How to adjust after cancer treatment

A cancer survivor is somebody that lives with or beyond their cancer. Advances in our understanding of how cancer develops and how to treat it have seen the amount of people surviving cancer increase.

While there is plenty of information and support available to you during your treatment, what happens afterwards? Below is some information that will help answer some of your questions and show that you can live a healthy, happy life after your cancer treatment.
After your treatment

Once your treatment is over, you may feel a range of emotions. Everyone’s experience is different – you may feel happy, relieved, fearful and anxious all at the same time. Getting back to normal for you may take some time, and you might find that your values and priorities have changed. You may change your diet, the things you do or the people you see, or things may go back to exactly how they were before your treatment. There’s no right or wrong way.

The most important thing is to give yourself plenty of time to adjust to the changes and find out what works for you by looking at all the support that is available.

Follow-up appointments

You won’t see your doctors and nurses as much as when you were having treatment, but you will still have regular check-ups with your doctor. Your first check-up will usually be a number of weeks after the end of your treatment your doctor will let you know when they would like to see you. After this, you may be seen every few months.

The gaps between your appointments will usually get longer as time goes on, for example, to once a year. Your appointments may continue for several years. It’s normal to feel anxious about these appointments, so finding ways to manage your anxiety can be helpful.

The following tips may help.

• Write down any questions you want to ask your doctor before your appointment.
• Take a pad and pen so you can write down any answers to help you remember them.
• Take a friend or relative with you. He or she can help you understand what has been said and offer support.
• Talk openly and honestly with your doctor about any symptoms, worries or problems you’re having.
• Make the day something to look forward to by planning something special after your appointment.

If you have any worries or concerns in between your scheduled appointments, contact your doctor or nurse.

Long-term effects of your treatment

Some people recover quickly after their treatment with few or no problems. For others, it can take weeks, months or even years. Some long-term effects may even be permanent. Everyone is different, so you may have long-term effects that are different to someone that has had the same type of cancer and treatment as you.

Your appearance

Some treatments for cancer may involve surgery, such as breast removal (mastectomy), or a colostomy. You may feel uncomfortable about how this makes you look and feel afterwards.

Talk to your family and friends about how you’re feeling. It may also help to join a support group to talk to people who have been through similar experiences to you, or speak to a psychologist or counsellor.

Fatigue

Fatigue is extreme tiredness and is common for people who have had cancer or treatment for cancer. It’s very different from normal tiredness because it doesn’t always go away with rest and sleep.

Fatigue can be frustrating and can impact your daily life. It’s normal for some people to feel tired for several months after treatment for cancer. Although doctors don’t know the exact causes of fatigue after cancer treatment, there are some things you can do that may help.

• Plan your day so you’re most active when you feel most energetic.
• Go to bed and wake up at the same time each day.
• Take regular naps and rest breaks throughout the day.
• Ask for help if you feel you need it. For example, ask somebody to help with your shopping or doing the school run if you have children.
• Get regular exercise. This can help reduce your feelings of fatigue. However, it’s important to balance exercise with rest.
• Eat a healthy, balanced diet. See our healthy diet during and after cancer for more information.

For further advice about ways of managing your fatigue, speak to your doctor or nurse.

Pain
Pain after cancer treatment can last for many months. However, some people may have no pain at all. Chemotherapy and surgery can damage your nerves and cause pain and numbness in certain parts of your body, such as your hands and feet. If you have any kind of pain, tell your doctor or nurse.

The earlier you get help and treatment for your pain, the easier it will be to relieve it. Your doctor may suggest taking over-the-counter painkillers, such as paracetamol (acetaminophen) or ibuprofen. Over-the-counter medicines can be bought from a chemist without a prescription.

Fertility

Cancer and its treatment can sometimes affect your ability to have children. Infertility means that you’re unable to conceive a child despite having regular, unprotected sex. This is sometimes temporary but it can also be permanent. Being told you’re infertile can be overwhelming, so it may be helpful to talk to someone about how you’re feeling.

Male infertility

Some cancers can affect your sperm, for example, testicular cancer can lower your sperm count. Certain cancer treatment, such as radiotherapy, can also affect your ability to get an erection (erectile dysfunction).

There are different ways to improve male infertility problems, including medicines and therapies. You may have been advised to store some sperm before your treatment. This can be used for artificial insemination or in vitro fertilisation (IVF) when you want to start a family. You might find it helpful to talk to your doctor or nurse if you’re having problems.

Female infertility

If you're a woman, fertility depends on having a supply of eggs from your ovaries and having a healthy womb. Some chemotherapy medicines won’t affect your fertility but others may temporarily or permanently stop your ovaries producing eggs. This can mean that you may not be able to become pregnant and have symptoms of the menopause, such as your periods stopping, hot flushes, dry skin and vaginal dryness.

Your doctor may prescribe hormone replacement therapy (HRT) if your cancer has caused early menopause to help prevent coronary heart disease and your bones from thinning (osteoporosis). However, HRT is not recommended if you have had breast cancer because it may increase the risk of your cancer returning.

Surrogacy or adoption may be alternatives for you to consider. Having problems with your fertility can be an anxious and stressful time. Speak to your doctor or nurse, who can put you in contact with support groups or a counsellor. Your partner, family and friends may also be able to offer support.

Sex and relationships
Many people experience changes in their sex life during and after cancer treatment. These changes are usually temporary but for some people they can be permanent, which means having to change the way you approach your sexual relationships.

Sexual problems can be caused by:

• how you see yourself (body image)
• changes in how your body looks and functions
• pain that you may be feeling
• fatigue
• emotions you may be having, such as anger, sadness and fear
• how your partner responds to you
• practical matters, such as your job, money or caring for your children, if you have any

It’s important to let your partner know how you’re feeling so they don’t feel like they are being rejected.

There are other things you can try if you’re having problems with your sex life, such as being intimate in other ways (hugging, kissing, and massaging), or experimenting with other ways to help increase your sex drive. You may find it useful to speak to a sex and relationship therapist for more help and support.

Fear of your cancer returning

One of the hardest parts of life after cancer treatment is dealing with the fear of your cancer returning. This fear is perfectly normal. Unfortunately, it’s impossible to predict if your cancer will return and the risk of it coming back is different for every person. It’s important to eat a healthy balanced diet, exercise regularly and attend your follow-up appointments with your doctor.

However, this can’t guarantee your cancer wont return.

You may find that over time, your fear of cancer coming back reduces and you may start to think about it less and less. Your doctor can tell you which symptoms to be aware of.

Thinking about your cancer coming back can make it hard for you to carry on with your daily life. Concentrating on what is important to you each day can be a form of distraction from these thoughts. Joining a support group or speaking to a counsellor may also help.

Work

You may want to go back to work as soon as possible for financial reasons or to regain a sense of normality. For some people though, it can take several months to adjust to everything that has happened and get used to the physical and emotional changes.

Developing a wellness plan

After your cancer treatment, you may decide that you want to live a healthier lifestyle to try to reduce the chances of your cancer coming back. Your doctor can help you to develop a plan for living healthier. He or she may suggest some of the following.

• Give up smoking, if you are a smoker. Smoking increases the chances of your cancer coming back.
• Reduce the amount of alcohol you drink. Drinking more alcohol than the recommended guidelines can increase the chance of you getting cancer. Recommended limits for alcohol differ from country to country. Check the guidelines in your region for more information about sensible drinking limits.
• Eat a healthy, balanced diet. A dietician can also give you practical advice and support on eating well and staying hydrated.
• Exercise. Staying active can provide mental and physical benefits.