Side effects of cancer treatment

Most side effects of cancer treatment get better within a few weeks or months after finishing treatment. For some people, these effects carry on longer (long-term) or may develop after treatment is finished (late effects). Not everyone who has cancer treatment will have late effects. The effects can be both physical and emotional.

People who have the same treatment won't always have the same side effects. Some people have very few or no side effects. However, we felt it was important to acknowledge the side effects some people get. If any of these side effects become a problem, talk to your doctor.

Some of the more common side effects are:

  • fatigue (extreme tiredness)
  • feeling down or depressed
  • pain
  • neuropathy (tingling or numbness)
  • changes in your sex life
  • memory and concentration changes
  • lymphoedema
  • hormone changes
  • bone and joint changes
  • bowel or bladder changes
  • loss of self-esteem and self-confidence
  • heart and lung changes
  • dental, hearing and vision changes
  • secondary primary cancer
  • skin, hair and nail changes.

"I had no idea that I would still be feeling tired five months after finishing treatment. I didn't know how to make it better and I was scared that's how it would be: that I wouldn't go back to normal: that I would never go back to having energy again." Georgina

Fatigue (extreme tiredness)

This is different from normal tiredness as it doesn't go away with rest or sleep. It may be due to the cancer itself or treatments and carry on for months after treatment finishes. Often, small changes can help you manage fatigue. Try setting small manageable goals. Don't expect too much of yourself. Asking for or accepting offers of help can be hard, but can make life easier. For example, family or friends may be able to help with meals, childcare or shopping. Research has shown that exercise can boost energy levels and make you feel less tired.

For more information, read the Cancer Society's information sheet "Managing Cancer Fatigue" on the Society's website.

Feeling down or depressed

Some people who have had cancer treatment struggle with how they are feeling. Others say they have a renewed outlook on life because of their cancer. For some people, feelings of sadness and anger after cancer treatment may continue and lead to depression. Depression can develop slowly or can hit you suddenly. One day you wake up and realise that you feel hopeless and helpless, and that you are engulfed in a 'cloud' of depression.

Depression is more than feeling down for a few days. It may mean you feel in a low mood most of the time, or your sadness lasts two weeks or more.

Symptoms of depression can include:

  • change in sleeping patterns
  • not enjoying your usual activities
  • loss of libido (sexual desire)
  • drinking alcohol and smoking more
  • crying a lot
  • feeling down most of the time
  • feeling impatient and irritable
  • poor concentration.

It is important to seek help and support. If you feel this way, tell your doctor about your feelings. They can arrange for you to see a counsellor, take some medication or both. For help you may like to phone LifeLine. LifeLine is the telephone counselling service operating 24/7, every day of the year. Calls to LifeLine from anywhere in New Zealand are free by calling 0800 543 354. LifeLine counsellors are fully trained volunteers and located in any of nine centres throughout the country.

You can also view the www.depression.org.nz website.

Pain

Some people experience pain after cancer treatment. Pain can prevent you from doing the things you want to do, which has a big impact on your life. Controlling the pain may allow you to return to many of the activities you enjoy.

Chemotherapy and surgery can injure nerves and cause pain and numbness in certain areas of your body. Your skin may be very sensitive in the area where you received radiation treatment. This can last for a few months. Scars from surgery can also hurt for a long time. Whatever the pain you have, there are usually many ways to manage it. If pain becomes a problem see your GP.

Neuropathy (tingling or numbness)

Neuropathy is tingling or numbness in a part of the body due to nerve damage, especially in the hands and feet. It can be caused by some types of surgery, chemotherapy drugs and radiation treatment. In some cases, it isn't noticed until years after treatment. Ask your doctor about your risk of developing neuropathy.

Many people recover fully from neuropathy although this may take a long time as the nerves slowly recover. For others, neuropathy may be an ongoing problem. Taking pain medications for nerve pain can help you manage your neuropathy. Often, physiotherapy and occupational therapy can help. Some people have found using acupuncture, massage or a TENS (Transcutaneous Electrical Nerve Stimulation) machine has helped. Talk to your doctor about whether these might be suitable for you.

Changes in your sex life

Cancer and its treatments may affect your ability or desire to have sex (also called your libido). You may not even be aware that you are not taking an interest in sex or being as intimate as you were before. If you have a partner, this can be confusing for them and they may worry that having sex might cause you pain. Some people don't feel any different sexually, but if you do, it can be difficult to deal with. Some of the changes are temporary, others can be longer lasting. It usually helps to talk to your partner about any issues. Let them know why it's difficult for you. Reassure them that you love them and want to be close. Most partners will be happy to do things at your pace.

"I didn't know when I was able to lift a vacuum cleaner or when it was safe to have sexual intercourse again. These things just weren't mentioned." Abbie

If you are having problems, talk to your GP or contact the cancer information nurses on the Cancer Information Helpline 0800 CANCER (226 237). There are sexual counsellors specialising in sexuality and intimacy whom you can be referred to. For more information, read the Cancer Society's booklet Sexuality and Cancer, which is available at your local Cancer Society or you can read it on our website.

New Zealand Sex Therapist

Memory and concentration changes

Problems with thinking, memory and concentration can happen after treatment to the brain, for example, by the removal of a brain tumour or radiation treatment to the brain. Some people notice these changes with chemotherapy. This is sometimes called 'chemo brain'. It usually improves with time after treatment finishes, but can make your daily life and your ability to work more difficult. Stress and anxiety can also make these changes worse.

Some tips to manage these changes are:

  • Plan your activities so you do things that require more concentration when you're more alert (for example, in the morning).
  • Use your mobile phone or daily planner to keep track of daily tasks.
  • Make notes of things you have to remember (for example, shopping lists).
  • Do tasks one at a time rather than multi-tasking.
  • Get plenty of sleep and exercise.

Lymphoedema                         

Lymphoedema is swelling of a part of the body where lymphatic drainage has been affected by treatment, such as surgery and radiation treatment.

Signs of lymphoedema include redness; swelling; skin warmth; a feeling of pain; heaviness or fullness; and tingling in the arm, leg or the part of the body affected by surgery or radiation. Symptoms are better managed if treated early. Talk to your cancer doctor or GP if you have any concerns.

Lymphoedema can take months or years to develop – some people who are at risk never develop it. For more information, read the Cancer Society's information sheet titled "understanding Lymphoedema" on the Society's website or get a copy from your local Cancer Society.

Hormone changes

Chemotherapy, radiation treatment, surgery and hormone treatment can cause:

  • damage to both the male and female reproductive system, which may cause hot flushes, sexual dysfunction, osteoporosis (thinning of the bones) and early menopause
  • infertility for both men and women (not able to conceive a child or maintain a pregnancy).

For more information, read the Cancer Society's booklet Sexuality and Cancer and our information sheet "Early Menopause and Cancer". You can receive a copy of this from your local Cancer Society or by phoning the Cancer Information Helpline 0800 Cancer (226 237). These resources can also be read and downloaded from the Society's website.

Bone and joint changes

Some cancer drugs, such as hormone treatments for breast or prostate cancer, can cause loss of bone density which may lead to osteoporosis. Osteoporosis is a condition that causes your bones to weaken and become fragile (break easily). To lower your risk, have a good diet with plenty of calcium and vitamin D. Limit the amount of alcohol you drink, don't smoke and do regular weight-bearing exercise (for example, walking).

Some cancer drugs can cause muscle and joint pain. Gaining a lot of weight can also put stress on your joints and muscles and cause pain. Regular exercise and control of your weight will help. Talk with your doctor about managing this.

Bowel or bladder changes

Chemotherapy, radiation treatment and surgery can cause problems with the bowel and bladder.

  • Surgery and/or radiation treatment to the pelvis can lead to tissue scarring, chronic (long-term) pain, bowel problems or bladder irritation (needing to go to the toilet often).
  • Some people who have had cancer treatment may have chronic diarrhoea because their body can't absorb food properly.

If these are problems for you, talk to your doctor and/or a dietitian. The Cancer Society has a booklet you may find useful titled Bowel Cancer and Bowel Function: Practical advice. You can view it on the Society's website, or receive a copy by phoning your local Cancer Society or the Cancer Information Helpline 0800 CANCER (226 237).

New Zealand Continence Association

Loss of self-esteem and self-confidence

Treatment can affect your appearance or how you feel about your body (for example, facial surgery, removal of a breast or having a stoma). These can cause a loss of self-esteem and self-confidence. For some people, having cancer makes them lose confidence in their body and can make them feel more vulnerable. Talking to those close to you or someone who has also been through a cancer experience or to a professional counsellor can help.

Heart and lung changes

Heart and lung problems in people who have had cancer treatment are most often caused by certain types of chemotherapy, radiation treatment to the chest, or both. Problems may include weakening of the heart muscle and scarring of lung tissue. People aged 65 or older, and anyone who had high doses of some chemotherapy drugs, have a higher risk of heart problems. Hormonal changes can also increase your risk of having heart problems and diabetes. Talk with your doctor about your risk.

Dental, hearing and vision changes

  • Chemotherapy and radiation treatment to the head and neck can affect tooth enamel, the gums and saliva production and increase the risk of long-term dental problems. For more information, read our booklet Got Water?/He Wai? and the "Coping with a Sore Mouth, dry Mouth or Mouth Infections" information sheet on the Society's website. You can also receive a copy by ringing the cancer information nurses on the Cancer Information Helpline 0800 CANCER (226 237).
  • Some types of chemotherapy drugs can cause hearing problems, such as tinnitus (ringing in the ear).
  • Steroid medications and radiation treatment near the eye may increase the risk of eye problems, such as cataracts (clouding of the lens of the eye).

Second primary cancer

Some people are at risk of developing a second cancer due to their treatment. Some chemotherapy drugs and radiation treatment may cause genetic damage to normal cells, which may lead to those cells becoming cancerous at a later date. The risk is thought to be small.

People can have more than one cancer during their life. Cancer is a very common disease, and not all second cancers are due to cancer treatment. Talk to your doctor about your risk of developing a second cancer.

Skin and nail changes

Some cancer drugs can cause changes to the nails such as changes in colour, lines and marks in the nails, loosening of the nail and change in the shape of the nail. All these reactions are temporary but can take months to grow out.

Tips to reduce these problems include:

  • keeping nails trimmed and clean
  • wearing gloves for cleaning and gardening to protect your hands and reduce the risk of infection
  • not wearing nail polish or false nails.

You may need antibiotics if you get an infection.

Skin problems can result from cancer treatments. Skin can be dry, scaly, rough, feel tight and itchy. Things that make skin problems worse include dehydration, extreme weather conditions and perfumed soaps.

Things that may help with skin reactions:

  • Avoid perfumed soaps and skin care products and lanolin-based creams.
  • Avoid anything you think you may be allergic to, such as detergents, plants or metals.
  • Dry your skin carefully by patting and not rubbing.
  • Use mild, un-perfumed skin products.
  • Drink plenty of fluids.
  • Shower instead of bathe.
  • Be careful about shaving.
  • Wear cotton close to your skin. Wash clothes in mild detergents.
  • Protect your skin in the sun and in very cold, windy weather.

Talk to you nurse or doctor for advice if you have any skin problems.

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