Life After Cancer

A cancer survivor is any living person who has ever been diagnosed with cancer. Someone is known as a cancer survivor from their initial diagnosis to the end of their life. Due to advances in medicine, cancer patients are surviving longer and leading fuller lives both during and after treatment. There are about 14 million cancer survivors living in the United States, and about 75% of American families have at least one family member who has been diagnosed with cancer. When a patient completes treatment, it can be both relieving and stressful. The patient may feel excited to be finished with treatment to get back to the life he or she had before cancer. However, the patient may also have new questions and concerns after completing treatment. These survivors may feel concerned that their cancer may come back or confused about what to do next.

This page covers the most common physical side effects, emotional and spiritual issues, and practical concerns that cancer survivors often face. It also contains helpful advice for dealing with these issues, and provides a roadmap for a patient's journey after cancer.

Collapsed Physical Side Effects

Physical Side Effects

Some cancer survivors experience long-term physical side effects as a result of the cancer and its treatments. Survivors should ask a doctor which side-effects to watch out for, based on the type of cancer they had and the treatments they received. It is common for survivors to worry that a symptom or side effect they experience means that the cancer has returned. However, these side effects are commonly experienced by cancer survivors, and do not necessarily mean the cancer has returned.

Fatigue

Some cancer survivors experience chronic fatigue. This fatigue may get better quickly or last long after treatment ends, depending on the type of cancer the patient had and the treatments they received.

Memory & Concentration

Chemotherapy can cause a side-effect commonly known as "chemobrain." Cancer survivors describe "chemobrain" as a "brain fog," and often have trouble concentrating, paying attention, or remembering things. "Chemobrain" usually goes away after treatment ends.

Peripheral Neuropathy

Peripheral neuropathy occurs when damage to the nervous system interferes with transmissions between the brain and the rest of the body. Common symptoms of peripheral neuropathy include tingling or pain in the hands or feet, burning, weakness, numbness, or sensitivity to hot or cold. This condition is usually irreversible after treatment ends.

Incontinence

Incontinence is urine leakage or the inability to control the flow of urine. Incontinence may be a problem if the prostate or bladder has been removed as part of cancer treatment. Talk to your doctor about treatments and procedures to manage this condition.

Early Menopause

Menopause is a period in every woman's life when she becomes infertile and stops having periods. Chemotherapy and hormone therapy medications can reduce the hormones in a woman's body and cause early menopause.

Diabetes

Steroid drugs can cause blood glucose levels to rise in some patients. These glucose levels may remain elevated after treatment ends and put these survivors at higher risk for diabetes.

Endocrine Changes

Some cancer treatments suppress the sex hormones that certain cancers need to grow and function. This may cause loss of libido, memory loss, muscle loss, anemia, depression, or weight gain. Talk to a doctor about the different ways to manage these symptoms.

Hypothyroidism

Some cancer survivors who have undergone radiation therapy to the head and neck region may develop hypothyroidism, a condition characterized by low levels of the thyroid hormone. This condition may cause weight gain, constipation, dry skin, and sensitivity to hot and cold. Talk to a doctor about ways to manage this condition.

Chronic Pain

Some cancer survivors may experience long-term pain. This pain may be a result of surgeries and other cancer treatments damaging nerves in the body. Talk to a doctor about medications and other ways to manage this pain.

Sexual Dysfunction & Infertility

Chemotherapy drugs and radiation therapy for certain cancers can cause sexual dysfunction and infertility.

Lymphedema

Lymphedema is a condition in which a buildup of lymph fluid in the body causes a body part to swell. Lymphedema typically occurs in the head, neck, arms, and legs.

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Digestive Problems

Chemotherapy and radiation therapy can damage the rapidly-dividing cells in the digestive tract. Some cancer survivors may experience problems such as chronic diarrhea and constipation. Patients with digestive problems may not be able to absorb all the required nutrients from the food they eat, which can lead to more serious problems like dehydration, malnutrition, pain, and inflammation. Talk to your doctor if you experience excessive or uncontrollable diarrhea. This side-effect can be life-threatening if not managed properly.

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Heart Problems

Certain chemotherapy drugs and radiation therapy to the chest cavity can damage the heart. The risk of heart damage increases with the age of the patient and the dosage of medication received. Chemotherapy medications that may cause heart damage include anthracyclines such as doxorubicin and epirubicin, and others such as cyclophosphamide, paclitaxel, and trastuzumab. These medications can cause inflammation of the heart muscle (myocarditis), congestive heart failure, arrhythmias, coronary artery disease, problems with the heart valves, and problems with the heart's electrical system. These conditions can increase the risk of heart attack and stroke. Ask your physician if your treatment plan puts you at risk for heart damage.

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Lung Problems

Certain chemotherapy drugs and radiation therapy to the chest cavity can damage the lungs. Medications most likely to damage the lungs include: bleomycin, carmustine, prednisone, dexamethasone, methotrexate, and cyclophosphamide. These medications can cause inflammation (pneumonitis) and scarring (pulmonary fibrosis) of the lung tissue, which can cause difficulty breathing, shortness of breath, coughing, wheezing, and fatigue. Pneumonitis is a condition in which the alveoli become inflamed, making it difficult to breath and absorb oxygen into the bloodstream. Pulmonary fibrosis is a condition in which scar tissue forms on the lungs, causing them to lose elasticity and making it difficult for the lungs to expand and fill with air properly. Ask your physician if your treatment plan puts you at risk for lung damage.

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Bone Problems

Osteoporosis is a condition that causes the bones to lose density and become weak and fragile. Many people, especially women, develop osteoporosis as they get older. This disease can greatly increase the risk of bone fractures and breaks. Certain chemotherapy drugs can decrease the amount of calcium in the body, and accelerate osteoporosis and bone thinning. Hormone therapy, radiation therapy, and steroid medications may also cause bone problems. Ask you physician if you are at risk for bone damage from your cancer treatments.

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Liver Problems

The liver is an organ whose primary functions include releasing bile into the intestines to aid in digestion, breaking down and storing nutrients, clearing medications from the body and removing toxic substances from the blood. Certain chemotherapy drugs can place added stress on the liver, which can eventually damage the liver and prevent it from functioning properly. Symptoms of liver damage may include dark urine, yellow skin and eyes (jaundice), abdominal pain, swelling in the abdomen, weakness, and fatigue. Ask your doctor if your cancer medications put you at risk for liver damage, and what steps you may take to prevent this complication.

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Kidney Problems

Your kidneys are two fist-sized, bean-shaped organs located in the back of your torso, just above your waist. Your kidneys are responsible for filtering waste and excess water from your blood and turning it into urine. Certain cancer medications, including chemotherapies and biological therapies, can damage the kidneys and cause this excess water and waste to build up in the body and cause the kidneys to stop functioning properly. The risk of kidney damage is higher in patients with comorbidities such as pre-existing kidney damage, diabetes, and heart disease. Symptoms of kidney damage may include dark urine, pain when urinating, blood in the urine, fatigue, and muscle weakness. Cancer medications that may cause kidney damage include cisplatin, interleukin-2, cytarabine, methotrexate, carboplatin, and others. Ask your physician if you are at risk for kidney damage and what steps you may take to prevent/inhibit this damage.

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Secondary Cancers

Certain cancer treatments can increase the risk of developing secondary cancers later in life, especially if you were treated for cancer as a child. Alkylating agents such as cyclophosphamide, cisplatin, and carboplatin, anthracyclines such as doxurubicin and epirubicin, and other chemotherapy medications carry the greatest risk. Acute Myeloid Leukemia (AML) is the most common secondary cancer caused by these medications. MDS and ALL may also occur in some cases. Radiation therapy can also increase risk of developing a secondary cancer. The most common cancer types linked to radiation therapy are leukemia and solid tumors of the thyroid, skin, bone, breast, and lung. The risk depends on the radiation dosage, the area of treatment, and the patient's age at time of treatment.

Collapsed Emotional Side Effects

Emotions

Cancer survivors often face a flood of emotions after finishing treatment. These emotions may include grief, depression, stress, a loss of self-esteem, loneliness, and anger. For many survivors, these emotions stem from the fear of the cancer returning. Worrying about a cancer recurrence is normal, especially within the first year of finishing treatment, and these feelings typically go away with time as the survivor resumes normal activities. However, some survivors may dwell on these negative feelings. If these feelings are overwhelming and get in the way of your daily life, be sure to tell your doctor. Your doctor can recommend counseling and support groups to help you through this time. Some people find that expressing strong emotions like anger or sadness helps to let go of them. Others deal with these feelings by talking to friends, family members, or other cancer survivors. You may also choose to keep a record and reflect on your feelings.

Spirituality

Many cancer survivors look at life in new ways. After treatment ends, survivors often reflect on their values, priorities, and the meaning of life. For many, this change is very positive, and causes them to fully enjoy each day and make important changes in their lives. Others may feel angry and question their spiritual beliefs because of the ordeal of living with cancer. Cancer survivors do not need to deal with these spiritual issues and life questions on their own, and can always talk to a trusted clergy member or professional counselor.

Social Life and Relationships

Cancer survivors often notice changes in their relationships. Many survivors find that the experience of overcoming cancer can strengthen bonds with close friends and family members and help form deeper relationships. Other survivors find that the stress of cancer can put a strain on relationships. Family members may not realize that recovery takes time, and may expect things to return to normal right away. This can cause survivors to feel overwhelmed and frustrated that they aren't getting the support they need. Other times, family members may continue to give survivors extra attention and support when they just want things to return to normal.

Going back to work may help survivors feel like they are getting their life back on track, and most survivors will return to work if they are physically able to. Research has shown that survivors who continue to work are no less productive on-the-job. However, survivors may worry that questions about their health may affect their employment. Additionally, relationships with friends and coworkers can change after cancer. Some people may seem very supportive, and others may make you angry or frustrated. It may be hard for others to understand the emotional stress you may feel after completing treatment. Be sure to talk with your friends and coworkers to help them better understand how you feel.

Financial Concerns

Risk of Recurrence and Follow-up Care

After treatment, survivors may have questions about follow-up care, such as which doctors to see, how often to see them, which tests are needed, how to relieve symptoms, how long to feel normal, and anything to do to prevent a recurrence. After treatment, the survivor should receive a follow-up plan from your treatment team. A follow-up plan tells him or her what to do to stay healthy, physically and emotionally, depending on the type of cancer and the treatments received. A follow-up plan should address issues such as long-term side effects, signs and symptoms of a recurrence, information about emotional and social support, recommendations for healthy living, and a schedule of recommended screening tests and examinations.

Most survivors see their doctor every two to three months for a few years after treatment. The doctor gives a physical exam, looks for any signs or symptoms of a recurrence, and assesses long-term side effects. Most patients also receive blood tests and imaging tests to check for any signs of cancer in the body. It is extremely important to keep all follow-up and screening exams, maintain a healthy lifestyle, and talk to your doctor about ways to manage any long-term side effects you may experience.

Staying Healthy

One of the best ways to deal with these practical and emotional concerns and to ease your worries is to stay in good health. Keep all scheduled follow-up appointments with your doctor and be sure to tell him or her about any changes in your body. Here are some other helpful tips to stay healthy:

Keeping your Records Current and Communicating with Your Doctor

Maintaining a full record of your medical history for your doctors is an important part of developing a follow-up plan. Here is some of the information you should keep on hand:

Questions to Ask the Doctor

Completing cancer treatment and becoming a survivor can be a confusing time, but can also bring relief and happiness. Allow healing time for you and your family members and caregivers. Think about what you can do to get your life back on track and begin living without cancer. This can be a time of new beginnings when many people learn to appreciate each day and the things that are truly important to them.