During active treatment, our cancer team works proactively with patients to manage the symptoms of cancer and various treatment modalities. While some cancer survivors are able to heal on their own after treatment and resume their active lives without lingering physical effects, other patients have lasting issues from these treatments or from the cancer itself. Our survivorship and wellness program includes counseling, rehabilitation, and medical care to help manage any long-term effects, from pain to physical changes, to disturbances in sleep or concentration.
Chronic Pain
Pain that continues after chemotherapy, radiation, or surgery may occur. However, pain can usually be reduced or managed. Treatment for chronic pain may include medicinal and non-medicinal options or a combination of both. It’s important to speak with your health care team about your symptoms. Keeping a record of your pain (timing, activity, pain level) can help your team recommend an appropriate treatment plan.
Chronic pain management may work best when medication is taken preventatively on a regular schedule, rather than “chasing” the pain. For mild to moderate pain, over-the-counter or other non-narcotic (non-opioid) drugs can provide effective relief.
For non-medicinal comfort and relief, consider:
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Cognitive Changes
Chemotherapy and radiation can cause cognitive problems such as forgetfulness, brain fog, and inability to concentrate. It may take more mental effort to complete or stay focused on a task. It’s a common-enough problem that there’s a name for it: “chemo brain.” The duration of chemo brain may vary and has an effect on a patient’s quality of life. There are steps you can take to treat this condition, beginning with discussing your symptoms with your cancer care team or primary care doctor.
Our cancer rehabilitation program includes occupational therapy to help with cancer-related cognitive issues. We can also refer patients for behavioral health support when appropriate. At-home strategies for coping with cognitive problems include:
- Physical exercise
- Spending time in nature and getting fresh air
- Meditation, yoga, and other relaxation techniques
- Setting reminders on your smart phone or keeping detailed written or digital notes in one place
- Puzzles, games, and other brain challenges such as learning a new skill
- Getting plenty of rest
- Eating a healthy diet rich in plant-based foods
- Establishing routines — keeping to a daily schedule; storing keys, chargers, remote controls, and other objects in a consistent place
- Avoiding multi-tasking
Fatigue
Persistent exhaustion after active cancer treatment, such as chemotherapy, is not unusual. Still, the specific causes of fatigue may vary, so treatment may involve a team approach to identify the root cause and address it appropriately. Fatigue management may include:
- Sleep evaluation and intervention
- Sleep hygiene — such as going to bed and getting up at a consistent time each day, minimizing naps, and avoiding stimulants like caffeine
- or alcohol in the evening
- Dietary changes or supplements—such as eating nutrient-dense foods, increasing hydration, adding more protein, eating several smaller
- meals instead of three larger meals, adding iron or other minerals or vitamins if needed
- Regular exercise to boost energy
- Emotional support and counseling and depression screening
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Neuropathy
Chemotherapy and other cancer treatments like surgery or radiation can cause nerve damage to the hands, legs, or feet, also known as peripheral neuropathy. Patients with this condition often describe sensations such as tingling (pins and needles), burning, shooting pain, or numbness, and complain of clumsiness, trouble walking, or feeling unsteady on their feet. Your palliative care and pain management team or primary care doctor may prescribe medication to manage painful symptoms. Other interventions include:
At home, to help manage symptoms:
- Avoid alcohol
- Control your blood sugar if you are diabetic
- Take precautions to avoid injury to extremities — be careful handling sharp tools, avoid exposure to extreme temperatures, wear supportive shoes that fit comfortably and cover your entire foot, beware of tripping hazards such as throw rugs or dimly lit paths
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Osteoporosis
Certain cancer medications, such as high-dose corticosteroids and hormonal therapies, can weaken bones and make them more fragile. Osteoporosis is a condition women are also more susceptible to when estrogen levels decrease in menopause. It can be treated with medication to increase bone density. Additional recommendations to strengthen bones or manage osteoporosis include:
- Weight-bearing exercise
- Exercises like yoga and Pilates for balance and strength
- Increasing vitamin D and calcium
- Osteoporosis physical therapy
- Fall prevention precautions
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Pelvic Floor and Sexual Dysfunction
Chemotherapy, hormonal therapy, surgery and radiation treatments can have short or long-term effects on the pelvic region of the body, from bladder or bowel incontinence in women and men, to vaginal changes in women, and erectile dysfunction in men. Our pelvic floor therapy program can help improve symptoms in women and men. We also treat a range of conditions for women at our urogynecology practice at Lancaster General Health’s Women’s Specialty Center.
At-home tips for managing urinary incontinence include:
- Kegel exercises to strengthen urinary muscles
- Limiting foods and beverages that can irritate the bladder, such as caffeine, alcohol, or citrus juice
- Emptying your bladder on a regular schedule before it becomes urgent
- Wearing a pad for incontinence to absorb any leakage
- Breathing and pelvic floor relaxation exercise for the diagnosis of pelvic pain
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Second Cancers
A second cancer is a new cancer that is unrelated to the previous cancer diagnosis but could be the result of the treatment for a previous cancer. It is not to be confused with a cancer recurrence, which is when the same type of cancer returns after treatment. The fear of a second cancer is common among cancer survivors. While it isn’t always clear why some people will develop a second cancer, there is a higher risk for people who survived certain types of cancers, had specific types of treatment, or have a family cancer syndrome.
Patients who are part of Penn Medicine Lancaster General Health’s Survivorship and Wellness Program are provided a care plan that includes guidance for screenings and surveillance to ensure early detection should a recurrence or second cancer develop. The care plan also includes recommendations for healthy lifestyle habits that are known to reduce the risk for cancer, including:
- Regular exercise
- A healthy diet that is low in red meat and high in plant-based foods
- Limiting alcohol
- Quitting tobacco or nicotine
- Consulting with a genetic counselor if you have cancer at a young age or a family history of cancer
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Skin, Hair, and Nail Changes
Cancer and treatments like chemotherapy and radiation therapy can cause changes to a person’s skin, hair, and nails, including:
- Hair loss or thinning strands
- Itchy or dry skin or rashes
- Hot flashes and sweating
- Changes in skin tone or texture
- Scars or pressure sores
- Changes in texture, color, and health of nails or cuticles
- Lymphedema—when lymph nodes are removed, lymphatic fluid can build, creating tightness in the skin, swelling or heaviness in limbs, changes in skin texture and flexibility
The Cancer Institute Boutique at Ann B. Barshinger Cancer Institute can help with many of these conditions, and offers wigs; organic products for skin, nails, and hair; cosmetic solutions for scars and brow or lash loss; hair salon services; manicures and pedicures; and more.
For dry skin, irritation, and sensitivity, suggestions for self-care include:
- Using mild products that are alcohol and fragrance-free
- Bathing in warm water, not hot
- Wearing loose-fitting clothing and soft fabrics
- Staying well hydrated
- Adding oatmeal, bath oil, or baking soda to your bath
- Keeping nails short to avoid scratching
- Taking precautions against skin cancer, including limiting sun exposure, liberally applying sunblock, avoiding tanning facilities, and
- conducting regular checks for suspicious moles (both self-checks and dermatologist exams)
- Talking to your cancer care team or primary care doctor about your symptoms — your doctor may be able to prescribe medication to ease itching
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Sleep Disturbances
Cancer treatments can affect a patient’s sleep patterns even after active treatment has ended. In addition to chemotherapy and medications like steroids, which can disturb sleep, mental stress, pain, and other effects of dealing with cancer can keep you tossing and turning at night. Penn Medicine Lancaster General Health has a Sleep Medicine Program to evaluate and treat lasting insomnia or daytime fatigue. Good sleep hygiene — adopting habits to promote better sleep — can also help. This includes:
- Regular exercise (not close to bedtime)
- Keeping your bedroom cool and dark at night
- Limiting beverages in the evening, including those containing alcohol and caffeine
- Limiting naps to 30 minutes in the early afternoon
- Avoiding large meals too close to bedtime
- Putting away your smartphone and other electronic devices at least an hour before bedtime
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Additional resources for managing cancer-related side effects can be found on the American Cancer Society website and on OncoLink.