Information for Survivors

A cancer survivor is a person with cancer of any type, current or past, who is still living.
Due to major advances in screening and diagnosis and better treatment for many types of cancer, many people with cancer are living longer.

Needs of cancer survivors
People who have finished cancer treatment often have psychological and physical medical challenges which may vary from one person to another, change over time, and range in intensity

Lifestyle changes that make a difference

  • Regaining and Improving Health through Healthy Behaviors

Healthy behaviors – exercise, diet, not smoking – may be especially important for survivors due to their increased risk for recurrence and developing a new cancer.
For example, post-treatment physi¬cal activity has been associated with increased recurrence-free and overall survival, whereas overweight and obesity have been consistently associated with increased risk of recurrence and poorer survival for many cancers. Continued smoking after treatment increases the risk of recurrence and second cancers.
In addition to improving disease outcomes, healthy behaviors may also improve survivor functioning and quality of life. Clinical trials demonstrate that exercise can improve heart and lung function and reduce cancer-related fatigue among survivors.

  • Physical activity

 Physical activity can fasten recovery from the immediate side effects of treatment, prevent long-term effects, and may reduce the risk of recurrence and increase survival.

All above side effects should be discussed with the doctor and make sure to how handle it.
Exercise for cancer survivors should be individualized and tailored according to the disease site and stage and the survivor’s capabilities. Barriers to engaging in physical activity may be symptomatic (e.g., fatigue, pain, and nausea), physical (e.g., amputees, lymphedema, neuropathy), psychosocial (e.g., feelings of fear, lack of motivation, or hopelessness), or financial. Other barriers include lack of awareness of exercise programs, unfavorable community environments, and work and family obligations.

  • Nutrition and maintaining, a healthy body weight

Weight management is an important issue for many survivors. Some patients begin the treatment process in a state of overweight or obesity, some may gain weight while in treatment, while others may become underweight due to treatment-related side effects (e.g., nausea, vomiting, difficulty swallowing). Numerous studies have shown that obesity and weight gain in breast cancer survivors lead to a greater risk of recurrence and decreased survival.

A diet that is plentiful in fruit, vegetables, and whole grains, but contains limited amounts of fat, red and processed meat, and simple sugars may reduce both the risk of developing second cancers and the risk of chronic diseases. In addition, alcohol consumption is an established cause of cancers of the mouth, pharynx, larynx, esophagus, liver, colorectum, and breast; therefore, it is recommended that those who consume alcoholic beverages limit their consumption (2 drinks per day for men and 1 drink per day for women).87

  • Smoking cessation

 Despite their increased risk for chronic health conditions and premature death, a significant number of cancer survivors continue to smoke after their diagnosis. The majority of survivors who smoke were smokers before diagnosis. There is a known association between smoking and cancer development, the fact that survivors have a higher risk of developing second cancers, and because smoking interferes with some common treatments for cancer. Studies have shown that smoking cessation efforts are most successful when they are initiated soon after diagnosis.

  • Surviving cancer and eating well

 Survivorship begins when cancer is discovered, and it continues for a lifetime. It is focused on the quality of a patient’s life and often involves family and others affected by a patient’s cancer diagnosis
 As a result of improved diagnosis, treatment, and follow-up care in recent decades, two in three adult cancer patients – and four in five children with cancer – will survive for at least 5 years after their diagnosis, and many will live long lives.

Ways to Manage Physical Changes

You may find that you are still coping with the effects of treatment on your body. It can take time to get over these effects. You may wonder how your body should feel during this time and what signs that cancer is coming back are.
This section describes some of the problems that can occur when treatment is over. Some of the most common problems that people report are:

  1. Fatigue
  2. Memory and concentration changes
  3. Pain
  4. Nervous system changes (neuropathy, Lymphedema or swelling)
  5. Mouth or teeth problems
  6. Changes in weight and eating habits
  7. Trouble swallowing
  8. Bladder or bowel control problems
  9. Menopause symptoms

Fatigue
Rest or sleep does not cure the type of fatigue that you may have. Doctors do not know its exact causes. The causes of fatigue are different for people who are receiving treatment than they are for those who have finished.
How long will fatigue last? There is no normal pattern. For some, fatigue gets better over time. Some people, especially those who have had bone marrow transplants, may still feel energy loss years later.
Coping With Fatigue
Here are some ideas

  • Plan your day. Be active at the time of day when you feel most alert and energetic.
  • Save your energy by changing how you do things. For example, sit on a stool while you cook or wash dishes.
  • Take short naps or rest breaks between activities.
  • Try to go to sleep and wake up at the same time every day.
  • Do what you enjoy, but do less of it. Focus on old or new interests that don't tire you out. For example, try to read something or listen to music.
  • Choose how to spend your energy. Try to let go of things that don't matter as much now.
  • Join a support group. Talking about your fatigue with others who have had the same problem may help you find new ways to cope.

Memory and Concentration Changes
Research shows that one in four people with cancer reports memory and attention problems after chemotherapy. This is sometimes called "chemobrain." Many survivors describe this as "brain fog," which can lead to problems paying attention, finding the right word, or remembering new things.

These effects can begin soon after treatment ends, or they may not appear until much later. They don't always go away. If a person is older, it can be hard to tell whether these changes in memory and concentration are a result of treatment or of the aging process.

Improving Memory and Concentration
Cancer survivors have found many ways to help improve their memory after cancer treatment. See if any of these ideas work for you:

  • You can write down each task, how long it will take, and where you need to go in a notebook or pocket r. Plan your whole day. Keep it simple, and be realistic about how much you can do in a day
  • Set up reminders. Put small signs around the house to remind you of things to do, such as taking out the trash or locking the door.
  • Talk yourself through tasks. When doing a task with a number of steps, such as cooking or working on a computer, whisper each step to yourself.
  • Manage stress. Managing stress better may improve your memory and attention. And learning how to relax can help you remain calm even in stressful moments.
  • Go over what you plan to say. Before you go to family events or work functions, go over names, dates, and key points you want to make.
  • Repeat what you want to remember. Saying it a couple of times can help your mind hold on to the information.

Pain
Some people have a lot of pain after treatment, while others have less. Everyone is different. Types of pain you may feel after cancer treatment include:

  • Pain or numbness in the hands and feet due to injured nerves. Chemotherapy or surgery can damage nerves, which can cause severe pain. For more information on nervous system changes, see Nervous System Changes (Neuropathy).
  • Painful scars from surgery.
  • Pain in a missing limb or breast. While doctors don't know why this pain occurs, it is real. It's not just "in your mind." This is sometimes called phantom pain.

Getting Help
If you find that you still have pain after treatment ends, your doctor can help find the source of your pain and get relief. You do not have to be in pain. And wanting to control pain is not a sign of weakness. It's a way to help you feel better and stay active. Pain may be caused by treatment or other health issues, such as arthritis.

With your help, your doctor can assess how severe your pain is and may recommend one or more of the following approaches:

  • Pain-relief medicines. In most cases, doctors will try the mildest medicines first. Then they will work up to stronger ones if you need them. The key to getting relief is to take all medicines just as your doctor prescribes. To keep pain under control, do not skip doses or wait until you hurt to take these medicines.
  • Talking With Your Doctor about Pain
  • There are different ways you can describe your pain to your doctor:
  • Use numbers. Talk about how strong the pain feels on a scale of 0 to 10, with 0 being no pain and 10 being the worst pain you could have.
  • Describe what the pain feels like. Is it sharp, dull, throbbing, steady
  • Point out the exact places it hurts, either on your body or on a drawing. Note whether the pain stays in one place or whether it moves outward from the spot.
  • Explain when you feel pain. Note when it starts, how long it lasts, if it gets better or worse at certain times of the day or night, and if anything you do makes it better or worse.
  • Describe how your pain affects your daily life. Does it stop you from working? Doing household chores? Seeing friends and family? Going out and having fun?
  • Make a list of all the medicines you are taking (for any reason). If you are taking any for pain relief, how much do they help?
  • Talk about any side effects that you have from your pain control medicine, such as constipation or other changes in bowel habits, or feeling groggy or "out of it." Many of these problems can be helped.
  • Keep a record of your pain. Jotting down notes about your pain can help you track changes over time. It can also show how you respond to any pain control medicine or other treatment you receive.

Nervous System Changes (Neuropathy)
Sometimes cancer treatment can cause damage to your nervous system. This is called neuropathy or problems with nerve function. Sometimes these symptoms can be made worse by other conditions, such as diabetes, kidney failure, alcoholism, and malnutrition. Most people first notice symptoms in their hands or feet, usually starting with their fingertips and toes. Sometimes, the tingling and pain move up the fingers to the hands or from the toes to the feet.

Common symptoms include tingling, burning, weakness, or numbness in your hands or feet; sudden, sharp, stabbing, or electric shock pain sensations; loss of sensation of touch; loss of balance or difficulty walking; clumsiness; trouble picking up objects or buttoning clothes; hearing loss; jaw pain; constipation; and being more - or less - sensitive to heat and cold.

Symptoms can start when you begin chemotherapy or after treatment. If they do, tell your health care team right away. Symptoms can improve over time, but it may take up to a year or more.
Managing Nervous System Changes

  • Be careful when handling knives, scissors, and other sharp objects.
  • Avoid falling. Walk slowly, hold onto handrails, and put no-slip bath mats in your tub or shower. Remove area rugs or cords you could trip over. Steady yourself when you walk by using a cane or other device.
  • Wear tennis shoes or other footwear with rubber soles.
  • Use a thermometer and gloves instead of your bare hand. These can help you avoid being burned when checking water temperature. If possible, lower the temperature setting on your hot water heater.
  • Allow yourself time to rest.

Lymphedema or Swelling
Lymphedema is a swelling of a part of the body caused by the buildup of lymph fluids. It often happens in the arm, leg, face, or neck. It can be caused by cancer or its treatment. There are many different types of lymphedema. Some types happen right after surgery, are mild, and don't last long. Other types can occur months or years after cancer treatment and can be quite painful. These types can also develop after an insect bite, minor injury, or burn.

People who are at risk for lymphedema are those who have had:

  • Breast cancer. If you had radiation therapy, or had your underarm lymph nodes removed, or had radiation in the underarm area after your lymph nodes were removed
  • Melanoma of the arms or legs. If you had lymph nodes removed and/or had radiation therapy
  • Prostate cancer. If you had surgery or radiation therapy to the whole pelvis
  • Cancer of the female or male reproductive organs. If you had surgery to remove lymph nodes or had radiation therapy
  • Other cancers that have spread to the lower abdominal area. The pressure from the growing tumor can make it hard for your body to drain fluid.
  • Something is, such as bath water or cooked food. You may be less able to feel hot and cold now.

Mouth or Teeth Problems

Many people who have been treated for cancer develop problems with their mouth or teeth. Some problems go away after treatment. Others last a long time, while some may never go away. Some problems may develop months or years after your treatment has ended.
Radiation or surgery to the head and neck can cause problems with your teeth and gums; the soft, moist lining of your mouth; glands that make saliva (spit); and jawbones. If you were treated with certain types of chemotherapy, you may also have these problems. This can cause:

  • Dry mouth
  • Cavities and other kinds of tooth problems
  • Loss of or change in sense of taste
  • Painful mouth and gums
  • Infections in your mouth
  • Jaw stiffness or jawbone changes

Who has these problems?

  • Almost all people who have had radiation therapy to the head and neck
  • Most people who have had bone marrow transplants
  • About two out of every five people treated with chemotherapy

Preventing or Relieving Mouth or Teeth Problems

  •   Keep your mouth moist.
    • Drink a lot of water.
    • Suck on ice chips.
    • Chew sugarless gum or suck on sugar-free hard candy.
    • Use a saliva substitute to help moisten your mouth.
  • Keep your mouth clean.
    • Brush your teeth, gums, and tongue with an extra-soft toothbrush after every meal and at bedtime. If it hurts, soften the bristles in warm water.
    • Ask your dentist for tooth sponges, such as Toothettes® or Dentips®, that you can use in place of a toothbrush.
    • Use mild fluoride toothpaste (like children's toothpaste) and a mouthwash without alcohol.
    • Floss your teeth gently every day. If your gums bleed or hurt, stay away from the areas that are bleeding or sore, but keep flossing your other teeth.
    • Rinse your mouth several times a day with a solution of 1/4 teaspoon baking soda and 1/8 teaspoon salt in 1 cup of warm water. Follow with a plain water rinse.
    • If you have dentures, clean, brush, and rinse them after meals. Have your dentist check them to make sure they still fit you well.

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.

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.

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.