Side Effects of Cancer Treatment

Side Effects of Cancer Treatment


While most cancer survivors lead healthy, active lives, cancer and the approaches used to treat it can sometimes have long-lasting effects on the body, from chronic pain to changes in memory and sleep patterns.

MSK offers many types of services to support cancer survivors.

Chronic Pain

Pain that persists after chemotherapy, radiation, or surgery can dramatically affect your quality of life. Fortunately, there are many ways to reduce or even eliminate chronic pain.

If your pain is moderate to severe, you likely need medication. Also try the following to make you more comfortable:

  • heating pads
  • hot or cold packs
  • massage
  • breathing exercises
  • relaxation exercises
  • visualization and guided imagery

Try keeping a pain diary in which you record your level of pain at different times of day and with various activities over time. This can help you define and better manage your pain as well as make it easier to discuss with your doctor. If the discomfort is so great that it’s interfering with your regular activities, contact a pain specialist.

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Cancer-related fatigue is a persistent feeling of tiredness or exhaustion related to cancer or its treatment that interferes with your ability to function normally. It’s not the kind of fatigue that you might feel after a lot of activity, for example.

How and when it occurs, as well as how severe it is, depends on the type of cancer you had and the treatment (and intensity of treatment) you received. This problem is most common among people receiving chemotherapy (with or without radiation therapy).

These strategies can help you manage cancer-related fatigue:

  • Establish a routine for going to sleep at the same time each night.
  • Avoid caffeine, alcohol, and tobacco after 6:00 p.m. They may keep you awake.
  • Minimize napping during the day, or alternatively take short naps and rest during the day if you can’t sleep through the night.
  • Plan and prioritize your activities to stay energized, and try to avoid the activities that fatigue you most.
  • Eat nutritious foods, with small, well-balanced, and high-protein meals and snacks. Keep in mind that smaller meals require less energy to digest than larger meals and provide you with an even supply of energy throughout the day.
  • Begin an exercise regimen you can tolerate (and will therefore do regularly) to perk you up and improve your sleep.

Additional Resources

  • Handling Fatigue during and after Cancer Treatment (in English, Russian)
Changes in Memory or Concentration

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

Try these strategies to help you manage changes in thinking and memory:

  • Keep a log or checklist of daily reminders.
  • Take on one task at a time and avoid distractions.
  • Return keys and other important items back to the same place after you use them, so they’ll be easier to find.
  • Create a structured environment for yourself, as free of clutter as possible.
  • Use wordplay, such as rhyming, to remember certain things more easily.
  • Get plenty of rest.
  • Prepare for tomorrow today. Every night, gather together the things you’ll need the next day, from outfits to important work papers to gym clothes.

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Most people with neuropathy complain of tingling or numbness in certain areas of the body, especially the hands and feet. It’s caused by interference in nerve pathways in the body and can result from chemotherapy, radiation, surgery, or a combination of these treatments. The discomfort or pain varies from person to person.

Certain medicines can help with neuropathy, as may some complementary treatments such as acupuncture. It’s also important to try to prevent injury to the areas that are numb and to avoid falls due to unsteadiness.

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Various treatments for cancer can cause your bones to become thinner, weaker, more fragile, and more brittle.  These include high doses of corticosteroids (treatments that decrease or block hormones) and hormonal therapies. Postmenopausal women are at increased risk due to the loss of protective estrogen.

If you have osteoporosis, your doctor may recommend that you take specific medicines and perform regular weight-bearing exercise to strengthen your bones and lessen your risk of fractures. Treatments that prevent bone loss or stimulate bone formation can help. Implementing safety measures to reduce falls is also important.

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Second Cancers

The risk of developing new or “second” cancers is a major concern among cancer survivors. Second cancers are different from a cancer recurrence, which refers to a reappearance of cancer cells from the original cancer. Second cancers are also biologically different from original cancers.

Cancer survivors are at increased risk for developing a second cancer, but this is influenced by many factors, including:

  • the type of cancer you originally had and how it was treated, as well as your age when you underwent treatment
  • environmental exposures
  • family history of cancer
  • lifestyle choices such as tobacco use and alcohol consumption

Steps you can take to help manage your risk for a second cancer include:

  • maintaining a healthy lifestyle
  • having regular checkups with your healthcare providers
  • getting genetic testing if you have a strong family history of cancer

Regular screening for certain types of second cancers also makes it more likely that your doctors will be able to find any cancers early on, when cure is more likely.

Talk to your doctor about your risk for a second cancer and what you can do to manage it.

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Skin, Hair, and Nail Changes

Skin, nail, and hair problems such as hair loss can often be minimized or alleviated through careful evaluation and treatment. In many cases, these difficulties result from treatments that affect rapidly growing cells, such as chemotherapy, radiation therapy, and cell or bone marrow transplantation.

The skin is the body’s largest organ, and constantly renews itself to provide a barrier against infections while retaining vital fluids. This constant renewal makes it extremely vulnerable to chemotherapy, causing rashes, itchiness, dryness, and infections.

Hair loss from chemotherapy can sometimes persist well after therapy has been completed. If it doesn’t grow back, doctors can look into possible causes such as thyroid gland dysfunction and altered stores of iron in the blood. Certain topical formulations such as minoxidil (for the scalp) and bimatoprost (for the eyelashes) can be used to accelerate growth.

Your nails are formed from skin and can be affected by chemotherapies, especially those that are taxane-based. Use cooling gloves and slippers during infusions to help prevent nail loss during treatment, and try using vitamins such as biotin to strengthen nails after treatment.

Radiation can cause skin burns, which can become painful and infected and require treatment with antibiotics or anti-inflammatory creams. Some studies indicate that skin cancer is more common in cancer survivors who were treated with radiation, so practice sun safety and limit your exposure to ultraviolet radiation from the sun by wearing protective clothing, using a sunscreen with SPF 30, even on cloudy days, and avoiding tanning beds.

Sleep Disturbances

Treatments for cancer such as chemotherapy and steroids can cause disturbances in your sleep patterns that last long after treatments have ended. Insomnia — defined as trouble falling asleep or staying asleep at least three nights a week for a month or more — can lead to significant daytime tiredness. Stress, pain, and other physical and emotional symptoms can contribute to insomnia as well.  

A sleep specialist is best equipped to diagnose and treat insomnia and other sleep disorders. But there are also basic measures you can take to promote rest.

  • 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 avoid going to bed extra hungry or full.
  • Avoid consuming a lot of liquids in the evening, which may prompt you to wake up to use the toilet.
  • Reduce caffeine intake overall, but especially after 3:00 p.m.
  • Avoid consuming alcohol, especially in the evening.
  • Turn the clock away from sight so you can’t see the time from your bedside.
  • Avoid napping.
  • Go to bed only when you feel sleepy.
  • Consider eliminating tobacco products, as they may affect your sleep patterns.
  • Don’t use the bed for activities such as television or snacking. Try to use it only for sleep and sexual intercourse.

Other sleep hygiene techniques such as deep breathing, muscle relaxation, meditation, and guided imagery can help you relax before bed.

If sleep problems persist, consider seeing a sleep specialist or spending a night in a sleep laboratory to determine whether another disorder, such as sleep apnea, is causing your sleep disturbances.

Urinary Incontinence

The uncontrollable loss of urine from the bladder — urinary incontinence — 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 you received.

If urinary incontinence is an issue for you, try some of these strategies.

  • Perform pelvic exercises to strengthen your urinary muscles. (Ask your doctor if you’re 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.

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Vaginal Changes

Treatment for cancer can cause changes in the shape and moisture of a woman’s vagina, leading to pain or difficulty with vaginal exams and sexual intercourse.

Women who’ve had radiation therapy to the pelvis or gynecologic surgery may experience these changes. A few simple strategies may make a big difference in improving your vaginal health and managing vaginal changes.

The resources below will explain these in more detail.

Additional Resources