Management of Long-Term Side Effects

Radiation, chemotherapy, surgery and other cancer treatments produce a variety of side effects—problems created when treatment affects healthy organs or tissues. Many of these troubling discomforts disappear when therapy is over.

For some patients, however, certain side effects continue even after treatment has ended. These include a range of problems such as swelling, pain, fatigue, bladder or bowel control troubles, and more.

Long-term side effects aren’t predictable. If you have any, they may differ from those experienced by other people who had the same type of cancer and treatment. Many long-term side effects can be managed, with help from your doctor or other health care professional.

Keep a written log or record of any side effects you may be experiencing. You can use the Symptom Tracker for this. LinktoSymptomTracker, Detail when the problems occur, their intensity and duration, what you did to try to relieve them, and how successful you were in those efforts. Bring that listing with you to your next follow-up care appointment, to discuss with your oncologist, primary care provider or other medical professional. You should also consult the log if you call in to discuss your problem.

Here are ways to handle several common long-term side effects of cancer treatment:

Pain

• Use a diary to keep track of the specifics of your pain. Rate the pain on a scale of 0 (no pain) to 10 (worst). Record how it affected your daily activities, if you took pain medication, and whether the pain was relieved. Share this information with your doctor or pain specialist.
• You may think the pain you’re having is from aging or arthritis. Mention it anyway.
• Take pain medication as prescribed. Your doctor will usually start you on a low dose or mild medication first and then adjust it upwards if needed. Do not fear “becoming an addict” if you take the medication as prescribed and are regularly monitored. For continued pain control, you need to maintain the dose and frequency your doctor recommends.
• Some types of pain are helped by physical therapy (for exercise, massage or hot/cold treatments), the use of braces (to prevent movement) and acupuncture.
• You may want to try complementary pain therapies, such as meditation, yoga or relaxation exercises.

Swelling (Lymphedema)

• If lymph fluid doesn’t drain from the body correctly, it builds up and causes uncomfortable and even painful swelling. This may happen long after your cancer treatment has ended—even years later.
• When swelling occurs in an arm or leg, keep the limb elevated, try special massage techniques (as instructed by a health care professional), and wear bandages or clothing designed to foster fluid draining.
• Losing weight and eating a low-salt diet help treat lymphedema and reduce its occurrence.
• Call your doctor’s office if you see any swelling, reddened or warm area on your skin or feel pain.
• Protect your skin by keeping it clean and moisturized. When outdoors, use insect repellant and sunblock. Cuts, bites and sunburn can lead to swelling.

Fatigue

• Feeling excessively tired can be one of the most frustrating long-term side effects of cancer treatment. There are many possible sources for fatigue and a variety of medical professionals who can help.
• Medications may cause fatigue, but others may alleviate it. Talk with your doctor about all the medications you’re taking.
• Moderate exercise, such as walking, can help you feel less tired.
• Rest when you need to. Keep naps short. Maintain regular hours for bedtime and wake-up.
• The foods you eat and drink can help reduce fatigue. You may want to talk with a nutritionist for guidance.
• Use your energy for important or enjoyable activities.
• When possible, delegate chores to others. Ask friends to run errands for you. People often don’t realize that fatigue continues to be a problem after cancer treatment ends.

Bladder and bowel control problems

• These side effects can make returning to normal activities especially difficult. Talk with your doctor about any changes you are experiencing.
• Strengthening pelvic-floor muscles with Kegel exercises can combat  incontinence. Tighten your internal muscles as you would to stop urine flow; hold, then release. If you’re unsure whether you’re tightening the right muscles, your doctor or nurse can advise you.
• Certain medications can help with control problems. Others may cause constipation. Ask your doctor for help in adjusting medications.
• If you have a bowel or urinary ostomy, request support services that can ease your adapting to an ostomy.

Eating or weight difficulties

• Cancer treatment often causes weight loss, due to loss of appetite, nausea or difficulty swallowing. Those side effects may continue beyond treatment as well.
• To improve your appetite, choose favorite foods and eat smaller meals, more frequently.
• Use nutritional supplements (drinks, shakes) and soft foods such as bananas, soup or pudding when you’re having trouble eating or swallowing. And, yes, ice cream is also helpful!
• You can also gain weight from cancer treatment, particularly chemotherapy. Make sure your diet is healthy (lots of fruits, vegetables and fiber) and include physical activity, especially strength-training exercises, when possible. Consult with a cancer nutritionist for advice.

Sexual effects

• Physical and emotional changes caused by treatment and medications can take a toll on your sex life. Loss of interest in sex, erectile problems and vaginal dryness are common side effects. To find solutions, discuss the sexual difficulties you’re experiencing with your doctor.
• Medications, counseling, Kegel exercises, and using lubricants can help.
• Improve intimacy with your partner through close physical contact. Spend time cuddling and touching. Think sensual rather than sexual, to build feelings of comfort.
• Re-discover the pleasurable responses of your own body.
• Talk about your fears—if not with your partner (or if you don’t have one), then with a therapist or social worker.
• When you’re ready, you may want to try new positions or ways of touching that make having sex fun again.

References

“Dictionary: Side Effects.” National Cancer Institute. http://www.cancer.gov Accessed 5/10/06.