the type of cancer you had and
the treatment you received. It is also very important to remember that
no two people are alike, so you may experience changes that are very different
from someone else's, even if they had the same type of cancer and received
the same treatment.
Fatigue
"I can walk and keep busy," said one testicular cancer survivor,
"but
it gets very tiring. If I sit in a chair and really want to read or watch
something, I'm gone in about 30 seconds, and it is a deep sleep."
Some cancer survivors report that they still feel tired or worn out
after treatment is over. In fact, fatigue is one of the most common complaints
during the first year after treatment.
Rest or sleep does not "cure" the type of fatigue you may have after
cancer treatment, and doctors do not know its exact cause(s). The causes
of fatigue are different for people who are receiving treatment than they
are for those who have completed treatment:
-
Fatigue during treatment can be caused by cancer therapy. Other
problems can also play a part in fatigue, like anemia (having too few red
blood cells), poor nutrition, not drinking enough liquids, and depression.
Pain can also make fatigue worse.
-
Researchers are still learning about what may cause fatigue after
treatment.
How long will fatigue last? There is no "normal" pattern. For some, fatigue
gets better over time. Others, such as those who have had bone marrow transplants,
may have less energy for years after their final treatment.
Some people feel very frustrated when fatigue lasts longer than they
think it should and gets in the way of their normal routine. They also
may worry that their friends, family, and coworkers will get upset with
them if they complain of fatigue often.
 |
Getting Help With Fatigue From Your Doctor or Nurse
|
Talk to your doctor about what may be causing your fatigue and what
can be done about it. Ask about:
-
How any medicines you are taking or other medical problems you have might
affect your energy level
-
How you can control your pain, if pain is a problem for you
-
Exercise programs that might help, such as walking
-
Relaxation skills
-
Changing your diet or drinking more fluids
-
Medicines or nutritional supplements that can help
-
Specialists who might help you, such as physical therapists, occupational
therapists, nutritionists, or mental health care providers
|
Tips: Fighting Fatigue
|
How do you fight fatigue? Here are some ideas that have helped others:
-
Plan your day. Be active at the time of day when you feel most alert and
energetic.
-
Save your energy by changing how you do things. For example, sit on a stool
while you cook or wash dishes.
-
Take short naps or rest breaks between activities.
-
Try to go to sleep and wake up at the same time every day.
-
Do what you enjoy, but do less of it. Focus on old or new interests that
do not tire you out. Try to read something brief or listen to music.
-
Let others help you. They might cook a meal, pick up something at the store,
or do the laundry. If no one offers, ask for what you need. Friends and
family might be willing to help but may not know what to do.
-
Just say "no" to things that do not matter as much to you now. This may
include housework and other chores. By using the energy you have in rewarding
ways, you can live a fuller life.
-
Think about joining a support/education group for people with cancer. (See
Joining
a Support Group 9.)
Talking about your fatigue with others who have had the same problem can
help you learn new ways to cope.
Pain
You may have pain after treatment. In some cases, it is caused by the treatment
itself.
Types of pain you may feel following cancer treatment include:
-
Skin sensitivity where you received radiation. This type of pain
is quite common and can last for many months. "I am so sensitive [there]
that I cannot put on anything tight," one breast cancer survivor noted.
-
Pain or numbness in the hands and feet due to injured nerves. Chemotherapy
or surgery can damage nerves, which can cause severe pain. (This is called
neuropathy.)
-
Painful scars from cancer surgery.
-
Pain in a missing limb or breast. While doctors do not know why
this pain occurs, it is real. It is not just "in your mind."
 |
Getting Help With Pain From Your Doctor or Nurse
|
You deserve to get relief from your pain, and your doctor or nurse can
help you. Wanting to control pain is not a sign of weakness. It is a way
to help you feel better and stay active.
If you are older, you may not know whether your pain is because of
cancer or because of other health problems, such as arthritis. You might
not think to mention it to either your oncologist or your other doctors,
but you should do so. If you are in pain, tell your oncologist or another
doctor.
With your help, your doctor can assess how severe your pain is. Then,
he or she might suggest one or more of the following approaches. These
approaches have helped others recovering from cancer and may help you.
-
Pain relief medicines. In most cases, doctors will try the mildest
medicines first. Then they will work up to stronger medicines if you need
them. The key to getting relief is to take all medicines just as your doctor
prescribes. To keep pain under control, do not skip doses or wait until
you hurt to take these medicines. You may be afraid that if you use medicines
you'll become a "drug addict," but this almost NEVER happens if you take
the correct dose and see your doctor regularly.
-
Antidepressant medicines. Some of these have been prescribed to
reduce pain or numbness from injured nerves.
-
Physical therapy. Going to a physical therapist may help relieve
your pain. The therapist may use heat, cold, massage, pressure, and/or
exercise to help you feel better.
-
Braces. These limit movement of a painful limb or joint.
-
Acupuncture. This is a proven method that uses needles at pressure
points to reduce pain.
-
Hypnosis, meditation, or yoga. Any of these may help your pain.
A trained specialist can teach you these approaches.
-
Relaxation skills. Many people with cancer have found that practicing
deep relaxation helped relieve their pain or reduced their stress. (See
Practicing
Relaxation to Help Relieve Pain and Stress and Relaxation
Exercises 10.)
-
Nerve blocks or surgery. If you do not get relief from the other
approaches in this section, you may want to ask the doctor about these.
Nerve blocks or surgery often help if you have persistent, limiting pain,
but they may put you at risk for other problems. They may also require
you to stay in the hospital.
NOTE:
Health insurance does not always cover these approaches. Find out whether
your policy covers the approaches your doctor recommends. |
|
Tips: Talking to Your Doctor About Pain
|
Here are some tips to help you describe your pain to your doctor:
-
Use numbers. Talk about how strong the pain feels on a scale of 0 to 10,
with 0 being no pain and 10 being the worst pain you could have.
-
Describe what the pain feels like. Is it sharp, dull, throbbing, steady?
-
Point out the exact places it hurts, either on your body or on a drawing.
Note whether the pain stays in one place or whether it moves outward from
the spot.
-
Explain when you feel pain. Note when it starts, how long it lasts, if
it gets better or worse at certain times of day or night, and if anything
you do makes it better or worse.
-
Describe how your pain affects your daily life. Does it stop you from working?
Doing household chores? Seeing your friends and family? Going out and having
fun?
-
Make a list of all the medicines you are taking (for any reason). If you
are taking any for pain relief, how much do they help?
-
Talk about any side effects from your pain control medicine, such as constipation
or other changes in bowel habits, or feeling groggy or "out of it." Many
of these problems can be solved.
-
Talk about your goals for pain relief. Do you want no pain at all (which
can sometimes be hard to achieve), or is your goal to feel well enough
to do specific activities?
 Keep a pain diary. A diary
can help you track changes over time. It can also show how you respond
to any pain control medicine or other treatment you receive. (A large version
of the Pain
Diary11
may be found in the Additional Resources.)
|
Tips: Practicing Relaxation to Relieve
Pain and Stress
|
Relaxation can help you feel better--both mentally and physically.
For most of us, though, it is not easy to "just relax." Relaxation is a
skill, and it needs to be practiced just like any other skill.
Many people wait until they are in a lot of pain or feel a lot of stress
before they try to relax, when it can be hardest to succeed. Then they
might try to relax by overeating, smoking, or drinking--activities that
are not helpful and might even be harmful.
-
Take the time to learn helpful relaxation skills and practice them often.
You can try the exercises 10
in the Additional Resources, take a class, or buy a relaxation tape or
CD.
Finding Humor and Laughing As Much As You Can
|
"Is [cancer] life-threatening? Yes, but why die mad? So
I joked about it all the way through, and I think it helped me."
Ari, kidney cancer survivor, age 56
|
Laughter can help you relax. When you laugh, your brain releases chemicals
that produce pleasure and relax your muscles. Even a smile can fight off
stressful thoughts. Of course, you may not always feel like laughing, but
other people have found that these ideas can help:
-
Enjoy the funny things children and pets do.
-
Watch funny movies or TV shows.
-
Buy a funny desk calendar.
-
Read joke books or check out jokes on the Internet. If you don't own a
computer, use one at your local library.
-
Go to comedy shows.
You may even find you can laugh at yourself. "I went by to help a friend
with her computer this summer, and it was really hot, so I took my wig
off," one woman said. "I got ready to go and I could not find my
wig. Well, her toy poodle had gotten it and had done a number on it, [but]
I just stuck it on and went home. My husband said, 'What happened?' Needless
to say that wig has never been the same." |
Lymphedema: Arm or Leg Swelling
Lymphedema is a swelling of a part of the body, usually an arm or leg,
that is caused by the buildup of lymph fluid. It can be caused by cancer
or the treatment of cancer. There are many different types of lymphedema.
Some types happen right after surgery, are mild, and don't last long. Other
types can occur months or years after cancer treatment and can be quite
painful. Lymphedema can also develop after an insect bite, minor injury,
or burn.
People who are at risk for lymphedema are those who have had:
-
Breast cancer--if you had radiation therapy or had your underarm
lymph nodes removed. Your risk is even higher if you had radiation in the
underarm area after your lymph nodes were removed.
-
Melanoma of the arms or legs--if you had lymph nodes removed and/or
had radiation therapy.
-
Prostate cancer--if you had surgery or radiation therapy to the
whole pelvis.
-
Cancer of the female or male reproductive organs--if you were treated
with surgery to remove lymph nodes or had radiation therapy.
-
Other cancers that have spread to the lower abdominal area. The
pressure from the growing tumor can make it hard for your body to drain
fluid.
 |
Getting Help With Lymphedema From Your Doctor or Nurse
|
Your doctor or nurse may be able to help you find ways to prevent and
relieve lymphedema. Ask about:
-
Ways to keep your skin healthy. It is important to keep your skin
clean. You should also keep it moist with lotion.
-
Exercising to help the body drain the lymph fluid, and what types
of exercise you should not do.
-
Treating lymphedema. He or she may suggest:
-
Keeping the arm or leg raised above your chest.
-
Special massage that can help by moving the lymph fluid from where it has
settled.
-
Special bandages and clothing that can help lymph fluid drain.
-
Losing weight.
-
Finding sources of emotional support to help you cope.
|
Tips: Preventing or Relieving Lymphedema
|
Other cancer survivors have found these tips helpful:
-
Watch for signs of swelling or infection (redness, pain, heat, fever).
Tell your doctor or nurse if your arm or leg is painful or swollen.
-
Keep your arm or leg free of cuts, insect bites, or sunburn. Try not to
have shots or blood tests done in that area.
-
Eat a well-balanced, protein-rich, low-salt diet.
-
Keep regular follow-up appointments with your doctor.
-
Wear loose-fitting clothing on your arm or leg.
-
Try not to use that arm or leg to figure out how hot or cold something
is--such as bathwater or cooked food. You may be less able to feel hot
and cold now.
Problems With Your Mouth or Teeth
Research shows that many people who have been treated for cancer
develop problems with their mouth and teeth.
Radiation to the head and neck can cause problems with your teeth and
gums; the soft, moist lining of your mouth; glands that make saliva (spit);
and jawbones.
This can cause:
-
Dry mouth
-
Cavities and other kinds of tooth problems
-
Loss or change in sense of taste
-
Painful mouth and gums
-
Infections in your mouth
-
Jaw stiffness or jawbone changes
If you were treated with certain types of chemotherapy, you can also have
many of the same problems.
Some problems go away after treatment. Others last a long time, while
some may never go away. Some problems may develop months or years after
your treatment has ended.
Who has these problems?
-
Almost all people who have had radiation therapy to the head and neck
-
Most people who have had bone marrow transplants
-
About 2 of every 5 people treated with chemotherapy
|
|
Getting Help With Your Mouth or Teeth Problems
|
If you find that these problems persist after cancer treatment ends,
talk to your doctor about:
-
What may be causing these problems
-
Ways to control mouth pain
See your dentist soon after you are done with treatment. Ask about:
-
How often you should have checkups
-
Ways to take care of your mouth and teeth
|
Tips: Preventing or Relieving Mouth or Teeth Problems
|
Keep your mouth moist.
-
Drink a lot of water.
-
Suck ice chips.
-
Chew sugarless gum or suck on sugar-free hard candy.
-
Use a saliva substitute to help moisten your mouth.
Keep your mouth clean.
-
Brush your teeth, gums, and tongue with an extra-soft toothbrush after
every meal and at bedtime. If it hurts, soften the bristles in warm water.
-
Use a mild fluoride toothpaste (like a children's toothpaste) and a mouthwash
without alcohol.
-
Floss your teeth gently every day. If your gums bleed or hurt, stay away
from the areas that are bleeding or sore, but keep flossing your other
teeth.
-
Rinse your mouth several times a day with a solution of 1/4 teaspoon baking
soda and 1/8 teaspoon salt in one cup of warm water. Follow with a plain
water rinse.
-
If you have dentures, clean, brush, and rinse them after meals. Have your
dentist check them to make sure they still fit you well.
If your mouth is sore, remember to stay away from:
-
Sharp, crunchy foods, like taco chips, that could scrape or cut your mouth
-
Foods that are hot, spicy, or high in acid, like citrus fruits and juices,
which can irritate your mouth
-
Sugary foods, like candy or soda, that could cause cavities
-
Toothpicks (they can cut your mouth)
-
All tobacco products
-
Alcoholic drinks
If you have stiffness in your jaw:
-
Three times a day, open your mouth as far as you can without pain, then
close it. Repeat 20 times.
Weight Changes
"I cannot believe I have cancer, and I'm gaining weight!"
Sara, breast cancer survivor, 43
|
|
Research shows that some cancer survivors who have had certain kinds
of chemotherapy or who have taken certain medicines have problems with
weight gain--and the added pounds stay on even when treatment ends. Breast
cancer survivors who have had certain types of chemotherapy gain weight
in a different way--they may lose muscle and gain fat tissue. Unfortunately,
the usual ways people try to lose weight may not work for them.
Some cancer survivors have the opposite problem: they have no desire
to eat, and they lose weight. Some men say that weight loss is a bigger
concern for them than weight gain. It makes them feel less strong--and
like "less of a man."
 |
Getting Help With Weight Gain From Your Doctor or Nurse
|
Your doctor or nurse can help you deal with weight gain. Ask about:
-
Doing strength-building exercises for your arms and shoulders, if you have
lost muscle and gained fat tissue
-
Talking to a dietitian or nutritionist who can help you plan a healthy
diet that won't add extra pounds
|
Tips: Regaining a Lost Appetite
|
Here are some tips that have helped others improve their appetites:
-
Start with small meals. Five small meals a day may be easier to manage
than three larger ones. Try to have a smaller breakfast than usual, then
have a healthy snack in the middle of the morning.
-
Focus on favorite foods. If the thought of eating still lacks appeal, try
the foods you really liked before treatment. They can help jump-start your
appetite.
-
Pamper yourself. Make mealtime a special time. Even if you only have a
nutritional supplement drink, serve it in a chilled glass or mug. Add some
fresh fruit, juice, or other flavor boost to make it taste better.
-
Find ways to make your meals look nice. Choose foods of contrasting colors;
serve the meal on a pretty plate; use a colorful napkin.
If You Have Trouble Swallowing
Some people who have had radiation therapy or chemotherapy to the head
or neck areas may find it hard to eat because they have trouble swallowing.
People who have had radiation to the breast or chest or those who have
had surgery involving the larynx may also have this problem. As one lung
cancer survivor said, "I had a really hard time swallowing and chewing
because of the chemo. I just couldn't do it. I lived on soup and soft rice
for weeks and weeks."
If you have trouble swallowing:
-
Eat soft, bland foods moistened with sauces or gravies. Puddings, ice cream,
soups, applesauce, and bananas and other soft fruits are nourishing and
usually easy to swallow.
-
Use a blender to process solid foods.
-
Ask for advice from your health care team, including your doctor, nurse,
nutritionist, and/or speech pathologist.
-
Tilt your head back or move it forward while you are eating.
-
Have a sip of water every few minutes to help you swallow and talk more
easily. Carry a water bottle with you so you always have some handy.
Bowel and Bladder Control
Bowel and bladder problems are among the most upsetting issues people face
after cancer treatment. People often feel ashamed or fearful to go out
in public. "Going back to work was the hardest thing," one prostate
cancer survivor noted. "I felt so foolish having to go to the bathroom
all the time. And it was a complete surprise. My doctor never told me I
would have this problem."
This loss of control can happen after treatment for bladder, prostate,
colon, rectal, ovarian, or other cancers. Your surgery may have left you
with no bowel or bladder control at all. Or perhaps you still have some
control, but you make lots of sudden trips to the bathroom.
The opposite problem can happen when a medicine you are taking for
pain causes constipation.
|
|
Getting Help With Bowel and Bladder Control From Your Doctor or Nurse
|
It is very important to tell your doctor about any changes in your bladder
or bowel habits. Ask your doctor or nurse about:
-
Help in dealing with ostomies. There are services and support groups to
help people deal with these changes.
-
Problems with constipation, which can be treated.
-
Doing Kegel exercises and other physical
training programs.
-
Medications that may help.
Menopause Symptoms
After chemotherapy, some women stop getting their periods every month--or
stop getting them altogether.
Some cancer treatments (and the medicine tamoxifen) can cause changes
in women's bodies and reduce the amount of hormones the body makes. These
changes can cause your periods to stop, as well as cause other symptoms
of menopause (also called "the change" or "change of life").
Over time, some women will start getting their periods again (this
is more likely for younger women), but others will not.
Some common signs of menopause are:
Irregular periods. One of the first signs is a change in your
periods. They may become less regular. They could be lighter. Some women
have short times of heavy bleeding. Sometimes, they stop all of a sudden.
Hot flashes. Hot flashes are often worse at night and can disrupt
sleep. This can cause mood changes and make it hard for you to make decisions.
Problems with your vagina or bladder. Tissues in these areas
become drier and thinner. You may be more likely to get infections in your
vagina. As you get older, you may also have urinary tract problems or problems
holding your urine.
Lack of interest in having sex. These changes may make it hard
for you to become sexually aroused.
Fatigue and sleep problems. You may feel tired or have trouble
getting to sleep, getting up early, or getting back to sleep after waking
up in the middle of the night.
Memory problems, and other problems such as depression, mood swings,
and irritability. Some of these, especially memory problems, may be
related to growing older. There may be a connection between changes in
your hormone levels and your emotions.
Other changes in your body. You may notice your waist getting
bigger, less muscle and more fat around your body, or thinning and loss
of elasticity in your skin.
It Is Important to Know That:
If you were still getting your period when you started treatment,
and
you are having menopause symptoms after treatment,
you still may be able to get pregnant.
|
|
|
Getting Help With Menopause Symptoms From Your Doctor or Nurse
|
See a gynecologist every year. Ask about:
-
Medicines or supplements or other approaches that can help you manage menopause
symptoms
-
Tests you should have (such as a bone density test to see if you are at
risk for osteoporosis)
-
Ways you can reduce your chance of getting:
-
Osteoporosis. Menopause can put you at risk for losing bone tissue,
which can weaken your bones and make them easier to break.
-
Heart Disease. Menopause can also lead to higher cholesterol in
your blood, which can increase your risk of diseases that affect your heart
and blood vessels.
|
Tips: Relieving Menopause Symptoms
|
Here are some tips that have helped others deal with menopause symptoms:
-
Quit smoking.
-
Exercise--both weight-bearing and musclestrengthening.
-
Eat wisely. A balanced diet will provide most of the nutrients and calories
your body needs to stay healthy.
-
Through exercise and diet, try to maintain a healthy weight.
-
Drink plenty of water.
If you are having hot flashes, try making a diary of when they happen and
what may start them. This may help you find out what to avoid. Otherwise:
-
When a hot flash starts, go somewhere that is cool, or carry a small fan
with you.
-
Sleep in a cool room; this may keep hot flashes from waking you up during
the night.
-
Dress in layers that you can take off if you get warm.
-
Use cotton sheets, and wear clothing that lets your skin "breathe."
-
Try having a cold drink (water or juice) at the beginning of a flash.
-
Try not to eat a lot of spicy foods. Limit the alcohol and caffeine you
drink.
Intimacy and Sexuality
"I knew about the impotence. What I did not know about ...
was the total lack of interest, which really caused some problems between
[me and my partner]."
Mitch, prostate cancer survivor, 73
|
You may have changes in your sex life after cancer treatment--many people
do. About half of women who have had long-term treatment for breast and
reproductive organ cancers and more than half of men treated for prostate
cancer report long-term sexual problems. Many cancer survivors say they
were not prepared for the changes in their sex lives.
Sexual problems after cancer treatment are often caused by changes
to your body--from surgery, chemotherapy, or radiation, or by the effects
of pain medicine. Sometimes these problems are caused by depression, feelings
of guilt about how you got cancer, changes in body image after surgery,
and stress between you and your partner.
What types of problems occur? People report four main concerns:
-
Losing interest in sex. Some may struggle with their body image
after treatment. Even thinking about their partners seeing them without
clothes is stressful. Others are worn out or in pain, and sex is the last
thing on their minds. Chemotherapy and some cancer medicines can also reduce
sex drive.
-
Not being able to have sex as you did before. Some cancer treatments
cause changes in sex organs that also change your sex life.
-
Some men can no longer get or keep an erection after treatment for prostate
cancer, cancer of the penis, or cancer of the testes. Some treatments can
also weaken a man's orgasm or make it dry.
-
Some women find it harder, or even painful, to have sex after cancer treatment.
Some cancer treatments, like chemotherapy, surgery, or radiation, can cause
these problems; sometimes, there is no clear cause for these problems.
-
Having menopause symptoms. When women stop getting their periods,
they can get hot flashes, dryness or tightness in the vagina, and/or other
problems that can affect their desire to have sex.
-
Losing the ability to have children. Some cancer treatments can
cause infertility, making it impossible for cancer survivors to have children.
Depending on the type of treatment you had, your sex and age, and the length
of time you've been out of treatment, you may still be able to have children.
 |
Getting Help With Sexual Problems From Your
Doctor or Nurse
|
Your doctor may be able to help you deal with these problems, but he
or she may not bring up the subject. You may need to "break the ice" yourself.
If you think you might have trouble getting started, bring this document
with you and show this section to your doctor or nurse.
Often, sexual problems will not get better on their own. To get help
with many of these problems, it is important to talk to your doctor. Ask
about:
-
Any medical problem that may be causing changes in your sex life.
You may be able to get treatment for the problems you are having. These
may include:
-
Erection problems. Medicines, counseling, finding ways to please
yourself, surgery, or other approaches may help.
-
Vaginal dryness. Dryness or tightness in the vagina, which can be
caused by menopause. Ask whether using a water-based lubricant during sex,
using vaginal dilators before sex, and/or taking hormones or using a hormone
cream are options for you.
-
Ways you can gain muscle control by doing
Kegel exercises. You can help strengthen muscles in your genital area
by doing these exercises. Practice by controlling your muscles to stop
the flow of urine. You can do these exercises even when you are not urinating.
Just tighten and relax the muscles as you sit, stand, or go about your
day.
-
Concerns about having children, and what you can do. Discuss family
planning concerns with your doctor. If you are a woman, ask if you still
need to use birth control even if you are not getting your period.
-
Seeing a sex therapist. He or she may be able to help you talk openly
about your problems, work through your concerns, and come up with new ways
to help you and your partner.
|
Tips: Feeling Intimate After Treatment
|
Most people can still enjoy sex and intimacy after cancer treatment,
even if they need to make changes. Here are some ideas that have helped
other people.
-
Create a sensual mood. Lighting, music, scent, or a romantic meal
for two can help.
-
Have a "date." If possible, set aside special time for just the
two of you.
-
Touch each other. Kiss, hug, and cuddle even when you cannot have
the kind of sex you are used to having.
-
Change positions. A new position may increase your comfort.
-
Find other ways to be sexual. For example, you may enjoy feelings
in parts of the body that were not touched as often before. Think about
ways to give yourself pleasure.
-
Go slowly at first. If you have painful scars, you may have to get
used to having the scar touched little by little.
-
Ask for more foreplay if you need it. Some women say they need more
time for foreplay to relax and get ready for sex. Some men say they need
a new type of caress to reach orgasm. Their climax may be stronger if they
stop and start a few times when they get close to climax.
-
Find ways to feel more sensual. Wear pajamas or a nightgown that
hides your scar and makes you feel attractive. Think about all the ways
you please your partner.
-
Be positive. Your thoughts can play a big role in your sex life.
-
Tell your partner about your worries or fears.
What if I Have Other Health Problems?
For some survivors, the long-term effects of cancer and its treatment may
be made worse by the effects of aging, or by other health conditions, such
as diabetes or heart disease, that you may have had before cancer. Breast
cancer survivors who have had surgery may find everyday activities like
reaching or stretching painful; health conditions such as arthritis can
make these activities even more difficult. Colorectal or prostate cancer
survivors may find that the aging process also affects their bowel or bladder
control.
It is very important that you tell your doctor about:
-
All your health conditions
-
All the medicines you are taking for these conditions
Some cancer treatments may cause future health problems. Sometimes these
problems don't appear right away; some don't appear until years after treatment.
Ask your doctor:
-
Whether your treatment can put you at risk for short-term or long-term
problems
-
What those problems are
-
What you should do to take care of your health
Your Mind and Your Feelings After Cancer Treatment
Download a PDF version of Your Mind and Your Feelings After Cancer Treatment.
| Just as cancer treatment affects your physical health, it affects the
way you feel, think, and do the things you like to do. Besides causing
many emotions that may surprise you, the treatment may actually change
the way your brain works. Just as you need to take care of your body after
treatment, you need to take care of your emotions. |
Each person's experience with cancer is different and unique, and the feelings,
emotions, and fears that you have are unique as well. The values you grew
up with may affect how you think about and deal with cancer. Some people
may feel they have to be strong and protect their friends and families.
Others seek support from loved ones or other cancer survivors or turn to
their faith to help them cope. Some find help from counselors and others
outside the family, while others do not feel comfortable with this approach.
Whatever you decide, it is important to do what's right for you and not
compare yourself to others.
Here are some common feelings other people have had after cancer treatment.
Fear That Cancer Will Come Back
"I don't think you ever forget the fact that it is always
possible for it to come back."
Grant, leukemia survivor, 68
|
"As long as I was in treatment, I was killing the cancer.
[After treatment] I was waiting for the other shoe to fall."
Judy, breast and thyroid cancer survivor, 45
|
Worrying about the cancer coming back (recurring) is normal, especially
during the first year after treatment. This is one of the most common fears
people have after cancer treatment. Even years after treatment, this fear
may always be in the back of their minds.
For some, the fear is so strong that they no longer enjoy life, sleep
well, eat well, or even go to follow-up visits. "If I get it again,
what am I going to do?" one woman said. "I never thought I'd make
it through the first time." Of course, not everyone reacts this way.
As one survivor put it, "[Cancer] is just part of life, and we always
have hope."
As time goes by, many survivors report that their fear of cancer coming
back becomes less, and they find themselves thinking less often about their
cancer. However, even years after treatment, some events can cause you
to become worried about your health. These may include:
-
Follow-up visits
-
Anniversary events (like the date you were diagnosed or had surgery or
ended treatment)
-
Birthdays
-
Illness of a family member
-
Symptoms similar to the ones you had when you found you had cancer
-
The death of someone who had cancer
-
Personal reminders. For example, one person said he used to go to a particular
restaurant during chemotherapy because the milkshakes they served were
the only thing he could stand to eat. After treatment, he found he had
to stop going to the restaurant because it reminded him of treatment and
made him "sick to his stomach."
|
Tips: Coping With Fear of Cancer Returning
|
How do you cope with fear of cancer returning? Here are some ideas
that have helped others deal with fear and feel more hopeful:
-
Be informed. Learning about your cancer, understanding what you
can do for your health now, and finding out about the services available
to you can give you a greater sense of control. Some studies even suggest
that people who are well informed about their illness and treatment are
more likely to follow their treatment plans and recover from cancer more
quickly than those who are not.
-
Express feelings of fear, anger, or sadness. Being open and dealing
with their emotions helps many people feel less worried. People have found
that when they express strong feelings like anger or sadness, they are
more able to let go of these feelings. Some sort out their feelings by
talking to friends or family, other cancer survivors, or a counselor. Of
course, if you prefer not to discuss your cancer with others, you should
feel free not to. You can still sort out your feelings by thinking about
them or writing them down on paper.
Thinking and talking about your feelings can be hard. Some people just
want to move on. They put the thought of cancer and all that goes with
it out of their minds. While it is important not to let cancer "rule your
life," it may be hard to do. If you find cancer is "taking over" your life,
it may be helpful to find a way to express your feelings.
-
Work toward having a positive attitude, which can help you feel better
about life now. Sometimes this means looking for what is good even
in a bad time or trying to be hopeful instead of thinking the worst. Use
your energy to focus on wellness and what you can do now to stay as healthy
as possible.
Don't blame yourself for your cancer. Some people believe that they
got cancer because of something they did or did not do. This is usually
not true--and you should not dwell on feeling this way. Remember, cancer
can happen to anyone.
You don't need to be upbeat all the time. Many people say they want
to have the freedom to give in to their feelings sometimes. As one woman
said,"When it gets really [bad], I just tell my family I'm having a
bad cancer day. I ... cancel all my appointments. I go upstairs and crawl
into bed."
-
Find ways to help yourself relax. The exercises within Practicing
Relaxation to Relieve Pain and Stress 10
have been proven to help others and may help you relax when you feel worried.
-
Be as active as you can. Getting out of the house and doing something
worthwhile can help you focus on other things besides cancer and the worries
it brings.
-
Control what you can. Some people say that putting their lives in
order makes them feel less fearful. Being involved in your health care,
keeping your appointments, and making changes in your lifestyle are among
the things you can control. Even setting a daily schedule can give you
more power. And, while no one can control every thought, some say they've
resolved not to dwell on the fearful ones.
Feeling Stress
When you were diagnosed, you may have put certain issues aside for a while,
such as concerns about family, work, or finances. Now that treatments are
over, these issues may begin to resurface just when you are tired and may
feel that there is already too much to handle.
Many cancer survivors also worry that stress may have played a role
in their illness. It is important to remember that the exact cause of many
cancers is still unknown. No research shows that stress causes cancer,
but stress can cause other health problems. Finding ways to reduce or control
|
Tips: Reducing Stress
|
Many survivors have found activities like the ones below useful in
dealing with cancer and their worries after treatment ends. Ask your doctor,
nurse, social worker, or local cancer organization about taking part in
activities like these.
Exercise. Exercise is a known way to reduce stress and feel
less tense--whether you've had cancer or not. As one man put it: "I
can feel down a little bit, and it is a fine line with depression, but
when I walk 45 or 50 minutes in the fresh air, I feel like I can take on
the world sometimes." See your doctor before making an exercise plan,
and be careful not to overdo it. If you cannot walk, ask about other types
of exercise that may be helpful.
Dance or Movement. People can act out their feelings about cancer
in classes using dramatic and/or dance-style body movements. Other class
members talk about the issues the "performer" was trying to express.
Sharing Personal Stories. Telling and hearing stories about
living with cancer can help people learn, solve problems, feel more hopeful,
air their concerns, and find meaning in what they've been through. See
Joining
a Support Group for support group information.
Music and Art. Even people who have never sung, painted, or
drawn before have found these activities helpful and fun.
Dealing With Depression and Anxiety
After treatment, you may still feel angry, tense, sad, or blue. For most
people, these feelings go away or lessen over time. For up to one in four
people, though, these emotions can become severe. The painful feelings
do not get any better, and they get in the way of daily life. These people
may have a medical condition called depression. For some, cancer treatment
may have contributed to this problem by changing the way the brain works.
Getting Help for Depression
Talk to your doctor. If your doctor finds that you do suffer from depression,
he or she may treat it or refer you to other experts. Many survivors get
help from therapists who are expert in both depression and helping people
recovering from cancer. Your doctor also may give you medicine to help
you feel less afraid and tense.
If you find it hard to talk about your feelings, you may want to show
your doctor this document. It can help you explain what you're going through.
Do not feel that you should be able to control these feelings on your own.
Getting help if you need it is important for your life and your health.
How Do I Know If I Need Help With Depression or Anxiety?
If you have any of the following signs for more than 2 weeks, talk to your
doctor about treatment.
Emotional signs:
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A sense of being worried, anxious, blue, or depressed that doesn't go away
-
Emotional numbness
-
Feeling overwhelmed, out of control, shaky
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A sense of guilt or worthlessness
-
Helplessness or hopelessness
-
Irritability and moodiness
-
Difficulties concentrating, or feeling "scatterbrained"
-
Crying a lot
-
Focusing on worries or problems
-
Not being able to get a thought out of your mind
-
Not being able to stop yourself from doing things that seem silly
-
Not being able to enjoy things any more, such as food, sex, or socializing
-
Finding yourself avoiding situations or things that you know are really
harmless
-
Suicidal thoughts or feeling that you are "losing it"
Body changes:
-
Unintended weight gain or loss not due to illness or treatment
-
Insomnia or increased need for sleep
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Racing heart, dry mouth, increased perspiration, upset stomach, diarrhea
-
Physically slowing down
-
Fatigue that doesn't go away; headaches or other aches and pains (These
may also be caused by cancer treatment; see Fatigue 15.)
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Dealing With Changes in Memory and Concentration
"I tell them it is a 'senior moment,' but I notice I have a lot more
of them now, and I'm sure [treatment] had something to do with it,"
one 70-something survivor noted. "Not being able to concentrate the
way I used to is the worst effect for me," a younger survivor added.
"I
worry about how it will affect my work."
Research shows that one in four people with cancer reports memory and
attention problems after chemotherapy. More research is needed to learn
what causes these changes.
These effects can begin soon after treatment ends, or they may not
appear until years later. They do not always go away. If a person is older,
it can be hard to tell whether these changes in memory and concentration
are a result of treatment or of the aging process. Either way, some feel
they just cannot focus as they once did.
Research is just starting to explore who may develop problems with
memory and concentration. It seems that people who have had systemic chemotherapy
or have had radiation to the head area are at higher risk of having these
problems. People who have had high doses of chemotherapy may be particularly
affected by memory problems, but even those who have had standard doses
have reported memory changes.
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Working With Your Doctor or Nurse on Memory and Concentration Problems
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Your doctor can help you with memory and concentration problems. Talk
with him or her if:
-
You think a medicine you are taking could be causing or adding to your
problem.
-
You think you suffer from depression or anxiety. These problems can affect
attention, concentration, and memory.
-
You are going through menopause. Some memory and concentration problems
can be related to menopause.
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Tips: Improving Memory and Concentration
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Cancer survivors have found many ways to help improve memory after cancer
treatment. See if any of these ideas work for you:
-
Get a notebook or pocket calendar and use it to plan your day. You
can write down each task, how long it will take, and where you need to
go. Plan the whole day, including night hours. Keep it simple, and be realistic
about how much you can do in a day.
-
Put small signs around the house to remind you of what you need
to do. Use them to remember tasks such as: 1) take out the trash; and 2)
lock the door. Hint: use only two or three signs. If you have too many,
you may ignore them.
-
Group long numbers (such as phone numbers and ZIP codes) into "chunks."
For example, the phone number 812-5846 can be repeated as "Eight-twelve,
fifty-eight, forty-six."
-
"Talk yourself through" something you need to do to help you stay
focused. When doing a task with a number of steps, such as cooking or working
on a computer, whisper each step to yourself.
-
Learn relaxation skills. (See Practicing
Relaxation to Relieve Pain or Stress 10.)
Learning how to relax can help you remain calm even in stressful moments.
Managing stress better can improve memory and attention.
-
Before you go to family events or work functions, practice saying important
information that you want to remember, like names, dates, and key points
you want to make.
-
Repeat what you want to remember. Saying it a couple of times can
help your mind hold on to the information.
"Women want to feel like women. And you want to be feminine
when you look in the mirror ... and especially if you are a single woman."
Sandra, breast cancer survivor, 53
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"I just did not feel like my body was the same after treatment.
I can't play hard with my grandchildren any more, and we both miss it."
George, non-Hodgkin's lymphoma survivor, 71
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Dealing With Body Changes
Some body changes are short-term, and others will last forever. Either
way, how you look may be a big concern after cancer treatment. People with
ostomies after colon or rectal surgery are sometimes afraid to go out.
They may feel shame or fear that others will reject them. They may be afraid
they will have an "accident" and feel embarrassed. Others do not like people
being able to see treatment effects like scars on the head or neck, skin
color changes, loss of breasts or limbs, weight gain or loss, and hair
loss. Even if your treatment does not "show," your body changes may trouble
you. Feelings of anger and grief are natural. You have lost your "old body"
and, with it, your sense of self.
Feeling bad about your body can also lower your sex drive, and the
loss of or reduction in your sex life can make you feel even worse about
yourself. "Mentally, it was strange," one prostate cancer survivor
said. "You're worried about your 'man thing.' It may be on the back
of your mind ... but it is always there." Women also have this concern.
"I
felt like I was half of a woman," one ovarian cancer survivor noted.
Changes in the way you look can also be hard for your loved ones--and
this can be hard on you. Parents and grandparents often worry about how
they look to a child or grandchild. They fear the changes in their body
will scare the child or get in the way of their staying close.
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Tips: Coping With Body Changes
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How do you cope with body changes? Here are some ideas that have helped
others:
-
If you find that your skin has changed color from radiation, ask your doctor
or nurse about ways you can care for your skin and if the color will change
over time.
-
Find new ways to enhance your appearance. A new haircut, hair color, makeup,
or clothing may give you a lift.
-
If you choose to wear a breast form (prosthesis), make sure it fits you
well. Your health insurance plan may pay for it.
-
Tell yourself that you are more than your cancer. Know that you have worth
no matter how you look or what happens to
-
Mourn your losses. They are real, and you have a right to
-
Focus on the ways that coping with cancer has made you you in life. grieve.
stronger, wiser, and more realistic.
Feeling Angry
Many people find themselves feeling angry about having cancer or about
things that have happened to them during their diagnosis or treatment.
They may have had a bad experience with a health care provider or with
an unsupportive friend or relative.
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Tip: Feeling Less Angry
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Hanging on to anger can get in the way of your taking care of yourself,
but sometimes anger can energize you to take action to get the care you
need. If you find yourself feeling angry, find a way to use that energy
to help yourself.
Feeling Alone
"I found myself kind of going through the motions, through
the treatments, through the doctor's appointments. I never really stopped
to consider the emotional side of things. After I finally realized what
I was dealing with, I didn't feel like I had the emotional support I needed."
Carmen, Hodgkin's disease survivor
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"I went [to radiation treatment] every day, and they treated
me, and we were like ... family. And now there's this instant separation."
Tom, prostate cancer survivor, 70
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After treatment, you may miss the support you got from your health care
team. You may feel as if your safety net has been pulled away and that
you get less attention and support from health care providers now that
treatment is over. You also may feel that only others who have had cancer
can understand your feelings. Feelings like these are normal any time you
leave people who mean a lot to you.
It is also normal to feel somewhat cut off from other people--even
family and friends--after cancer treatment. Often, friends and family want
to help, but they don't know how. Others may be scared of the disease.
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Tips: Feeling Less Alone
|
What can you do to make yourself feel better during this lonely time?
Here are some methods other people have found helpful:
-
Figure out how you can replace the emotional support you used to receive
from your health care team. Think about:
-
Asking one of your nurses or doctors if you could call sometimes. Your
call could help you stay connected and help you feel less alone. Even just
knowing you can call them may help.
-
Finding support services offered over the phone or Internet.
-
Finding new sources of support for your recovery. Friends, family, other
cancer survivors, and clergy are a few ideas.
-
Think about joining a cancer support group. In a cancer support group,
people who have had cancer meet to talk about their feelings and concerns.
Besides airing their own issues, they hear what others have gone through
and how other people have dealt with the same problems they are facing.
A support group also may help members of your family cope with their concerns.
Joining a Support Group
"I could feel myself getting down, and I joined this group
and we have a great time. We cry, we laugh, we carry on."
Elia, breast cancer survivor, 58
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