Overview
Common late effects of cancer treatment include fatigue, pain and sleep issues, as well as nerve changes (peripheral neuropathy) and fluid build-up (lymphoedema).
Some treatments can also affect certain organs such as your heart, bowel or bladder, or lead to hormonal changes.
Talk to your GP or cancer care team about any new or worsening symptoms, so they can be managed as soon as possible.
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Fatigue, pain and sleep issues
Fatigue
Fatigue is the most common side effect of cancer treatment. It’s linked to all cancer treatments and often occurs with other late effects, such as pain and sleep issues. Cancer-related fatigue can be short-term or last for many months or years.
Cancer-related fatigue makes you feel very tired and weak and it doesn’t always go away with rest. Other symptoms include muscle aches, difficulty with daily tasks, low mood and irritability.
Fatigue can be caused by low red blood cell count (anaemia), hormone changes, reduced muscle strength or fitness, depression, side effects from medicines, nutrition issues, and effects from the cancer itself. These can often be managed by your GP and allied health professionals. Your GP may also refer you to a specialist or a late effects clinic, if available.
I experienced brain fog and fatigue after finishing my treatment. My doctors explained how common these issues are, which was really reassuring.
Pain
You may feel different types of pain as a late effect of cancer treatment. Nerve damage, lymphoedema (see below), or scar tissue can cause pain. Some people feel pain in a body part that is no longer there (phantom pain).
How your pain is treated depends on the cause, as well as your general health. Your GP may prescribe pain medicine or refer you to a pain clinic. Physiotherapists and other allied health professionals can help improve your strength and movement.
For more information, see Cancer pain and listen to Cancer Council's Managing Cancer Pain episode of The Thing About Cancer podcast series.
Sleep issues
Many people have trouble sleeping at some point in their lives – with or without cancer. But cancer and some treatments can cause sleep problems. You may find it hard to fall asleep, or you may wake up during the night or too early.
Sleep problems after cancer treatment can be linked with pain, anxiety or depression. Some medicines and hormonal changes can also affect sleep.
Your GP can suggest ways to improve your sleep. They may prescribe medicine if needed. They can also refer you to a counsellor or psychologist for help with anxiety or depression.
Listen to Cancer Council's Sleep and Cancer episode of The Thing About Cancer podcast series.
Changes in your body
Nerve changes
Peripheral neuropathy is a nerve condition that affects the hands or feet. It can cause tingling or numbness, pain, or a burning feeling. Some chemotherapy drugs can damage nerves. So can some types of surgery, radiation therapy, and some newer drug therapies.
Peripheral neuropathy can start during cancer treatment, or in the months after treatment finishes. Your GP can help you manage some symptoms with exercises or medicines. They may also refer you to a pain specialist, physiotherapist, exercise physiologist, occupational therapist or psychologist for extra support.
Lymphoedema
Swelling caused by a build-up of lymph fluid under the skin is called lymphoedema. It can occur if lymph nodes are removed during surgery or damaged by radiation therapy. Lymphoedema can appear anywhere in the body but often affects an arm or leg.
Let your healthcare team know if you experience symptoms including swelling, aching, heaviness or tightness, reduced movement, and small dents in the skin (pitting). Lymphoedema can happen during or soon after treatment, or years later.
Early treatment is important to prevent lymphoedema from worsening. Treatment may involve compression, drainage and exercises from a specially trained occupational therapist, physiotherapist, or nurse.
Heart conditions
Some cancer treatments can affect how your heart and blood vessels work. This can increase your risk of heart disease (cardiovascular disease) and heart conditions. Cancer treatments linked to heart conditions include some types of chemotherapy, targeted therapy, immunotherapy and radiation therapy to the chest.
Common heart conditions are heart inflammation (myocarditis), irregular heartbeats (arrhythmia) and damage to the heart muscle (cardiomyopathy). Some hormone therapies can also increase the risk of high blood pressure and cholesterol.
Bone changes
Some cancer treatments can cause thinning of your bones and raise your risk of fractures (a condition called osteoporosis). Other risk factors for poor bone health include your age (being over 50), family history and low hormone levels (oestrogen for women and testosterone for men).
Your GP may arrange a scan to check your bone mineral density. They may also prescribe medicine or refer you to an exercise physiologist, physiotherapist or dietitian for support.
Call Healthy Bones Australia on 1800 242 141.
Bowel and bladder changes
Some cancer treatments can cause bowel and bladder problems. These are usually linked to radiation therapy to the pelvic area and some types of surgery. You may have trouble controlling your bowel or bladder (incontinence), difficulty passing bowel motions (constipation), or loose stools (diarrhoea).
See your GP or cancer care team if you notice blood in your stools (poo) or urine (wee), or if you need to go to the toilet more often. These changes may be signs of inflammation of the bowel (radiation proctitis) or bladder (cystitis) and should be checked by a doctor.
Most bowel and bladder problems can be managed. Your GP or cancer team can help by prescribing medicines, treatments, dietary changes and special exercises. You may be referred to specialists to help with ongoing problems.
Lung conditions
Some chemotherapy, targeted therapy, immunotherapy, and radiation therapy to the chest can damage the lungs. A rare but serious condition that can develop as a late effect is lung inflammation (pneumonitis). See your GP if you have shortness of breath, a cough, chest pain, or feel faint.
Teeth and mouth changes
Surgery or radiation therapy to the head and neck, and chemotherapy and other medicines, can affect your mouth and teeth. You may have mouth sores, tooth decay or trouble swallowing. Have regular dental check-ups. You may find it helpful to see a dietitian or speech pathologist.
Why is my memory worse after cancer?
You may find it harder to focus, remember details or learn new information. These changes can happen before, during or after cancer treatment, and are sometimes called “chemo brain” or “brain fog”.
The exact cause of these changes isn’t known. They may be linked to cancer treatments or medicines. Other factors, including ageing, fatigue, hormone changes, stress, anxiety or depression, may play a part. Your GP can help you manage these changes, and may refer you to an occupational therapist or psychologist for extra support.
For more information, see Changes in thinking and memory and listen to Cancer Council's Brain Fog and Cancer episode of The Thing About Cancer podcast series.
Hormonal changes
Different cancer treatments can affect the body’s hormone system (endocrine system). This can lead to late effects, including:
- Menopause – The ovaries stop working and periods end. You may have hot flushes, night sweats, joint pain, trouble sleeping, dry or itchy skin, low sex drive, vaginal dryness, and anxiety.
- Underactive thyroid – The body makes too little thryoid hormone. This can cause weight gain, constipation, dry skin and feeling cold.
- Overactive thyroid – The body makes too much thyroid hormone. This can cause weight loss, tiredness, shaky hands and feeling too hot.
- Weight gain – Your general health, fatigue, mood, diet and activity levels can all affect your weight.
Your GP or cancer care team can help you manage these changes. They may prescribe medicines or suggest treatments to ease symptoms.
Changes to your senses
Hearing loss
Radiation therapy to the head or neck and some chemotherapy drugs can affect hearing. You may have trouble hearing high sounds or notice ringing in your ears (tinnitus). An audiologist can test your hearing and suggest devices to help.
Vision changes
Some treatments increase the risk of cataracts. This can cause blurred or cloudy vision, double vision, light sensitivity, and trouble seeing at night. Have regular eye checks. An eye specialist can treat cataracts with surgery.
Changes to sex and intimacy
You may find sex difficult, painful or less enjoyable, and your interest in intimacy may drop. Cancer treatments like pelvic radiation therapy can lead to a loss of sensation, changes to the vagina and erection difficulties. Fatigue, pain, hormone changes, depression and anxiety can also contribute.
Speak with your GP about treatments, including medicines. A psychologist, counsellor or sex therapist can provide emotional support.
For more information, see Sex, intimacy and cancer and listen to Cancer Council's Sex and Cancer episode of The Thing About Cancer podcast series.
Am I more likely to get a different cancer now?
Rarely, people may develop a new cancer that is different from their first cancer. This is called a second cancer. The overall risk of a second cancer is low, but it can be slightly higher after some types of radiation therapy and chemotherapy. Other factors, such as age, family history and smoking, can also affect risk.
For most people, the benefits of treating the original cancer far outweigh the risk of developing a second cancer. Talk to your GP if you notice any new or ongoing symptoms that concern you.
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