Survivorship Center: Physical Effects

While most cancer survivors lead healthy, active lives, cancer treatment can have a longstanding impact on the body. This section describes some of the problems caused by treatment, identifies who is at risk, and provides information on how these challenges can be managed.

Chronic Pain

Chronic pain can be mild or very severe and can dramatically affect your quality of life after cancer. It can result from chemotherapy, radiation, surgery, or a combination of any of the three. Fortunately, there are many ways to greatly reduce or even eliminate pain.

Medication is almost always needed when pain is moderate or severe. Other methods and techniques can also bring comfort. Heating pads, hot or cold packs, or massage can soothe the body; breathing exercises, relaxation, visualization and guided imagery can reduce stress and promote wellness. Seeing a pain specialist is important if pain is interfering with your regular activities. Keeping a pain diary can help to define your pain better so that it can be better managed.

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Fatigue

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Psychiatrist William Breitbart describes medical and non-medical approaches to combating cancer-related fatigue.

(19:00)

Cancer-related fatigue is a persistent feeling of tiredness or exhaustion related to cancer or cancer treatment and interferes with the ability to function normally. How and when it occurs, as well as its severity, depends on the type of cancer and treatment as well as the intensity of the treatment. Fatigue occurs most frequently among patients receiving chemotherapy with or without radiation therapy. Cancer-realted fatigue is not the result of recent activity.

Here are a few strategies for managing fatigue:

  • Establish a sleep pattern.
  • Avoid caffeine, alcohol, and tobacco after 6:00 PM. They may keep you awake.
  • Develop a routine for going to sleep.
  • Reduce naps during the day if they are interfering with your ability to get a restful sleep at night.
  • If you are unable to sleep at night, take short naps and rest during the day.
  • Plan and prioritize your activities.
  • Try to avoid the activities that make you most fatigued.
  • Follow a healthy diet. Eat small, well-balanced, high-protein meals and snacks. Smaller meals require less energy to digest than larger meals. They provide you with an even supply of energy throughout the day.
  • Begin a tolerable daily exercise regimen to reduce fatigue and improve sleep.

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Memory and Concentration Changes

Videos

Learn how cancer treatments can impact the body and mind.

Cognitive changes are problems with thinking, memory, and behavior and can develop as a result of chemotherapy or radiation therapy.

The following is a list of strategies that you may wish to try help you manage changes in mental alertness:

  • Keep a log or checklist containing daily reminders.
  • Take on one task at a time, and avoid distractions.
  • Put things back in the same place after you use them, so they will be easier to find. For example, try putting your keys in the same spot every night when you get home.
  • Create a more structured environment that is free of clutter.
  • Use wordplay, such as rhyming, to remember certain things more easily.
  • Get plenty of rest.
  • Prepare for tomorrow today. The night before, take out the things you will need for the next day.

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Neuropathy

Neuropathy is caused by interference in nerve pathways in the body. It can result from chemotherapy, radiation, surgery, or a combination of any of the three.

Most people with neuropathies complain of tingling or numbness in certain areas of the body, especially the hands and feet. There is usually some degree of discomfort or pain, which varies from patient to patient. There are medications that can be helpful in reducing the discomfort of neuropathy. Other treatments such as acupuncture may also be helpful. Preventing injury to areas of numbness or from falling because of unsteadiness is very important.

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Osteoporosis

Osteoporosis is a condition in which the bones are weakened and fragile. Cancer treatments can cause bone loss and lead to osteoporosis. Certain medications such as high doses of steroids lead to bone loss. Treatments that decrease or block hormones can also cause it. Both men and women on hormonal therapies may be at higher risk. Postmenopausal women are also at risk because of the loss of the protective hormone, estrogen.

If you have osteoporosis, your doctor may recommend that you take specific medicines, perform regular exercise, or both. These steps can help improve bone health and decrease your risk of fractures. Treatments that prevent bone loss or stimulate bone formation can be used to prevent fractures. Implementing safety measures to reduce falls is also important.

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Second Cancers

The risk of developing new cancers, also known as second cancers, is among the major medical concerns for cancer survivors. Second cancers are biologically different from an original cancer. This is different from a cancer recurrence which refers to a reappearance of cancer cells from the original cancer. Studies from the National Cancer Institute have revealed that cancer survivors have a higher risk of developing a new cancer than would have been expected in the general population.

The chance of developing a second cancer can be influenced by many factors, including the following: the first cancer type, treatments received and age at which they were given, environmental exposures, family history, and lifestyle choices such as smoking and alcohol consumption.

Maintaining a healthy lifestyle, having regular checkups with your health care providers, and utilizing genetic testing if you have a strong family history of cancer are steps you can take to manage the risk of second cancers. Additionally, screening for certain types of second cancers can offer the possibility of early detection and improved chances of cure.

It is recommended that you discuss with your physician your individual risk of developing a second cancer and what can be done to manage this risk.

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Skin, Hair, and Nail Changes

Pictured: Mario E. Lacouture, MD
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Memorial Sloan Kettering dermatologist Mario Lacouture discusses common skin, hair, and nail conditions affecting cancer survivors.

(67:00)

Chemotherapy, radiation therapy, and cell or bone marrow transplants affect rapidly growing cells, including skin, hair, and nails.

The skin is the largest organ in our body, and it is constantly renewing itself to provide the best barrier against infections while retaining vital fluids. This constant renewal makes it extremely vulnerable to chemotherapy, which can lead to rashes, itching, dry skin, and skin infections.

Hair loss is also common during chemotherapy, and sometimes can persist well after therapy has been completed. If hair does not regrow, other causes, such as thyroid gland function and iron stores in the blood, should be investigated. Certain topical formulations such as minoxidil (for the scalp) and bimatoprost (for the eyelashes) can be used to speed up regrowth.

Nails, which are formed from skin, can also be affected by chemotherapies, especially those that are taxane based. Use of cooling gloves and slippers during infusions can prevent nail loss during treatment, and vitamins such as biotin can be used to strengthen nails after treatment.

Radiation can cause skin burns, which can become painful and infected and require treatment with antibiotics or antiinflammatory creams. In addition, studies have shown that skin cancer is more frequent in cancer survivors who have been treated with radiation. To minimize your risk of developing skin cancer, limit your exposure to ultraviolet radiation from the sun by wearing protective clothing and using a sunscreen with SPF 30, even on cloudy days. Also avoid tanning beds.

Taken as a whole, skin conditions in survivors can often be alleviated through careful evaluation and treatment.

Sleep Disturbances

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Sleep specialist Amy Lowery of Memorial Sloan Kettering discusses the importance of sleep and how to prevent and treat sleep problems.

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Cancer treatments, such as chemotherapy and steroids, can cause sleep disturbances, which may last long after treatments have ended. Insomnia is troubling falling asleep or staying asleep at least three nights a week for a month or more, and causes daytime tiredness. Stress, pain, and other physical and emotional symptoms can cause insomnia, too. Although insomnia and other sleep disorders are best diagnosed and treated by a sleep specialist, there are things you can do to improve your sleep:

  • Exercise regularly, but not within three hours of bedtime
  • Make sure your room is comfortable, cool, and free from light and noise
  • Eat regular meals, but do not go to bed too hungry or full
  • Avoid excessive liquids in the evening
  • Cut down on caffeine, especially after 3:00 PM
  • Avoid alcohol, especially in the evening
  • Turn the clock so you can't see the time
  • Avoid naps
  • Only go to bed when you feel sleepy
  • Do not use your bed for activities other than sleep and sex

Other techniques such as deep breathing, muscle relaxation, meditation, and guided imagery can help you to relax before bed. Smoking may also disturb sleep. If sleep problems persist, you may need to be seen by a sleep specialist or spend a night in a sleep laboratory to determine whether another disorder, such as sleep apnea, is causing your sleep problem.

Urinary Incontinence

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Urologic surgeon Jaspreet Sandhu describes advances in the management of incontinence after pelvic surgery.

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Urinary incontinence is the uncontrollable loss of urine from the bladder which can develop as a result of nerve damage after surgery or radiation treatments to that area of the body. The frequency and amount of incontinence varies and depends on the extent of treatment.

The following are steps you can take to improve urinary continence:

  • Perform pelvic exercises, as directed, to strengthen urinary muscles. Contact your doctor's office if you are not sure how to do these exercises.
  • Empty your bladder on a schedule. Modify your diet to limit or eliminate foods and fluids that irritate your bladder, such as caffeinated beverages.
  • Wear an incontinence pad to absorb unexpected leakage.

Additional Resources

Vaginal Changes

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Psychologist Jeanne Carter describes common changes in sexual and vaginal health that can occur after cancer treatment.

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Cancer treatment can cause changes in the shape and moisture of a woman's vagina. These changes can make vaginal exams and sexual intercourse difficult or uncomfortable. Women who have had radiation therapy to the pelvis and/or surgery involving gynecologic structures may experience these changes. There are a few simple strategies that can help you manage vaginal changes. Using a vaginal dilator in combination with Kegel exercises will help maintain elasticity. Furthermore, vaginal moisturizers and lubricants can alleviate vaginal dryness. The resources below will explain these in more detail.

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For Patients Who Have Had Surgery

For Patients Who Have Had Radiation Therapy