Coping
Living with cancer and cancer treatments

From emotional ups and downs to treatment side effects, there are many ways to deal with the challenges cancer will bring as you work to overcome it.

General Information

Going through cancer treatment can be a long and painful ordeal. People often experience emotionally draining and physically challenging side effects. Fortunately, most side effects will go away in time and there are ways to learn to deal with them and minimise the disruption to your life.

Side effects will vary from person to person and from one treatment to the next. The types of drugs being used and the treatment period will also impact the range and severity of side effects experienced. No matter what type of treatment you are receiving, it is important to have a good understanding of all possible side effects which can be gained from talking openly with your doctor.

  1. Before your treatment begins, ask your doctor what short-term and long-term side effects to expect.
  2. During, between and after treatment, tell your doctor or nurse about any side effects experienced. If you have a particularly severe side effect, the doctor may prescribe a break in your treatments or change your treatment.
  3. Ask your doctor if you can take any medicines, creams, home remedies or complementary therapies during treatment. Some of these remedies can affect your treatment and how it reacts with your body.
  4. Consult a general practitioner when you have any doubt about a side effect you are experiencing, or call the nurse at the oncology department of the hospital you are consulting.

Tell a health professional immediately about any unusual, painful or worrying problems or side effects. If you keep quiet, your doctor won't necessarily know anything is wrong and won’t be able to offer solutions. Consider keeping a diary to write down any side effects experienced and what you did to cope with them to share with your nurse or doctor.

Side effects usually start during the first few weeks of treatment and most of them will go away in time. Remember that the type and severity of any side effects have nothing to do with the success of the treatment.

If you are having difficulties coping with the emotional burden of your treatment or would like more information on how to deal with your side effects, contact us by calling our hotline on 3656 0800.

Radiotherapy

 

Managing Side Effects of Radiotherapy

Common side effects

Feeling tired and lacking energy

During radiotherapy, your body uses a lot of energy dealing with the effects of radiation on normal cells. Some people are able to carry on with life as usual, but many people find they can't do as much and feel tired during and after treatment. Your weakness and weariness may develop slowly over the course of treatment but should go away gradually after treatment is over.

Tips

  1. Save your energy by doing less and taking time to rest. Try to get more sleep at night and take naps during the day if needed.
  2. Let other people help you. Family members, neighbours and friends may be glad of the chance to help you with tasks like shopping, child-care, housework and driving.
  3. Plan to take a few weeks off work during or after your radiotherapy, work fewer hours or if possible, work from home.

Skin problems

Radiotherapy may make your skin dry and itchy around the treatment area. Some of the radiation passes through your body, so some areas of skin can also be affected. You may temporarily develop a sunburnt look with redness, tanning or burning in the treated area.

Tips

  1. Wear soft clothing. Some of the dye marks may rub off on your clothes, so it is best to wear loose and comfortable older clothes that you can throw out if they get stained.
  2. Protect the treatment area from the sun. Stay out of the sun and, before going outside, always cover your treated skin with a light, close-weave clothing. Ask your doctor about using a sunscreen (SPF 30+).
  3. Tell your doctor about changes in your skin, such as cracks or blisters, very moist skin, rashes, infections or peeling, or any changes in your nails.
  4. Don't rub, scrub or scratch treated skin or any sensitive spots. Let the dye outlines after your treatment wears off gradually.
  5. Avoid using any soap, creams, deodorants, medicines, perfumes, cosmetics, talcum powder or other substances on the treatment area without your doctor's approval. Many products leave a coating that can interfere with radiotherapy.
  6. Bath or shower in lukewarm water. Hot water can injure your sensitive skin. Pat skin dry with a soft towel. Don't put very hot or cold things (hot-water bottle, ice pack, etc) on the treatment area.
  7. Don't use a blade razor on the treatment area. Check with your doctor or nurse before using an electric razor.

Hair loss

If you have hair in the area being treated (scalp, face or body), you may lose some or all of it during radiotherapy. Usually, it will grow back and return to normal after the treatments are finished.

Tips

  1. If it makes you feel more comfortable and confident, wear a wig or toupee, hats, scarves or turbans. If you plan to buy a wig, it is a good idea to choose it early in your therapy so you can match the colour and style of your own hair.
  2. If you prefer to leave your head bare, remember to protect it against sunburn or extreme cold and to look after your scalp the same way you would treat the rest of your body.
  3. Expect the hair that first grows back to be a little different than it was before treatment. It might, for instance, be curly although you have always had straight hair and, occasionally the new growth can be patchy for a while. In time, your hair will probably return to its normal condition.

Loss of appetite

Eating healthily with a good variety of food is important when you are undergoing treatment. A balanced diet is important for you to get the most from your treatment. Depending on the site of your treatment, you may lose your normal interest in food, even when you know that eating properly is important, there may be days when you can't eat much. If you have radiotherapy in the head and neck area, expect that chewing and swallowing might be difficult or painful.

Tips

  1. Eat smaller amounts while eating more often.
  2. Try to catch up on days when you do feel like eating.
  3. You may find you can drink a lot, even if you don't feel like eating solid foods. If so, try enriching your drinks with powdered milk, low-fat yoghurt, eggs, and honey or weight-gain supplements. The hospital dietician will also be able to help if you have problems with food.

Nausea and diarrhoea

If you have radiotherapy on your stomach or part of your lower abdomen, you may experience an upset stomach or diarrhoea. After the diarrhoea episodes have ended, it is important to return to a healthy eating plan that includes fresh fruits and vegetables and wholegrain breads and pasta. These problems will fade when your treatment is over.

Tips

  1. Eat nothing or only a bland snack such as toast, dry biscuits or apple juice for a few hours before your treatment. If the problem persists, you can ask your doctor for medicine to prevent nausea and/or diarrhoea.
  2. Try having nothing but clear liquids as soon as diarrhoea starts, or when you feel it is going to start. Liquids that will not make your diarrhoea worse include apple juice, peach nectar, weak tea and clear broth It is important to stay hydrated.

Face, mouth, neck and upper chest problems

Radiotherapy is often used to treat cancers of the face, mouth, neck and upper chest. Depending on the area being treated, it can affect your mouth and teeth, making eating difficult. After about two weeks of treatment, your mouth or throat may become dry and sore and your voice may become hoarse. This should start to improve after another two or three weeks and is usually gone about a month after treatment finishes. You might also have some phlegm in your throat or a lump-like feeling that makes it hard to swallow.

Tips

  1. Suck ice chips and sip cool drinks, try to have more liquids and soft food if chewing and swallowing are painful.
  2. Avoid tobacco and alcohol (including mouthwashes containing alcohol) because they will dry your mouth even more.
  3. Ask your doctor or nurse for information on artificial saliva preparations and if eating is uncomfortable or painful, request something to relieve the pain.
  4. If your sense of taste changes during radiotherapy, try different ways of preparing food. For example, lemon juice makes many foods, including meat and vegetables, tastier.

Your doctor can help you with these problems or see a speech pathologist if you continue to have difficulties swallowing.

Dental problems

If you are having radiotherapy to your mouth, your teeth will be more likely to decay. Discuss your dental care with your doctor before treatment starts, and tell your dentist about your treatment. Your dentist will probably want to see you regularly during your radiotherapy. He or she will give you detailed instructions about caring for your mouth and teeth, to help prevent tooth decay and to deal with problems such as mouth sores.

Effect on sex life

Men and women usually find that radiotherapy to the pelvic area results in sexual intercourse to become uncomfortable and undesirable temporarily. Women may experience a dry, itchy or burning sensation in the vaginal area. If you have these problems, you should tell your doctor or nurse, because the symptoms can usually be relieved quickly and easily. Radiotherapy to the pelvic area can also cause a woman's vaginal tissues to shrink, making sexual intercourse painful. These changes are permanent and can become progressively worse. However, regular intercourse, the use of an instrument to expand the vagina (a dilator) and vaginal lubricants can stop the deterioration. 

Fertility

Radiation in the pelvic region can cause permanent infertility. It is important to discuss how your treatment will affect fertility and discuss fertility preservation options with your doctor before commencing treatment.

Click here to download our radiotherapy booklet.

Chemotherapy

 

Managing Side Effects of Chemotherapy

Self-care during chemotherapy

Many people feel they have no control over their treatment when they are receiving chemotherapy. However, there are many things you can do to help yourself.

Some chemotherapy side effects are common and to be expected however any unusual or serious side effects should be reported to your doctor. Contact your doctor urgently if any of the following problems occur:

  1. Fever over 38°C or chills
  2. Sweating, especially at night
  3. Easy bruising or any unusual bleeding
  4. A sore throat
  5. mouth ulcers
  6. Persistent or severe vomiting more than 24 hours after treatment
  7. Severe constipation, diarrhoea or abdominal pain
  8. Burning or stinging on passing urine
  9. Tenderness, redness or swelling around the place where the injection goes in
  10. Any serious unexpected side effects or sudden deterioration in health.

Common side effects of chemotherapy 

Feeling tired and lacking energy

During radiotherapy, your body uses a lot of energy dealing with the effects of radiation on normal cells. Some people are able to carry on with life as usual, but many people find they can't do as much and feel tired during and after treatment. Your weakness and weariness may develop slowly over the course of treatment but should go away gradually after treatment is over.

Tips

  1. Save your energy by doing less and taking time to rest. Try to get more sleep at night and take naps during the day if needed.
  2. Let other people help you. Family members, neighbours and friends may be glad of the chance to help you with tasks like shopping, child-care, housework and driving.
  3. Plan to take a few weeks off work during or after your radiotherapy, work fewer hours or if possible, work from home.

Feeling sick or vomiting

Not everyone feels sick (nauseous) after chemotherapy. If it does occur, it usually starts a few hours after treatment and may last many hours. If you still feel nauseous after a few days, contact your doctor. Changes to your diet are to be expected. Sometimes you may not feel hungry. Try to catch up on days when you do feel hungry and eat small, frequent meals or snacks if your appetite is poor. Be willing to change your meals around. If you happen to feel hungrier at breakfast time, have your main meal then and a light meal (such as breakfast cereal) at a time when you feel less like eating. It is important you find a diet that meets your needs.

Tips

  1. Eat a light meal before your treatment (for example, soup and dry biscuits) and drink as much fluid as possible.
  2. Drink small amounts more often rather than large drinks after treatment. Soda water, dry ginger ale or weak teas are all good choices. Ice cubes, icy-poles or jellies are other ways to increase your fluid intake.
  3. Avoid foods that usually upset your stomach, eat dry toast or crackers - they often help.
  4. Eat slowly and chew well to help you digest your food better.
  5. Don't do anything too strenuous after a meal; have a lie down for a while.
  6. Try breathing deeply through your mouth whenever you feel like being sick.
  7. Prepare meals between treatments and freeze them for the days you don't feel like cooking.
  8. Try to avoid odours that bother you such as cooking smells, perfume or smoke.

Anti-nausea medication can help. If you have intravenous treatment, anti-nausea medication may be added to the drip before and during treatment. If nausea is likely, you will be given anti-nausea tablets to take at home. These are best taken regularly. Several anti-nausea medications are available. It may take some time before you find the right medication for you but keep trying. Anti-nausea suppositories are sometimes used to help control nausea or vomiting. These are placed in the back passage (rectum), where they dissolve.

 

Chemotherapy affects rapidly multiplying cells. This includes cancer cells and normal cells. The effect on normal cells may cause unwanted side effects. Side effects can vary greatly:

  1. From person to person - some people will have no side effects, others will experience a few
  2. According to the type of drugs
  3. From one treatment period to the next

Side effects usually start during the first few weeks of treatment. Most go away in time. The type and severity of any side effects have nothing to do with the success of the treatment.

Helping yourself during chemotherapy

Many people feel they have no control over their treatment when they are receiving chemotherapy. However, there are many things you can do to help yourself.

Some chemotherapy side effects are common and to be expected however any unusual or serious side effects should be reported to your doctor. Contact your doctor urgently if any of the following problems occur:

  1. fever over 38°C or chills
  2. sweating, especially at night
  3. easy bruising or any unusual bleeding
  4. sore throat
  5. mouth ulcers
  6. persistent or severe vomiting more than 24 hours after treatment
  7. severe constipation, diarrhoea or abdominal pain
  8. burning or stinging on passing urine
  9. tenderness, redness or swelling around the place where the injection goes in
  10. any serious unexpected side effects or sudden deterioration in health.

Common side effects

  • 1. Feeling tired and lacking energy
  • 2. Feeling sick or vomiting
  • 3. Constipation or diarrhoea
  • 4. Mouth problems Mouth sores or infections
  • 5. Hair loss and scalp problems
  • 6. Itching skin and other skin problems
  • 7. Nerve and muscle effects
  • 8. Change in hearing
  • 9. Effects on the blood
  • 10. Fertility

1.Feeling tired and lacking energy

During radiotherapy, your body uses a lot of energy dealing with the effects of radiation on normal cells. Some people are able to carry on with life as usual, but many people find they can't do as much and feel tired during and after treatment. Your weakness and weariness may develop slowly over the course of treatment but should go away gradually after treatment is over.

Tips

  1. Save your energy by doing less and taking time to rest. Try to get more sleep at night and take naps during the day if needed.
  2. Let other people help you. Family members, neighbours and friends may be glad of the chance to help you with tasks like shopping, child-care, housework and driving.
  3. Plan to take a few weeks off work during or after your radiotherapy, work fewer hours or if possible, work from home.

2.Feeling sick or vomiting

Not everyone feels sick (nauseous) after chemotherapy. If it does occur, it usually starts a few hours after treatment and may last many hours. If you still feel nauseous after a few days, contact your doctor. Changes to your diet are to be expected. Sometimes you may not feel hungry. Try to catch up on days when you do feel hungry and eat small, frequent meals or snacks if your appetite is poor. Be willing to change your meals around. If you happen to feel hungrier at breakfast time, have your main meal then and a light meal (such as breakfast cereal) at a time when you feel less like eating. It is important you find a diet that meets your needs.

 Tips

  1. Eat a light meal before your treatment (for example, soup and dry biscuits) and drink as much fluid as possible.
  2. Drink small amounts more often rather than large drinks after treatment. Soda water, dry ginger ale or weak teas are all good choices. Ice cubes, icy-poles or jellies are other ways to increase your fluid intake.
  3. Avoid foods that usually upset your stomach, eat dry toast or crackers - they often help.
  4. Eat slowly and chew well to help you digest your food better.
  5. Don't do anything too strenuous after a meal; have a lie down for a while.
  6. Try breathing deeply through your mouth whenever you feel like being sick.
  7. Prepare meals between treatments and freeze them for the days you don't feel like cooking.
  8. Try to avoid odours that bother you such as cooking smells, perfume or smoke.

Anti-nausea medication can help. If you have intravenous treatment, anti-nausea medication may be added to the drip before and during treatment. If nausea is likely, you will be given anti-nausea tablets to take at home. These are best taken regularly. Several anti-nausea medications are available. It may take some time before you find the medication that is right for you, but keep trying. Anti-nausea suppositories are sometimes used to help control nausea or vomiting. These are placed in the back passage (rectum), where they dissolve.

Constipation or diarrhoea

Some chemotherapy drugs, pain relief medicines and anti-nausea drugs can affect the lining of the digestive system and cause constipation or diarrhoea. Let your doctor or nurse know if you experience constipation as your medication may be changed or other medication given to relieve the constipation. At first, diarrhoea can be treated with medication at home. If the diarrhoea is severe, it could cause dehydration and you may need to be admitted to hospital. If you have diarrhoea, it is important to return to a balanced diet that includes fresh fruits and vegetables and wholegrain bread and pasta after the diarrhoea has stopped.

 Tips

  1. If you have constipation, eat more high-fibre foods, such as wholegrain bread and pasta, bran, fruit and vegetables.
  2. If you have diarrhoea, avoid spicy foods, dairy products, coarse wholegrain products, fatty or fried foods, rich gravies and sauces and raw fruit or vegetables with skins or seeds. Instead, try snacking on clear broth and toast, biscuits, or cooked rice.
  3. Drink plenty of fluids. This will help loosen the bowels if you have constipation and replace the fluids lost through diarrhoea. Warm and hot drinks work well.
  4. Get some light exercise. Walking is a good option.
  5. Eat small, frequent snacks instead of big meals.

Mouth problems Mouth sores or infections

Some chemotherapy drugs can cause mouth sores or infections, particularly in people with head and neck cancer. Ask your doctor or nurse whether you need to take extra care.

Tips

  1. Use a soft toothbrush to clean your teeth twice a day. You may be given special mouthwashes to try to prevent mouth infections such as thrush.
  2. Rinse (swill and spit) with a teaspoon of salt in a glass of warm water at least four times a day.
  3. Don't use commercial mouthwashes without first asking the doctor. Sometimes they can irritate your mouth.
  4. Sip fluids, especially water, and eat moist foods such as casseroles if you have a dry mouth. It may also help to suck on frozen pineapple or chew sugar-free gum.
  5. Other ideas include: blending foods and eating soups and ice-creams.

If you notice any change in your mouth or throat, such as sores or thickened saliva, or find it difficult to swallow, contact your doctor. Discuss any dental problems with your doctor. Before you have any dental treatment, tell your dentist you are having chemotherapy.

Hair loss and scalp problems

Most people having chemotherapy worry about losing their hair. Some drugs may cause hair to thin or fall out but many others do not cause hair loss. If you do lose some or all of your hair, it will usually grow back when your treatment stops.

When hair loss does occur, it usually starts two to three weeks after the first treatment. Some people lose all their hair very quickly; others lose it after several treatments, while others may only lose a little hair or none at all. Your scalp may feel hot or itchy just before your hair starts to fall out. Although losing head hair is most common, some people may also lose hair from their arms, legs, chest, pubic region and eyelashes. If hair loss occurs, you can wear a hat, scarf or wig. The important thing is to do whatever feels comfortable and gives you the most confidence.

Tips

  1. Keep your hair and scalp very clean, using a mild shampoo like baby shampoo.
  2. Comb or brush your hair gently using a large comb or a hairbrush with soft bristles.
  3. Use a cotton, polyester or satin pillowcase--nylon can irritate your scalp.
  4. Avoid hair perms and dyes which may increase hair loss.
  5. Avoid daily use of hair dryers and rollers and harsh hair care products.
  6. Use sunscreen, a hat or scarf to protect your head from the sun.
  7. Wear a light cotton turban or beanie to bed, if you are cold at night.
  8. If your eyelashes fall out, wear glasses or sunglasses to protect your eyes from the sun and dust when outside.

It takes between four to twelve months to grow back a full head of hair. When your hair first grows back it may be a little different. Sometimes it will be curly even though you have always had straight hair. In time your hair will return to its normal condition and you will be able to continue your usual hair care routine. Your scalp may be itchy when your hair is growing back. Frequent shampooing can relieve the itching.

Cancer care specialists at Hong Kong Cancer Fund Support Centres or staff within the Cancer Patient Resource Centres throughout numerous public hospitals can help you find a suitable wig.

Itching skin and other skin problems

You may notice that your skin darkens, peels, becomes dry and itchy or more sensitive to the sun during chemotherapy.

Tips

  1. Apply corn flour over the affected area to keep skin dry and free from irritation
  2. Use a lotion or cream to stop dryness. Ask your doctor for advice if these suggestions don't work.

Nerve and muscle effects

Some drugs can cause tingling and loss of sensation in the fingers and/or toes, and muscle weakness in the legs. If this happens, tell your doctor or nurse before your next treatment. A slight change in the treatment is usually all that is needed to stop this happening in the future.

Change in hearing

Some chemotherapy drugs can cause the loss of ability to hear high-pitched sounds. They can also cause a continuous noise in the ears known as tinnitus. Let your doctor know if you notice any change in your hearing.

Effects on the blood

The soft and spongy material inside bones (the bone marrow) makes three types of blood cells:

  1. white blood cells: fight infection
  2. red blood cells: carry oxygen to cells throughout the body
  3. platelets: help blood to clot and stop bleeding.

The bone marrow's job is to maintain normal levels of blood cells (the blood count) to keep you fit and healthy. Some chemotherapy drugs can occasionally affect the bone marrow so that your blood count is reduced. The count may fall with each treatment. Blood tests will be done regularly to make sure your blood cells return to normal before your next treatment. Occasionally, a low blood count will cause some complications related to the type of blood cell affected.

(1) Infection

During chemotherapy, colds and flu may be harder to shake off and scratches and cuts may get infected easily. See your doctor if you are unwell: don't wait out a cold when you are having chemotherapy. Sometimes doctors recommend taking antibiotics as a precaution against infection. If you are having chemotherapy in winter, check with your doctor about having a flu injection.

Granulocyte-colony stimulating factor (G-CSF) is a treatment given by injection to some people after chemotherapy. It helps to increase the number and function of a type of white blood cell called neutrophils, which help to protect against infection. G-CSF is not prescribed for everyone after chemotherapy; you may wish to check with your doctor if it is an appropriate option for you.

(2) Bleeding problems

A fall in the number of platelets can cause you to bleed for longer than normal after minor cuts or scrapes, or to bruise more easily.

Tips

  1. Take care not to cut yourself when shaving or using nail scissors.
  2. If you bleed, apply pressure for about 10 minutes.

 

(3) Anaemia
If red blood cells are low, anaemia can occur, making you feel weak, tired and look pale.

Tips

  1. Avoid people with coughs, colds and other infections. Naturally, this is not practical with people you are living with, so just use your common sense.
  2. Let your doctor know if you are in contact with a person who has chickenpox. You may need an injection to prevent chickenpox or shingles.
  3. Be careful not to cut or nick yourself when using scissors, needles, knives or razors. Small cuts can harbour germs and can be a good place for an infection to start.
  4. Wash your hands with soap after using the toilet and before eating to avoid spreading germs.

Fertility

Chemotherapy may affect sexual organs and function in both women and men. This may have a temporary or permanent effect on your ability to have children (fertility). It is best for you and your partner to talk about these issues and fertility preservation options with your doctor before commencing any treatment.

For women

Some women's periods become irregular during chemotherapy but return to normal after treatment. For other women, chemotherapy may cause periods to stop completely (menopause). After menopause, women can't have children. The signs of menopause include hot flushes, sweating, particularly at night, and dry skin. Talk to your doctor about medication for relieving the symptoms of menopause. Early menopause (before age 40) may cause bones to become weaker and break more easily. This is called osteoporosis.

For men

Chemotherapy drugs may lower the number of sperm produced and reduce their ability to move. This can cause infertility, which may be temporary or permanent. The ability to get and keep an erection may also be affected but this is normally temporary. Women may be able to store eggs (ova) and men may have sperm stored before treatment starts for use at a later date. Ask your doctor about this.

Contraception

Although chemotherapy reduces fertility, it is possible for some women to become pregnant while having chemotherapy and a man having chemotherapy could still make his partner pregnant. Pregnancy should be avoided during chemotherapy in case the drugs harm the unborn baby. Birth control (contraception) must be used. Ask your doctor about your contraceptive options. The Pill may be prescribed to some young women as a contraceptive and to help protect the ovaries from the effects of chemotherapy. Should you or your partner become pregnant, talk to your doctor urgently.

It is also important to use contraception (condoms) during sexual intercourse while on active chemotherapy treatment as there is a chance drugs can be passed through bodily fluids potentially causing harm to your partner.

Surgery

Side effects of surgery will vary depending on the location and complexity of your surgery.  It is important to have a clear understanding of what is planned for your surgery and to have a thorough debrief on the procedure with your doctor once it is complete. Some common side effects may include the following:

Pain

It is common to have some pain after any surgery. Pain after surgery lessens gradually as the body heals. In the meantime, your doctor may give you pain medications to decrease your discomfort.

Fatigue

 Many patients feel very tired after major surgery, especially when the surgery involves the abdomen or chest. This is a reaction to the anaesthesia, and also part of your body’s natural healing process. Fatigue usually goes away gradually, within two to four weeks after surgery.

Loss of appetite

Poor appetite after surgery is very common, especially when general anaesthesia was used, and it may be associated with temporary weight loss. Most patients regain their appetite and return to their normal weight as the effects of the surgery wear off.

Infection

This may occur at the site of the incision, but it can also occur elsewhere in the body. Surgeons take great care to minimize the risk of infection during the operation, and your health care team will teach you how to prevent infection during recovery through proper care for yourself. Signs of infection in a surgical incision include redness, warmth, increased pain, and sometimes, drainage from the wound. If these signs occur, contact your surgical care team to have the wound evaluated. Antibiotics generally work well to treat most infections.

Lymphedema

When a surgery involves the removal of lymph nodes, which fight infection in the body, fluid can build in the surrounding tissue resulting in swelling. This swelling is called lymphedema and can cause discomfort and disrupt normal functioning and movement of the affected body part. Check with your doctor if lymph nodes are being removed during your surgery and for advice on how to manage this side effect.

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