Side Effects of Cancer Treatment

Cancer and it’s treatment can have many side effects and in this section we discuss these and offer suggestions on how you can learn to cope with these.

 

How to Make Positive Lifestyle Changes While Living With Cancer

Living with cancer is a life-changing experience on many levels. You may find that your perspective has changed or that you are thinking about your life in new ways. For many people, this experience serves as an opportunity to re-evaluate their lifestyle and make positive changes to improve their overall physical, mental, and emotional health.

Making thoughtful changes helps people living with cancer reduce their stress levels, gain confidence, discover new interests, and find greater meaning in life. Moreover, setting realistic goals and working to achieve them often helps people feel more in control of their future amidst the uncertainty of a cancer diagnosis.

In order to know where we are going, we first need to know where we are now.

The graph below identifies the stages people can go through when dealing with a major change to their life.

Shock often coupled with anger can happen when you are first given a diagnosis of cancer.

Denial This can’t be true. I’ve always lived a healthy life I can’t have cancer. My results have been mixed up with someone else’s.

Emotion Feeling overwhelmed, unable to cope, depressed unable to see a way forward. Unwell from chemotherapy and other interventions. Worried for ourselves and loved ones.

Acceptance of Reality I do/did have cancer. It is part of my life now.

Testing Who am I now? What should I do differently in order to get back on with my life? To be me again and not just a cancer patient? Trying out new behaviours and habits putting old good things about me back in place.

Internalisation A time to reflect on all that has happened, the changes you’ve made/are making, reflecting on how you feel now and where you are now with your life.

Integration Incorporating new ways of behaving, new habits, looking and going forward. Getting on with your life.

Adapted by Lewis and Parker from the original work of Elizabeth Kubler Ross

Adapted by Lewis and Parker from the original work of Elizabeth Kubler Ross

Look at the graph and say where you mostly are now. Because of course life and our emotions aren’t neat and orderly and although I might be mostly in one place it is quite possible to slip backwards now and again and that’s quite normal. But the target is to reach integration to get back on with your life

Journaling: Keeping Track of Your Feelings and Thoughts

We all face cancer differently. How you respond to your disease, and how you move through your cancer journey is up to you. Writing in a journal is just one way to express your feelings and confront your cancer.

A journal is a book, notebook, or any collections of written thoughts. It can include feelings, opinions, beliefs, hopes, fears, reflections and more. By recording your thoughts in a journal, you can release the power your emotions hold over you and free you from being consumed by them. In addition, keeping a journal will help you find and heal forgotten pain, detect subconscious feelings and enhance your life by giving you the means to discover the hidden gift that every crisis brings. It is also possible that reliving our best experiences through writing can help retrieve those good feelings and emotions. Keeping a journal may help you get through each day, face the tough issues and possibly start a new life.

Not everyone is comfortable with self-disclosure. Here are a few suggestions to get you started.

  • Pick out a diary or blank notebook. A loose-leaf version will allow you to add photocopied pages.
  • Try to journal at least four days a week.
  • A quiet journaling session in the morning may help to soothe, compose and give you balance throughout the day.
  • Always journal when you notice your mind is “racing.”
  • Make time…because you’ll never find time.
  • Keep a pen with you.
  • Use a different colored pen or highlighter to mark your most important thoughts.
  • Don’t lose the opportunity to journal in different locations. Carry your journal with you to treatment centers, doctors’ offices, hospitals and wherever you travel.
  • Do not make your journal a to-do list or record just the events of the day. This is about feelings.
  • Write quickly so that revelations about you make themselves known.
  • Don’t censor yourself. Be free. Don’t worry about grammar, punctuation or spelling.
  • When you are done with one journal, buy another one!  

 

Living with “Chemo-Brain” (Cognitive Dysfunction after Cancer)

Many people who have previously received or are currently undergoing chemotherapy report experiencing cognitive changes, often referred to as “chemo-brain.” These changes include difficulty with short term memory, multi-tasking, new learning, reading comprehension, working with numbers and a decrease in concentration ability. For many years, this was attributed by physicians and researchers to depression or anxiety over the diagnosis and treatment of cancer. More recently, researchers have begun to study and document what people have been saying all along; cognitive changes after chemotherapy are real. Although we are not yet able to pinpoint whether only certain chemotherapy drugs are responsible, it seems certain that the effects are cumulative. That is, those who receive more chemotherapy tend to experience greater deficits. Studies have found that cognitive ability can improve over time in some but deficits are still present in many even years after treatment. Each person’s experience is unique, making it difficult to predict what deficits, if any, a person will experience, and whether or not they will persist after treatment.

‘Brain rehab’ might help, utilizing exercise, tasks that use memory and puzzles to “rehabilitate” one’s mind. Puzzles using numbers, like Sodoku, may help “exercise” your brain. Fatigue can enhance cognitive problems, so avoiding fatigue by getting enough sleep, incorporating exercise into your life and eating a healthy diet.

It is important to remember that some very treatable problems can result in cognitive difficulties, such as thyroid dysfunction, depression and anxiety, so it is important to exclude or treat these diagnoses. Don’t just assume your cognitive concerns are due to chemo-brain; speak to your Specialist nurse or Doctor.

Tips

As you can see, there is no “quick fix” for chemo-brain, so get creative and incorporate things into your daily life that can help combat the symptoms.

  • Keep a detailed calendar or Got a smartphone? Set alarms to remind you of important appointments. The all-to-important sticky note – just be sure to put them in places you will see them!
  • In the evening, start a list for tomorrow- what needs to get done? Who do I need to call? Create a notebook for this so you can flip ahead and add something to next week’s list when it comes to
  • Keep a pad in the kitchen for a shopping list- when you see something is running low; make it a habit to add it right
  • Put a basket near the front door for those items you need every day- cell phone, keys,

Most importantly, know your limitations. Don’t take on tasks that require too much multi-tasking. Ask for help. Try to keep a positive outlook and find some humor in your “chemo-brain moments”

 

Fatigue after treatment.

This is one of the most common symptoms experienced by cancer patients. Studies have reported that 17 to 99% of patients experience fatigue at some time during their treatment. The reason for this large range is that the definition of fatigue has varied in these studies, as fatigue is very subjective and is different for each person who experiences it.

One definition of cancer-related fatigue is “a persistent, subjective sense of tiredness related to cancer or cancer treatment that interferes with usual functioning.” This sense of tiredness is usually not relieved with rest and is not related to an excessive amount of activity. Many patients describe it as feeling “bone tired”. They feel physically, mentally, and emotionally drained.

Researchers are investigating the link between cytokines and fatigue. Cytokines include interleukins and a chemical called tumour necrosis factor (TNF). The higher than normal levels of cytokines that are found in people who have cancer could cause fatigue by affecting hormones and chemicals that nerves use to communicate. All body chemicals are finely balanced and any upset in one area can easily affect another. This theory has been suggested to explain chronic fatigue syndrome (ME) and could also apply to cancer.

We don’t fully understand what causes cancer fatigue, but we know that a number of things can contribute to it. Fatigue is often worse in people who

  • Are having a combination of treatments
  • Have an advanced cancer
  • Are elderly

It is important that you know you are more likely to suffer from fatigue if you fall into one of these groups.

You may have other medical conditions that cause fatigue, such as

  • Heart problems
  • Diabetes
  • Being overweight
  • Problems with your lungs
  • Depression

Fatigue can be a constant reminder of your cancer and this can be hard to accept. You may worry that because you feel so tired all the time your cancer must be getting worse. But it is more likely to be a side effect of treatment,

Fatigue after Surgery

If you had surgery for your cancer you are likely to feel some fatigue. This may last for a few weeks or months after your operation. People often underestimate how long it takes to get over surgery. Surgery stresses your body and it needs time to heal. You may have felt quite anxious before your operation, and the feeling of letting go and relaxing afterwards can leave you very tired. It is a bit like the build -up to an important event in your life, which leaves you feeling exhausted for some time afterwards. Pain can be exhausting

Fatigue after Radiotherapy

Most people who have had radiotherapy feel increasingly tired as they go through their treatment. Travelling back and forth to the hospital for treatment can make you feel very tired. But there also seems to be a direct effect from the radiation itself. Fatigue usually starts to improve within a week or so of finishing treatment. But it can go on for weeks and months afterwards for some people.

Fatigue after Chemotherapy

Nearly everyone who has chemotherapy has some fatigue. Your white and red blood cell counts drop midway between treatments. Many people feel very tired at this time. After that, you get a bit of energy back. Then it’s time for your next treatment and so it goes on. Knowing that you will get tired again can make you feel anxious and frustrated. Your body will take variable amounts of time to recover from this once your treatment has finished.

Fatigue and Hormone treatment

Many hormone treatments can disturb the body’s balance and the speed it does things. This is called your metabolism. Changing your metabolism can lead to several side effects, including fatigue.

Drugs that block hormones are used to treat some cancers, for example breast cancer or prostate cancer. This can cause fatigue as a side effect. It is similar to the fatigue that women going through menopause have.

Side effects of other drugs

Drugs that can make you feel drowsy and tired include

  • Painkillers
  • Anti-sickness drugs
  • Anti -depressants
  • Cough medicines
  • Sleeping tablets
  • Steroids

If you are taking a combination of these drugs, your fatigue may be worse. Talk to your doctor if you think your tablets and medicines are making you unnecessarily tired. But don’t stop taking anything until you’ve spoken to your doctor or specialist nurse.

All this can affect the way you feel about yourself and your relationships with other people. You may feel very down and not want to go out or be with people. This may be hard for them to understand.

You may have to stop work or cut down your hours because of fatigue. This may affect how much money you have. In one study up to 8 out of 10 people who worked before they had cancer had to give up or change their hours due to fatigue. All this adds up to a lot of worry, and can add to the fatigue.

In a survey in the UK, over 9 out of 10 people with cancer (90%) said fatigue stopped them leading a normal life. People with cancer have described their fatigue as

  • Unusual
  • Excessive
  • A whole body experience
  • Unrelated to how much or how little they do
  • Not helped by rest or sleep
  • Unbelievable

You are not imagining your cancer fatigue. It is very real and can have a big impact on your life. If you have symptoms of fatigue, let your doctor or specialist nurse know. Over half of the people with cancer never report fatigue because they think that nothing can be done about it. But there are ways of managing fatigue, so it is important to let someone know.

Things that can help some people

  • Finding out more about your cancer
  • Talking to other people at the outpatient department
  • Going to a support group

Just about everyone needs support from someone else when they have cancer. You can get some support from family and friends, or doctors and nurses. But support from other people who’ve been through the same thing can make all the difference. Talking to other people in a support group can show you that you are not alone. It can confirm that fatigue is something many people with cancer have and that fatigue will lessen with time.

You can do many things in your everyday life that will help to save your energy. Taking short cuts on some things or getting help from other people may both help you feel less tired. You could

  • Try not to rush – plan ahead where possible and give yourself plenty of time to get to places, preferably not in the rush hour
  • Where possible do household tasks sitting down – peeling vegetables, ironing (or better still, buy clothes that don’t need ironing!)
  • Write a shopping list and go when the shops are quiet
  • If you have children, play games that you can do sitting or lying down – reading, puzzles, board games or drawing
  • Ask family and friends for help with shopping, housework or collecting the children from school
  • Have plenty of nutritious snacks and drinks in, so you can have something quickly and easily whenever you feel like eating
  • Don’t forget to do things that you enjoy – it will take your mind off your cancer and make you feel more relaxed

If you have short term fatigue, caused by treatment you may be better off taking a little exercise rather than resting

It is understood that a lack of physical activity can aggravate or cause fatigue. This may be because deconditioned muscles require a person to exert more energy and effort to perform.

Exercise can increase your energy levels and help you to feel better about yourself and your condition. You can see progress in a short space of time. Generally speaking, the more you do, the more you are able to do and the better it works at reducing fatigue. It depends on your individual situation as what you will be able to do.

 

Hot Flushes & Sweating

Hot flushes are described a sudden unpleasant sensation of burning heat spreading across the face, neck and chest, can occur. Shortly after the sweat patients can then feel cold and clammy and even shiver. Some patients experience one or two flushes a week, whilst others can have ten or more a day but generally, the number of hot flushes will decrease over time.

Night sweats are described as a sudden sweat often linked to hot flushes and tend to happen at night. Patients sometimes find that their sleep patterns are disturbed because of these sweats. Research published form our team has shown that trying different hormone drugs many help or if this fails limited success has been gained from some prescribed drugs including; progesterone, clonidine or antidepressants. All these drugs of course have side effects of their own so lifestyle strategies are certainly worth a try first.

Causes – All women will naturally go through the menopause usually between 50-55 years of age. Some lucky women have very few effects but in other they suffer considerable hot flushes and night sweats. Some cancer treatments interfere with the function of the ovaries in women or testes in men. This often causes hot flushes which may be permanent or temporary. The risk of this should have been discussed before the start of therapy. The ovaries and testes have two main functions; to produce eggs and sperm and to produce sex hormones (testosterone in men & oestrogen and progesterone in women). In pre-menopausal women the 3 main causes ovarian failure which can cause menopausal hot flushes are:

  • Chemotherapy
  • Radiotherapy to the ovaries or testes
  • Hormones – LHRH agonists (e.g. zoladex, prostap), aromatase inhibitors
  • Surgery – removal of the ovaries (oophorectomy) or testes (Orchidectomy)

Other drugs can cause hot flushes without necessarily affecting ovarian failure. These include hormone therapy such as

  • Tamoxifen
  • Arimidex (anastrozole)
  • Femara (letrozole)
  • Aromasin (exemestane)
  • Stilboestrol

Non hormonal drugs can also cause or increase the severity of hot flushes ven less obvious causes such as some bone hardening drugs. such as the bisphosphonates

  • Aredia
  • Bonefos

What can you do to help?

Many people practice self-help techniques that can assist in making hot flushes less uncomfortable. You may find it useful to keep a note of when you have hot flushes so that you can identify any pattern. If you know when to expect hot flushes you can be better prepared. Otherwise here are some practical tips which may help:

Clothes, environment and hot flushes:

  • Wear cotton clothing rather than polyester or other man made fibres, as cotton absorbs moisture and still provides warmth after a flush is over
  • Try wearing layers of clothing that can be taken off or put on as your body temperature changes
  • Use several layers of bedclothes (natural fabrics are better) which you can remove as required
  • Try using sprays or moist wipes to help lower your skin temperature (you could add pleasant smelling oils to the spray, such as peppermint which has cooling properties or lavender which has a relaxing effect.
  • Use an electric fan placed on a desk or table to help lower your skin temperature
  • If you are not sleeping well because of flushes, try to find time to have a rest during the day
  • Try to avoid warm, stuffy rooms as they can make flushes worse
  • Take plenty of cool baths and showers

Diet & hot flushes:

  • Avoid spicy foods, especially at night
  • Avoid large meals and excess sugar
  • Hot drinks can trigger a hot flush – open a window and take your coat or scarf off first
  • Being over weight can be more difficult to regulate body temperature – if so, try to lose some weight
  • Avoid stimulants such as caffeine
  • Drink plenty of healthy fluids, particularly if you are sweating a lot
  • Avoid too much alcohol which can aggravate hot flushes, particularly wine (chianti) and cherrybrandy
  • Soya foods and other phyto-oestrogens – these are chemicals which are found in plants. They are similar in structure to the female sex hormone oestrogen. They are found in soya bean products, others are found in the fibre of whole grains, fruit, vegetables and flax seed. Milk may also contain Phyto-oestrogens, but this depends on what the cows have been eating! Women whose diets are high in Phyto-oestrogens have a lower risk of hot flushes. In some studies eating phyto-oestrogens (soya flour and linseed supplements) regularly over several weeks reduced the individuals own oestrogen levels despite the higher levels of the plant oestrogen. Unfortunately, the only well conducted trials of phyto-oestrogens in breast cancer patients with hot flushes have recorded very little benefit. Of more concern is that many oncologists around the world are not comfortable to recommend supplements of phtyo-oestrogens as, at this concentration, they may stimulate any residual cancer cells encouraging them to grow and spread – There is no evidence for this either but the most common sense stance would be to try foods with plant oestrogens as they are generally health and also packed with other health components such as anti-oxidants, fibre and vitamins but avoid supplements unless further evidence of a benefit ensues.
  • Evening primrose oil  Many people have found that taking evening primrose oil helps with hot flushes, although it may take several months before any improvement is noticed. Evidence from clinical trials is lacking but apart from the calories it is regarded as generally safe. You can buy evening primrose oil in chemists and health food shops.
  • Vitamin and mineral supplements Vitamin E, selenium and vitamin B6 have provided relief for some people. Again evidence is lacking but provided you check with your GP or cancer specialist before you start taking any vitamins or minerals and never take more than the recommended dose they are probably not harmful.

Smoking & hot flushes:

  • Smokers suffer worse hot flushes around and after the menopause
  • Smokers are at higher risk of osteoporosis
  • It is strongly advised to give up altogether

Relaxation techniques:

Stress can increase the number and intensity of hot flushes a person has. Being anxious about hot flushes could make your symptoms worse. Knowing what to expect and being prepared will help you feel more in control and ease your anxiety. Relaxation therapy can reduce stress and flushes. Hot flushes usually come and go over short periods, so try to relax and wait for the sensation to pass. You may find it helps to imagine yourself in a cool place, for example by the sea, when you feel a hot flush coming on. It may also help to know that although hot flushes are uncomfortable for you, other people are unlikely to notice them happening. (For information on training courses and resources, contact the Stress Management Training Institute. There is also a wide range of relaxation tapes available from health food shops and bookshops).

Weight control

Exercise & hot flushes

Regular gentle exercise may help reduce hot flushes. Choose an activity that you enjoy and feel comfortable with. (see exercise section on how to exercise after cancer)

Medical interventions

These are listed after lifestyle strategies on this page as it is always worth trying non-drug therapies first as drugs can have risks and side effects of their own. Nevertheless, if hot flushes persist and are affecting your quality of life then it will be worth discussing drugs with your general practitioner / oncologist

Change current medication. If you are post menopausal and are taking tamoxifen for breast cancer it may be worth discussing changing to an aromatase inhibitor such as anastrozole. Although these can also cause hot flushes and have other side effects a recent study showed they are, in general, not as severe. (read full paper by Thomas et al). In any case if after trying AI’s  for 6-8week you can then be in a position to choose which one suits you best. If you are already taking an aromatase inhibitor and still have troublesome hot flushes you may wish to discuss with your doctor switching to a different brand. There was a piblished trial which showed that a significant proportion of women had a different group of symptoms after they tried switching (read full paper by Thomas and Makris et al)

  • Clonidine
  • Venlaflexine
  • Progesterone

Complimentary therapies & hot flushes

Many patients use a range of complementary therapies, such as acupuncture, reflexology, chiropractic measures, massage and meditation. Strong evidence for these has not been published but there are a number of interesting anecdotal reports of success. If you want to try a complementary approach it is best to go to a recognised, qualified practitioner.

Homeopathic remedies: Homeopathic remedies recommended for hot flushes include sage, pulsatilla, rhubarb, root extract, sulpha and graphites. A qualified homeopath will prescribe the remedies that are best for you.

Aromatherapy: Some patients find that aromatherapy massage with essential oils such as clary sage and chamomile improves symptoms.

Herbal remedies: Ginseng, black cogosh, dong quai, lavender, fennel, false unicorn toot and wild yam are all herbal or plant remedies that have been used to relieve menopausal symptoms. Some of these herbal remedies help because they have phytoestrogenic properties so it is important to discuss with your cancer specialist first. Most herbalists will tell you that sage is a natural anhidrotic (reduces sweating) and can help excess sweating during the hot flush.

Massage, & reflexology: Are perfectly safe. There is absolutely no evidence that they can push cancer cells around the body as is commonly quoted in folk law. Although evidence of benefit is lacking they are enjoyable and relaxing.

Acupuncture: The are now some good randomised trials showing a good benefit from acupuncture. Certainly acupuncture has been found to be as good as anti-depressants such as venlaflexaine.

 

Coping with sleep problems

We have all had sleepless nights and know they can make you feel tired, cranky and a bit dazed. If feeling sad or depressed is making you have trouble sleeping at night, it may help to change a few things about when and where you sleep.

  • If you have severe depression, sometimes getting a lot of sleep may not help much, and can make you feel worse. But to make sure you sleep as well as possible
  • Go to bed and get up at the same time each day
  • Try to sleep in a quiet, calm room
  • Make the room you sleep in a comfortable place you like to be – an untidy room may be distracting and make you feel anxious
  • Make sure the temperature is right – not too hot or too cold.
  • Sleep with the window open if you prefer, as long as there isn’t too much noise outside
  • Spend time relaxing before you go to bed – have a bath, read or listen to music
  • Do some light exercise each day to help tire yourself out
  • Don’t drink too much alcohol before bed – you may fall asleep to start with but you’ll have a disturbed night
  • Avoid caffeine (coffee, tea, chocolate and cola drinks) after early afternoon
  • If you are napping a lot during the day, try to cut down – you may find you then sleep longer and deeper at night
  • Have a light snack before you go to bed to stop hunger waking you up
  • Try and relax before sleep – you could imagine somewhere beautiful you’d like to be
  • Listen to a relaxation tape

When you really can’t sleep, get up and watch TV, read, or listen to music until you feel sleepy. Or try simple relaxing things like taking a warm bath and a warm milky drink. Then go back to bed and try again. Do let your doctor or specialist nurse know if you often have trouble sleeping.

 

Managing your emotions

Many questions might arise when your treatment has finished

  • Will I ever feel happy again?
  • Am I going to die?
  • Why has this happened to me?
  • Will I be able to get myself together and enjoy the things that I used to – even my husband or children can’t seem to make me feel happy any more

All these thoughts, feelings and questions are very natural and completely understandable. Your family and friends may expect you to feel back to normal once your treatment finishes. But many people with cancer find that this is the time when the emotional impact of their diagnosis hits them and they need more support.

Will anything help?

Although you may feel low and as though you can’t do anything, there are things that you can try and do to help yourself feel better. You may think that nothing is going to help but you won’t know until you give it a go. Try not to feel guilty about feeling like this. This will only increase your levels of anxiety and depression.

At first, you may find it very difficult to want to try any of these suggestions. But, along with other treatment from your doctor or specialist nurse, they are worth a try when you feel up to it.

Taking it slowly

Set small goals for yourself and build them up slowly. Try to take each day as it comes and not think ahead too much. If your anxiety, fear or depression is very severe, you may need to get some medical help. Talk to your GP or specialist cancer nurse who can advise you.

Some people find it helps to set themselves small goals each day, even if you just say to yourself, ‘I will get up today and walk around the block once’. Or, ‘I will ring a friend for a short chat today’. This is a start and a big achievement for someone who is very depressed or anxious.

So give yourself a pat on the back for every task you manage to do each day. You shouldn’t expect to feel better overnight. Feeling better takes time and happens gradually.

Relaxation technique

Some people find that complementary therapies help them to relax and cope with episodes of anxiety, fear and depression. Relaxation techniques such as meditation and yoga may help. Having a massage or reflexology may also make you feel better.

Come along to the ‘Drop in’ which is held weekly at the Holiday Inn, Brampton. There is always one of the Community Cancer Nurses present and some patients who have been through what you are experiencing and can support how you are feeling. Here you will also be able to find out about some of the other support activities we are hosting. These change throughout the year. Ask for a programme of events.

Exercise is another great way to help control the intensity of some of your feelings. Exercise increases the body’s level of chemicals called endorphins. These play a part in helping us feel good.

Don’t push yourself too much if your cancer is making you feel ill. Listen to your body, but do try and do something physical, even if it’s a more gentle form of exercise such as yoga. Even if you just go out for a short walk each day, it can help.

Keep a journal or draw; it can be a great release to get your thoughts onto paper instead of keeping them all inside. Writing something each day, even if it’s just a few words, can be really helpful. If you think that feeling better is taking too long, reading back over your journal may help you see that you are making progress. You may see from what you wrote a month ago, that you are not feeling as bad now.

Trying to stay positive

One of the things that people with cancer are often encouraged to do is to be positive. But it is not always that easy. Living with cancer and its treatment can be frightening. There will be times when you may feel low and worry about your future.

It may seem impossible to be positive if you are feeling very depressed or anxious. It may help to remember that being positive

  • Doesn’t mean being cheerful and optimistic
  • It does mean recognising some of the fearful possibilities that can arise from having cancer
  • Being positive and thinking positively can include feeling upset and frightened. Such feelings can be a sign of strength and may reflect your courage in facing up to an uncertain future. But sometimes it can help to try to change negative thoughts into something more positive when they come into your head. This takes practice.
  • A good rule of thumb is to stick to what you know is true and don’t let your imagination run away with you. For example, if you keep thinking that your life will never be any good again because of your cancer, consider that this is not true. Most people with cancer do go through some negative feelings during their treatment, but in time things do usually get better.

This doesn’t mean that you always have to stop yourself feeling down. It is important to allow yourself to experience your feelings. So if you need to cry, it is fine to do that. Or if you feel very angry, find a safe way to express this. For example, throwing cushions around a room, listening to very loud music, or doing some exercise. These may sound very unoriginal suggestions but they do sometimes help.

If you feel very frightened, panicky or anxious, you may have problems with

  • Sleeping
  • Lack of appetite
  • Going out and seeing others socially
  • Being short tempered
  • Concentration

If your anxiety becomes a long term problem, you may constantly feel that something bad is about to happen. You may also

  • Keep asking people close to you about your illness and what they think you should do
  • Feel very negative
  • Feel very upset
  • Feel unable to cope with changes to your routine

Fear and anxiety can also have physical effects on you. This is a bit like feeling very nervous about an exam, job interview or giving a speech. You may have

  • A thumping heart (palpitations)
  • Shortness of breath, or an urge to over breathe (hyperventilating)
  • Sweating
  • Shaking hands or overall body shakes
  • A dry mouth
  • A fluttering feeling in your stomach (like butterflies)
  • Tiredness
  • Dizziness, or light or heavy headedness
  • Diarrhea
  • An urgent need to pass urine
  • Sickness
  • A sensation of having a lump in your throat
  • Difficulty swallowing
  • A dry cough
  • Tense and aching muscles especially in the neck and shoulder area
  • Chest pain
  • Pins and needles
  • Ringing in your ears
  • Abdominal pain
  • Going red in the face or looking very pale

Being constantly anxious can also affect your relationships and sex life. You may lose interest in sex and have very low self-esteem.

What causes these symptoms?

All these symptoms are very real and you may worry that your cancer is causing them. That is possible with some of the symptoms. But stress and anxiety are also likely causes.

When your body is faced with something stressful or frightening, it releases adrenalin (also called epinephrine), which prepares your body to either run, or fight the stress. This is known as the fight or flight response.

The adrenalin speeds up your body functions. Your heart beats faster; your breathing becomes rapid, your muscles contract and your gut movements shut down.

The natural response that is supposed to protect you can become the problem. The more you worry, the more likely it is that your fight and flight response starts up and so your symptoms increase. It can become a vicious circle and you may end up feeling as though you have no control over your situation.

Panic attacks

Sometimes fear or anxiety gets so overwhelming that you may have a panic attack. These can come on very suddenly and for no obvious reason. People describe them as among the most terrifying experiences they have ever had.

You may have the physical symptoms of anxiety described above but they may be far more intense. Some people even feel as if they are going to die or are going mad. Talk to your specialist Nurse or GP about this if it happens to you.

Feeling Sad

If you have feelings of sadness that won’t go away for longer than two weeks and you’re finding it hard to feel good about anything, then you may be depressed. It is important to recognise this difference between normal levels of sadness and clinical depression. But it’s hard to do this when you are in the middle of it. Other people close to you may recognise signs of depression before you do. If someone close to you is worried that you may be depressed, it is sensible to listen and get a professional opinion.

Being depressed is much more intense than feeling down or sad, as we all do from time to time. Feeling sad now and then is part of life but depression is a much stronger feeling than sadness.

Depression is harder to bear, and can affect your ability to cope with everyday things such as eating, sleeping, hygiene, social activities and work.

It’s important to remember that being depressed does not mean that you are weak. Depression needs treatment. It is a medical illness, like having a broken leg or a heart condition. Depression that needs treatment is called clinical depression. It is not a condition that you can just shake off.

If you are depressed, it’s impossible to simply get over it. This is very often difficult for people around you to understand. Unless someone has been depressed themselves, it is almost impossible for them to understand how it feels.

Depression in people with cancer

Depression is said to be the least noticed symptom in people with cancer. Yet it can be one of the hardest for you and your family to cope with. We are now better at recognising and treating depression in people with cancer. But there is still a lot more significant research to be done.

Anything up to 58 out of every 100 people with cancer (58%) will get depressed. This may happen soon after you are diagnosed. But it is also quite normal to become depressed after finishing your treatment. As one person told us

“It wasn’t until a long time afterwards that I realised the stress of my cancer had made me depressed and very tearful.”

At the time, you put so much effort into getting over the diagnosis and getting through the treatment that you don’t always have time to think it all through. It isn’t until everything is over that it hits you. This can be difficult for other people to understand. Just when they think you should be getting back to normal, you may feel more down than ever.

It’s completely understandable to have very strong feelings of sadness for some time after your diagnosis or during your treatment. But this is not the same as being depressed.

The important thing to know is that depression can be treated. Without treatment the symptoms of depression may go on for a very long time, sometimes months or years.

But with the right treatment for depression, 8 out of 10 people (80%) will feel better within a few weeks. So if you suspect you could be depressed, it’s best to speak to your Specialist Nurse or doctor so that you can have treatment quickly.

Are my symptoms depression?

Some of the classic symptoms of depression, such as weight loss and tiredness, can be caused by your cancer or by cancer treatment. They are not always reliable signs of depression in people with cancer.

If you are unsure what is causing your symptoms it is best to discuss it with your doctor or specialist nurse. They will be able to advise you whether your cancer is causing the symptoms or not.

Symptoms of depression can include

  • Feeling sad, anxious or ‘empty’ all of the time
  • Loss of appetite
  • Weight loss or gain
  • Loss of interest or enjoyment in doing day to day things
  • Loss of interest in seeing friends and family
  • Difficulty getting to sleep
  • Waking up in the early hours of the morning
  • Not being able to get out of bed in the morning
  • Feeling tired and lacking in energy
  • Feelings of guilt, hopelessness and worthlessness
  • Difficulty concentrating, making decisions or remembering things
  • Loss of interest in your appearance
  • Feeling restless and irritable
  • Wishing that death would come quickly or that life could be over now
  • Having thoughts of killing yourself (suicide)
  • Attempting suicide

You may be clinically depressed if

  • You have 5 or more of these symptoms every day for longer than 2 weeks
  • And the symptoms are causing problems in your day to day life

Clinical depression is treatable so do talk to your doctors and nurses.

Suicidal thoughts

The information in this section is not meant to scare you or make you think that everyone with cancer will have suicidal thoughts. They won’t. But it is important that we mention it for those few people who do.

Some people are more likely to think about taking their own life than others. This includes

  • People with very advanced cancer
  • People who are in a lot of pain
  • People whose cancer has made them lose their independence

If your cancer and treatment becomes too much to cope with, you may have thoughts about wanting to die. But you may not actually plan how you would actually take your own life. You may wish that death would come quickly and your life would be over now. Doctors call this having passive suicide thoughts. Although this is very distressing and you need to still seek medical help, it is different to actually planning to kill yourself (suicide).

If you feel that life is not worth living anymore or you can see no way out of your situation you may think about killing yourself. If you feel like this or try to harm yourself in any way then you must try to get medical help immediately. Your outlook on life is likely to be distorted when you are depressed. So you may not be seeing the true picture. Situations can look far more hopeless than they really are. If you get the treatment that you need, things may not look so awful. You may find that you have more resources to cope with your situation.

Once your symptoms are under control, you may feel a lot better and your suicidal thoughts may disappear. The most important thing is to seek professional help and talk to people who will know the best way to help you.

 

Effects on your sexuality and sex life

Not everyone who has cancer will have changes in sexual desire or how they feel about themselves sexually. You may not notice any changes at all. But you may find that the changes cancer causes to your body image affect the way you feel about yourself and having sex. Some people lose interest in sex and feel very tired. But some people say that they want to make love more than usual. If you are in a relationship, a crisis can sometimes bring couples very close together.

Because we’re all so different and have different sexual needs, it’s impossible to say exactly how cancer will affect each person’s sexuality and sex life. Some types of cancer and their treatment affect your ability or desire to have sex more than others. If you are already in a loving relationship your concerns may be different than for someone who is single.

If your feelings about your body and having sex change during your cancer treatment, it doesn’t mean that it will last forever. If you are able to talk to your partner, doctor or specialist nurses about your worries it can ease them.

Having cancer or its treatment can cause

  • Sickness or feeling sick
  • Tiredness (fatigue)
  • Irritability
  • Sadness or depression
  • Anxiety or tension
  • Pain
  • Bowel problems such as diarrhoea
  • Bladder problems
  • Mouth problems
  • Breathing problems
  • Skin changes or scarring
  • Changes in your sex hormones

If you have any of these side effects or feelings, you may not feel like having sex. Some people say that they feel less attractive because of them. You may not have the energy to take as much interest in your clothes, hair or make up as you did before. If you’re the partner of someone in this situation, you may be very worried about your loved one seeming so low. This is understandable. But most people come out of this phase once their treatment is over, or their symptoms are better controlled.

But simply touching can help you feel cared for and reduce any anxiety and depression you may have. So if you have a partner, you can focus on showing your feelings for one another in other ways by

  • Enjoying being close to each other
  • Touching and stroking
  • Kissing
  • Massaging
  • Talking
  • Holding hands

How practical issues can affect your sex life

Practical issues can include worries about your job or money. It can also mean any problems you may have getting everyday jobs done, such as picking children up from school or doing the shopping. If these things are not flowing well, life can be very stressful.

If your illness means that you have to stop work, you still need a regular income to pay all the usual bills and any extra ones relating to your illness. If you have to deal with the stress of not having enough money, it can cause a lot of conflict within relationships and intimacy can suffer.

Cancer symptoms and treatment side effects can sometimes make it very difficult to keep up your normal daily routine, especially if you have children. At times you may have to organise other people to look after them.

If practical issues are worrying you, it can stop you having the energy or desire to be intimate with a partner. It may all just feel too overwhelming to try and relax and enjoy sexual activity. But it’s very important to try and talk to your partner about your concerns and find ways to sort through any problems you may have.

Try to find a quiet time together where you can talk openly and honestly about your worries. Listen to each other and then try to find solutions to your problems. Even though it may be difficult to stay calm and talk about problems in a rational manner, you may be surprised at how much it helps. And

Cancer doesn’t just change you physically. It can cause many different emotions such as fear, depression and anger. These intense feelings may also affect how you feel about sex and about yourself. You might find that you look at the world differently after having cancer. Some people really do find that they can use cancer as a new beginning. However your outlook on life changes, you and the people close to you will need time to get used to it.

If you have had a period of time without sex and now feel ready to rekindle your sex life, you might wonder how to get started? Set the mood- what sparked romance for you and your partner before cancer? Music, a romantic meal or an evening out? Relax and don’t pressure yourselves. Take your time, enjoy each other and most of all, communicate.

Remember that problems with sex are very common, even among people who are not currently ill, or coping with the impact of cancer. They just aren’t always talked about much.