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Facing Forward: Life After Cancer Treatment by National Cancer Institute - HTML preview

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Changes in Weight and Eating Habits

Some survivors who have had certain kinds of chemotherapy or medicines have problems with weight gain. Sometimes 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. Try to be patient with yourself. Look for the positive things that you can control, such as eating a healthy diet. Try to focus on the fact that treatment is over, and you are trying to get stronger with time.

Some cancer survivors have the opposite problem: they have no desire to eat, and they lose weight. Some men say that weight loss or loss of muscle tone is a bigger concern for them than weight gain. It makes them feel less strong and like less of a man.

Managing a Healthy Weight

For weight issues, ask your doctor or nurse about:

■ Doing strength-building exercises, if you have lost muscle or gained fat tissue

■ Talking to a dietitian or nutritionist who can help you plan a healthy diet that won’t add extra pounds

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.

Focus on your favorite foods. If the thought of eating still lacks appeal, try the foods you really liked before treatment to jump-start your appetite. Try adding some fresh fruit, juice, or other flavoring to improve the taste.

Stay active. A short walk before a meal can help you feel hungry.


Trouble Swallowing

Some people who have had radiation therapy or chemotherapy may find it hard to eat because they have trouble swallowing. People who have had radiation therapy to the head, neck, breast, or chest or those who have had surgery involving the larynx may also have this problem.

Getting Help

■ 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.

Bladder or Bowel Control Problems

Bladder and bowel 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.

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 bladder or bowel 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

It is very important to tell your doctor about any changes in your bladder or bowel habits. Ask your doctor or nurse about:

■ Problems with constipation

■ Kegel exercises (see page 34 on muscle weakness)

■ Medicines that may help

■ Help in coping with ostomies. If you have an ostomy, an opening from inside the body to the outside to pass urine or waste material, there are services and support groups to help you cope with changes (see page 13).


Menopause Symptoms

After chemotherapy, some women stop getting their periods every month—

or stop getting them altogether. Some cancer treatments (and the medicines tamoxifen and raloxifene) can cause changes in women’s bodies and reduce the amount of hormones they make. 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. Even though your doctor may have discussed early menopause with you, give yourself permission to mourn the loss of your fertility.

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 affect sleep or cause mood changes.

Problems with your vagina or bladder. Tissues in these areas become drier and thinner. You may be more likely to get vaginal infections. As you get older, you may also have problems holding your urine or urinary tract problems.

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 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 of your skin.

Ask your doctor if you still need to use birth control—

even if you are not getting your period.



Getting Help

See a gynecologist every year. Ask about:

■ Medicines, 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, which can increase your risk of diseases that affect your heart and blood vessels.

Relieving Hot Flashes

Here are some tips that have helped others deal with hot flashes:

Quit smoking.

Drink plenty of water.

Through exercise and diet, try to maintain a healthy

weight. Exercise most days of the week, doing both weight-bearing and muscle-strengthening activities. Eat wisely. A balanced diet will provide most of the nutrients and calories your body needs to stay healthy.

If you are having hot flashes, try to write down when they happen and what may cause them. This may help you find out what to avoid. You may also want to:

• Sleep in a cool room to avoid being awakened by hot flashes.

• 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 or turning on a fan at the beginning of a hot flash.

• Try not to eat a lot of spicy foods.

• Limit the alcohol and caffeine you drink.


Body Changes and Intimacy

Some body changes are short-term, and others will last forever. Either way, your looks may be a big concern after treatment. For example, people with ostomies after colon or rectal surgery are sometimes afraid to go out. They may feel ashamed or afraid that others will reject them. They may worry about the idea of having an “accident” in social situations.

Others don’t like people being able to see treatment effects such as scars, skin changes, loss of limbs, and changes in weight. Even if your treatment doesn’t show, your body changes may trouble you. Feelings of anger and grief are natural. Feeling bad about your body can also lower your sex drive. This loss of or reduction in your sex life may make you feel even worse about yourself.

Changes in the way you look can also be hard for your loved ones, which can be hard on you. Parents and grandparents often worry about how they look to a child or grandchild. They fear that changes in their appearance may scare the child or get in the way of their staying close.

Getting Help

How do you cope with body changes?

■ Mourn your losses. They are real, and you have a right to grieve.

■ Try to focus on the ways that coping with cancer has made you stronger, wiser, and more realistic.

■ If you find that your skin has changed from radiation, ask your doctor about ways you can care for it.

■ Look for 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.

■ Try to recognize that you are more than your cancer. Know that you have worth—no matter how you look or what happens to you in life.


Body Changes and Intimacy

Changes in Sex Life

You may have changes in your sex life after cancer treatment—many people do. Depending on the cancer you had, these problems may be short-term or long-term. For example, 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 certain medicines. Sometimes emotional issues can be the cause of sexual problems.

Some examples include anxiety, depression, feelings of guilt about how you got cancer, changes in body image after surgery, and stress between you and your partner. Your past sex life is not related to your current sexual problems.

What types of problems occur? People report these main concerns:

Worrying about intimacy after treatment. Some may struggle with their body image after treatment. Even thinking about being seen without clothes may be stressful. People may worry that having sex will hurt or that they won’t be able to perform or will feel less attractive.

Pain, loss of interest, depression, or cancer medicines can also affect 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 can cause these problems; sometimes, there is no clear cause. Some women also have a loss of sensation in their genital area.

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 type of treatment, age, and length of time since treatment, you may still be able to have children. For more information about fertility, refer to the organization Fertile Hope at


Getting Help

“I knew about the chance of impotence. What

I didn’t expect was my total loss of interest in

sex, which really caused some problems

between my wife and me.” —MITCH

Your doctor may be able to help you deal with these problems, but he or she may not bring up the subject. You may have to mention it yourself. If you think you might have trouble getting started, bring this booklet with you.

Often, sexual problems will not get better on their own. To get help with many of these problems, it’s important to tell your doctor about any changes in your sex life. Sometimes there can be an underlying medical problem that causes changes, such as:

Erection problems. Medicine, assistive devices, counseling, surgery, or other approaches may help.

Vaginal dryness. Dryness or tightness in the vagina 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.

Muscle weakness. You can help strengthen muscles in your genital area by doing Kegel 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.

Other issues you may want to discuss include:

Concerns about having children. Discuss family planning concerns with your doctor. If you’re a woman, ask if you still need to use birth control, even if you are not getting your period.

Talking with a counselor or a psychologist. You may feel that some of your sexual problems are due to your emotions, like stress or body image. Some people find that sexual problems related to cancer start to strain their relationship with their partner. If this is the case, ask a nurse or social worker if you can talk to a counselor. Talking to someone alone, or with your partner, may help.

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.



Talking With Your Partner

Even for a couple that has been together a long time, staying connected can be a major challenge at first. It may be comforting to learn that very few committed relationships end because of ostomies, scars, or other body changes. Divorce rates are about the same for people with and without a cancer history.

Tell your partner how you feel about your sex life and what you would like to change. You might want to talk about your concerns, your beliefs about why your sex life is the way it is, your feelings, and what would make you feel better.

Approaching it openly avoids blame, stays positive, and gives your partner a better sense of how you are feeling. Here is an example of how you might start your discussion:

“I know it’s tough to talk about, but I think we should discuss our sex life.

We’ve only made love a few times lately. I miss being close to you. I worry that my scars might be a problem. Can you tell me how you feel?”

Try to be open minded as you listen to your partner’s point of view:

■ Focus on your partner’s comments, not on what you plan to say in response.

■ Repeat what he or she says in your own words.

■ Ask questions to better understand your partner’s concerns.

■ Acknowledge that your partner’s views matter to you. Say things like “I see why you might think that” or “I never thought of it that way before.”

Feeling Intimate After Treatment

Be proud of your body. It got you through treatment!

Think of things that help you feel more attractive and confident.

Focus on the positive. Try to be aware of your thoughts, since they can affect your sex life.

Touch each other. Kiss, hug, and cuddle, even if you cannot have the kind of sex that you used to have.

Be open to change. You may find new ways to enjoy intimacy.



If you’re single, body changes and concerns about sex can affect how you feel about dating. As you struggle to accept the changes yourself, you may also worry about how someone else will react to physical things, such as scars or ostomies. Or you may find it awkward to bring up sexual problems or loss of fertility, which can make feeling close even harder.

You may wonder how and when to tell a new person in your life about your cancer and body changes. For some, the fear of being rejected keeps them from seeking the social life they would like to have. Others who choose not to date may face pressure from friends or family to be more sociable. Here are some ideas that can make it easier to get back into social situations:

■ Focus on activities that you have time to enjoy, such as taking a class or joining a club.

■ Try not to let cancer be an excuse for not dating or trying to meet people.

■ Wait until you feel a sense of trust and friendship before telling a new date about your cancer. Practice what you will say to someone if you are worried about how you will handle it. Think about how he or she might react, and be ready with a response.

■ Think about dating as a learning process with the goal of having a social life you enjoy. Not every date has to be perfect. If some people reject you (which can happen with or without cancer), you have not failed. Try to remember that not all dates worked out before you had cancer.


Your Feelings

Your Feelings

“I don’t think you ever forget the fact that

it could come back.” —EMILY

Just as cancer treatment affects your physical health, it can affect the way you feel, think, and do the things you like to do. It’s normal to have many different feelings after treatment ends. 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 the feelings, emotions, and fears that you have are unique. 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 seek help from counselors and others outside the family, while others don’t feel comfortable with this approach.

Whatever you decide, it’s important to do what’s right for you and try not to compare yourself with others.

Worrying About Your Health

Worrying about the cancer coming back is normal, especially during the first year after treatment. This is one of the most common fears people have after cancer treatment. 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.” Others may react in a more positive 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 they think about their cancer less often. However, even years after treatment, some events may cause you to become worried. Follow-up visits, symptoms similar to the ones you had before, the illness of a family member, or the anniversary of the date you were diagnosed can trigger concern.



Coping With Fear of Cancer Returning

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 your feelings of fear, anger, or sadness. People have found that when they express strong feelings like anger or sadness, they’re more able to let go of them. Some sort out their feelings by talking to friends or family, other cancer survivors, or a counselor. But even if you prefer not to discuss your cancer with others, you can still sort out your feelings by thinking about them or writing them down.

Look for the positive. Sometimes this means looking for the good even in a bad time or trying to be hopeful instead of thinking the worst. Try to 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.

Remember, cancer can happen to anyone.

You don’t have 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 and go upstairs and crawl into bed.”

Find ways to help yourself relax. The exercises on pages 60–61

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 can help you focus on other things besides cancer and the worries it brings.

Look at what you can control. Some people say that putting their lives in order helps. 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 a sense of control. And while no one can control every thought, some say that they try not to dwell on the fearful ones.


Feeling Stress

When you were diagnosed, you may have put concerns such as family, work, or finances aside. Now that treatment is over, these issues may begin to resurface.

Many cancer survivors also worry that stress may have played a role in their illness. It’s important to remember that the exact cause of many cancers is still unknown. No research shows that stress causes cancer, but we do know that stress can cause other health problems. Finding ways to reduce or control the stress in your life may help you feel better. Devoting time to any activities that make you feel calm or relaxed may help.

Reducing Stress

Many survivors have found activities like the ones below useful in dealing with 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 30 or 45 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 can’t walk, ask about other types of movement that may be helpful, such as chair exercises or stretching.

Mind-body methods. Things like meditation or relaxation may help you lower stress by quieting your mind. Try focusing on your breathing or repeating words or phrases to yourself. Other methods include hypnosis, yoga, or imagery.

Creative outlets. Art, music, or dance gives people the chance to express themselves in different ways. Even people who have never danced, painted, or drawn before have found these activities helpful and fun.

Sharing personal stories. Telling and hearing stories about living with cancer can help people air their concerns, solve problems, and find meaning in what they’ve been through. See pages 44–45 for support group information.


Finding Humor and Laughing

“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

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:

Ask people to send you funny cards.