Download side effects treatment cancer of

A practical guide to living
with and after cancer
side effects
of
cancer
treatment
Contents
Contents
About this booklet
3
What are side effects?
4
Treatment for cancer
5
Changes to bone marrow and blood cell production
7
Hair loss
12
Tiredness (fatigue)
14
Mouth problems
16
Feeling sick (nausea) and being sick (vomiting)
18
Eating problems
20
Bowel changes
24
Skin changes
27
Peripheral neuropathy
29
Lymphoedema
32
Fertility
33
Changes to your sex life
35
Hormonal changes
36
How we can help you
39
Other useful organisations
43
Further resources 47
1
Side effects of cancer treatment
2
About this booklet
About this booklet
This booklet aims to help you understand more
about side effects of cancer treatment. It gives a
brief overview of some common side effects that
might happen during treatment for cancer. It also
suggests ways to help manage them.
Everyone’s experience of cancer and its treatment is
different. The doctors and nurses at your hospital will discuss
in detail with you the treatment you might have, and its
possible side effects.
We have further information about specific treatments and
coping with side effects. We also have information about
different types of cancer, and aspects of living with cancer.
If you’d like to discuss this information, call the Macmillan
support line free on 0800 808 00 00, Monday–Friday,
9am–8pm. If you’re hard of hearing you can use textphone
0808 808 0121, or Text Relay. For non-English speakers,
interpreters are available. Alternatively, visit macmillan.org.uk
Turn to pages 43–49 for some useful addresses
and websites.
3
Side effects of cancer treatment
What are side effects?
Side effects happen as a direct result of treatment for cancer.
They can be mild and temporary. But sometimes they can
have a bigger impact on your quality of life. They are different
from symptoms you may have experienced before the cancer
was diagnosed.
The side effects you may have will depend on your treatment.
You’ll probably only have a few of the side effects mentioned
here. Some people don’t experience any side effects and can
feel better during treatment than before diagnosis. Your doctors
or nurses will tell you about any side effects you’re likely to
have. They’ll also be happy to answer any of your questions
if there’s anything you don’t understand.
This booklet describes some of the more common physical
side effects you might have, and offers some suggestions
about how to deal with them. You should always ask your
doctor before using any medicines, creams, mouthwashes or
dietary supplements.
The thought of side effects can be frightening, but there are
many different ways to help manage them.
Coping with cancer and the side effects of treatment
can affect your feelings too. You might find our booklet
How are you feeling? useful.
4
Treatment for cancer
Treatment for cancer
Cancer can be treated in different ways depending on what
type of cancer it is, where it is in the body, and whether it
has spread (its stage). You may have more than one type of
treatment. Your doctors will discuss with you the best treatment
for your situation. When planning your treatment, they will take
into account your general health as well as the type and stage
of the cancer.
Some cancers are very slow growing, so treatment may not
be needed when the cancer is first diagnosed.
Your treatment may include one or more of the following:
•• Surgery – This aims to remove a tumour and nearby
tissues that may contain cancerous cells.
•• Chemotherapy – The use of cytotoxic (anti-cancer)
drugs to destroy cancer cells.
•• Radiotherapy – The use of high energy x-rays and similar
rays (such as electrons) to treat disease.
•• Hormonal therapies – These alter the way particular
hormones are produced or work in the body.
•• Biological therapies – This term covers a number of
treatments that work in a variety of ways. These include
using the body’s immune system to destroy cancer cells,
or blocking cancer cell growth.
5
Side effects of cancer treatment
There are also some other types of treatment, which are used
less commonly. Your doctor will explain these to you if they
are suitable for your situation.
Treatment affects each person differently, and many
people experience some side effects during treatment.
In the following sections, we outline some common
side effects of cancer treatment and some ways you
may be able to manage them.
6
Changes to bone marrow and blood cell production
Changes to bone marrow
and blood cell production
Chemotherapy, radiotherapy and biological therapies
can all affect your bone marrow and blood.
The marrow inside your bones produces stem cells,
which develop into the three different types of blood cell:
red blood cells, white blood cells and platelets. Some cancer
treatments can affect the production of these cells in the
bone marrow, and so reduce the number of cells in the blood.
This is temporary and your blood cells will recover between
treatments. If you’re having treatment that may affect the bone
marrow, you’ll have regular blood tests to monitor this.
Risk of infection (low number of white blood cells)
The immune system is the body’s defence against causes of
infection, such as bacteria and viruses. It’s very complex and has
to work properly to protect us from infections. Cancer and its
treatment can affect the immune system in a number of ways.
White blood cells fight infection. If a treatment reduces the
number of white blood cells in your blood, this can put you
at a greater risk of getting an infection.
Surgery can make you more prone to infection because it
involves making a break in the skin or mucous membranes,
which are part of the body’s natural defences.
Radiotherapy often has a mild and temporary effect on the
immune system.
7
Side effects of cancer treatment
Chemotherapy can often have a major effect on the immune
system, and may reduce the body’s defences against infection
for some months, both during and after treatment. This is
because chemotherapy reduces the production of white blood
cells by the bone marrow. People having chemotherapy are
at risk of developing infections at any time during the treatment,
but are particularly at risk of picking up infections 7–14 days
after the chemotherapy treatment. This is when the level of
white blood cells is at its lowest. This time is known as the
nadir, and it can vary slightly depending upon the
chemotherapy drug, or combination of drugs, used.
Infections can usually be effectively treated with antibiotics.
If an infection is not treated quickly, it can be much more
difficult to get it under control.
We have a slide show on our website about how to
avoid infections during chemotherapy treatment. You
can watch this at macmillan.org.uk/avoidinginfection
What you can do:
•• You must contact the hospital straight away if your
temperature goes above 38°C (100.4°F) or if you
suddenly feel unwell, even with a normal temperature.
•• Keep away from crowded places and people you know
to have an infection as much as you can.
•• Always wash your hands before preparing food.
•• Speak to your doctor or nurse about any foods you should
avoid during treatment. This may include paté, uncooked
seafood and unpasteurised dairy products that might
contain bacteria, as these could make you unwell.
8
Changes to bone marrow and blood cell production
Anaemia (low number of red blood cells)
Some chemotherapy drugs, biological therapies or
radiotherapy, especially if aimed at the spine or pelvic
areas, can reduce the number of red blood cells.
Red blood cells contain haemoglobin (Hb), which carries
oxygen around the body. If you have a shortage of red blood
cells, you will have anaemia. This can make you feel tired and
lethargic. You may also feel breathless, as there is less oxygen
being carried around your body. People with anaemia can feel
dizzy and light-headed, and have aching muscles and joints.
You will have blood tests to measure your haemoglobin level.
If it’s low, you may be offered a blood transfusion. The extra
red blood cells in the transfusion will pick up oxygen from your
lungs and take it around the body. This should make you feel
more energetic and ease your breathlessness.
Bruising and bleeding (low number of platelets)
Platelets help the blood to clot. If you have a low number of
platelets in your blood, you may bruise easily, have nosebleeds,
bleeding gums, and bleed more heavily than usual from minor
cuts or grazes. You may develop a rash of small red or purple
spots just beneath the skin, anywhere on the body, where
blood has leaked out of a nearby blood vessel. This is known
as a petechial rash. You should contact your doctor or the
hospital straight away if you develop any of these side effects.
You may have to go to hospital for a platelet transfusion.
This is given through a drip (infusion). The platelets will start
working immediately to prevent bruising and bleeding.
9
Side effects of cancer treatment
What you can do:
•• Take care to avoid injury, for example by wearing gloves
if you are gardening.
•• Use a soft toothbrush when brushing your teeth.
•• Tell your doctor if you have any nosebleeds, bleeding gums,
blood spots or rashes on the skin.
10
Side effects of cancer treatment
11
Side effects of cancer treatment
Hair loss
Some chemotherapy drugs can cause hair loss or hair thinning.
Hormonal therapies can also affect your hair. Radiotherapy
causes hair loss in the targeted treatment area.
If you’re having treatment with certain chemotherapy drugs,
your hair may fall out. Your hair may become brittle and start
breaking off near the scalp. This can be very upsetting. You may
also lose your body hair, eyelashes or eyebrows. If you lose
nasal hairs, you may have a runny nose.
The hospital staff will tell you if you’re likely to lose your hair
as a result of treatment. They will also be able to arrange a
wig for you if you’d like one. You may be entitled to a free wig
– your nurse can tell you more about this. Your hair will usually
grow back over a few months, after you’ve finished treatment.
Radiotherapy can cause hair loss in the treatment area –
where the radiation beam enters the body, and sometimes
where the beam exits as well. The hair should grow back after
your treatment, although this will depend on the dose
of radiotherapy you’ve had.
12
Hair loss
What you can do:
•• Have your hair cut short before your chemotherapy
treatment starts, (if your doctor confirms that the treatment
is likely to cause hair loss). The weight of long hair pulls
on the scalp and may make your hair fall out sooner.
•• Brush your hair gently with a soft brush, and avoid using
hairdryers, tongs and straighteners.
•• Use gentle hair products and avoid perming or colouring
your hair.
•• Instead of a wig, you could wear a hat, turban or scarf.
If you decide not to cover your head, remember to use
a high protection factor sun cream (at least factor 30) on
your scalp when you go out, even when it’s cloudy outside.
•• Some Toni&Guy salons have specially trained stylists who
can advise you on how to care for your hair during and
after treatment.
•• Scalp cooling is a method of reducing hair loss that may
be helpful for some people being treated with particular
chemotherapy drugs. You can ask your doctor or nurse
if it’s available at your hospital.
We have a video on our website about coping with hair
loss. You can watch this at macmillan.org.uk/hairloss
13
Side effects of cancer treatment
Tiredness (fatigue)
Fatigue is a general feeling of extreme tiredness. Having a
good night’s sleep doesn’t usually help. It can affect your
everyday life, meaning that even simple tasks can feel
exhausting and that it’s difficult to concentrate on anything.
Chemotherapy, radiotherapy, surgery, biological therapies and
hormonal therapies can all cause fatigue. Sometimes, other side
effects of the treatment can lead to fatigue – for example if
you’re not eating enough because of a sore mouth (see page
17) or if your treatment is causing anaemia (see page 9).
What you can do:
•• Speak to your doctor or nurse if you’re feeling tired all
the time. They can check the cause of your tiredness.
•• Try to cut down on unnecessary tasks, and ask family
and friends to help you out.
•• If you have a big task to do, try to break it down into shorter,
more manageable ones so you can rest in between.
•• Do necessary tasks at times when you have the most energy.
Prepare meals in advance and keep prepared food in the
freezer, ready to heat up.
•• Try to do a little light exercise, such as going for a walk,
as it may actually make you feel less tired.
•• Try to keep to a regular sleep routine.
We have a video on our website about coping with
fatigue. You can watch this at macmillan.org.uk/fatigue
14
Side effects of cancer treatment
15
Side effects of cancer treatment
Mouth problems
Radiotherapy can cause your mouth to become dry,
while chemotherapy, radiotherapy and some biological
treatments can make your mouth sore and prone to
mouth ulcers.
Dry mouth
Radiotherapy treatment to the head and neck can cause
the glands in the mouth to produce less saliva. This can
be temporary or permanent.
What you can do:
•• Speak to your doctor, who may be able to prescribe drugs
that can help stimulate the production of saliva.
•• Keep your mouth clean. Brush your teeth with a soft
toothbrush after every meal. You should also have regular
dental checks, as lack of saliva can increase the risk of
tooth decay.
•• Keep your mouth moist – sip water or sugar-free drinks
regularly. Some people find sucking on ice soothing.
•• Try using an artificial saliva product to moisten your mouth.
•• Try chewing sugar-free gum or sucking on sugar-free sweets
to encourage saliva production.
•• Avoid alcohol, caffeine and cigarettes, as these can dry your
mouth even more.
16
Mouth problems
Sore mouth and ulcers
The lining of the mouth can become sore and ulcers may
develop. This is quite common with some of the newer
biological therapies. If this happens, you are more likely to
get a mouth infection. The most common infection is oral
thrush, which usually appears as white patches or a white
coating over the lining of the mouth and the tongue.
What you can do:
•• Clean your teeth gently at least twice a day with a
soft-bristled or children’s toothbrush. Try children’s
toothpaste if your usual brand is stinging your mouth.
•• Change your toothbrush regularly.
•• Use a mouthwash prescribed by your doctor or given to
you at the hospital – your doctors and nurses at the hospital
will advise you on what you should and shouldn’t use.
•• Drink plenty of liquid (at least three pints a day if possible).
•• Eat soft, moist foods and avoid neat spirits, tobacco and
spicy foods.
•• Use Vaseline® or a flavoured lip balm to keep your
mouth moist.
•• Tell your doctors if you have a sore mouth and if it
gets worse – you may have an infection, which will
need treatment.
We have a slide show on our website about mouth care
during chemotherapy. You can watch this at macmillan.
org.uk/mouthcare
17
Side effects of cancer treatment
Feeling sick (nausea)
or being sick (vomiting)
Chemotherapy, radiotherapy, biological therapies and
hormonal therapies can all make you feel sick (nausea) or
be sick (vomit).
Your hospital doctors will usually prescribe anti-sickness
medicines for you if nausea and vomiting are possible side
effects of your treatment. Often, a combination of more
than one type of anti-sickness drug is used. If one medicine
doesn’t work, tell your doctor. There are different types of
anti-sickness medicines, and some may work better for you
than others. There are very effective ways to help control and
prevent sickness.
What you can do:
•• Try to avoid greasy, fatty and fried foods.
•• Eat little and often.
•• Chew your food well.
•• Try food or drinks that contain ginger.
•• You could try wearing sea bands (available from
chemists) around your wrists – they use acupressure
to help relieve nausea.
•• If the smell of cooking puts you off food, try eating food
that’s cold or at room temperature instead. You could also
ask someone else to cook for you.
18
Feeling sick (nausea) or being sick (vomiting)
•• Try eating peppermints or drinking peppermint tea.
•• Try sitting by an open window, so there’s plenty of fresh
air in the room while you eat.
•• Sit at a table in an upright position when eating,
and remain sitting for a short time after the meal.
19
Side effects of cancer treatment
Eating problems
Chemotherapy, radiotherapy, biological therapies and
hormonal therapies can all cause eating problems.
As well as the side effects already mentioned, you may have
other symptoms that make eating difficult or uncomfortable.
These include:
Loss of appetite
You may just not feel like eating, or you may feel very sick
or too tired to eat.
What you can do:
•• Add extra calories and protein to your food. Butter, cream,
and full-fat milk will all add calories without meaning you
have to eat more.
•• Eat little and often.
•• If you can’t face food, try having a nourishing drink,
such as a fruit smoothie or milkshake, instead.
•• Try powders, drinks or ready-to-use supplements.
Some supplements are available from your chemist
and others on prescription.
•• Tell your doctor or nurses if you have lost your appetite –
they can refer you to a dietitian or prescribe nutritional
supplements for you.
We have a slide show on our website about things you
can do to help if you’ve lost your appetite. You can
watch this at macmillan.org.uk/poorappetite
20
Eating problems
Change in taste
You may find that your sense of taste changes. Food may
have a metallic taste, a different texture or no flavour at all.
What you can do:
•• Try using seasonings, spices and marinades to enhance
the flavour of food.
•• Try eating cold foods as they may taste better than hot foods.
•• Use plastic cutlery if you’ve developed a metallic taste.
•• Drink herbal or fruit teas if you go off tea and coffee.
•• Sharp-tasting foods, such as lemon and fruit juices,
may leave a pleasant taste in your mouth.
Swallowing problems
Chemotherapy and radiotherapy treatments for head or neck
cancers can affect the healthy cells in the lining of the throat.
This can make it painful to chew or swallow.
What you can do:
•• Where possible, keep eating your favourite foods, but make
changes to soften them. For example: cover foods in tasty
sauces and gravies; finely chop meat and vegetables,
and casserole or stew them; and cut the crusts off bread
for softer sandwiches. If you have a blender, you could
blend or liquidise cooked foods.
21
Side effects of cancer treatment
•• Let your doctor or dietitian know if you’re having difficulty
swallowing. They can advise you on making changes to
your diet to ensure you’re getting enough calories every day.
•• There are several shop-bought products that you may find
helpful. You can get these products from your chemist.
Your doctor or dietitian may give you a prescription for
some of them.
We have a booklet with more information on coping
with eating problems, which we can send you.
22
Side effects of cancer
Eating treatment
problems
23
Side effects of cancer treatment
Bowel changes
Chemotherapy, radiotherapy, hormonal therapies and biological
therapies can all cause bowel changes, such as constipation
or diarrhoea.
Constipation
Constipation is a common problem, but many people find it
embarrassing to discuss. Loss of appetite, poorly controlled
pain and nausea can all lead to constipation. A lack of fibre
(roughage) in your diet, low fluid intake and being less mobile
can also contribute. Some medicines can cause constipation,
particularly the painkillers morphine and codeine, and some
of the anti-sickness drugs used during chemotherapy. If you’re
taking regular painkillers, you may need a laxative to help
prevent constipation.
Everyone’s normal bowel pattern is different, but as a general
guide you should let your doctor or nurse know if you’ve not had
a bowel movement for three days, unless this is usual for you.
What you can do:
•• Try to include plenty of fibre in your diet. Good sources
of fibre include: wholegrain breakfast cereals; porridge;
muesli; wholemeal bread and flour; brown rice; wholemeal
pasta; and fresh fruit and vegetables with their skins on.
•• Drink plenty of fluids. Aim to drink at least two litres
(three and a half pints) of fluid a day.
•• Natural remedies for constipation include apricots, prunes,
prune juice and syrup of figs.
24
Bowel changes
•• Gentle exercise will help keep your bowels moving.
•• Flaxseed (linseed) can help ease constipation and soften
stools. One teaspoon or dessertspoon of the seeds can
be taken daily with a glass of water.
If you have cancer of the gullet (oesophagus) or bowel,
ask your doctor before taking fibre or linseed.
Diarrhoea
Diarrhoea may be a side effect of cancer treatments, such
as chemotherapy or radiotherapy to the pelvis. Infections can
also cause diarrhoea. Some medicines can cause diarrhoea,
and some cancers may prevent food from being absorbed
properly from the bowel, causing diarrhoea. Sometimes,
severe constipation can be mistaken for diarrhoea – when the
bowel is blocked by constipation, liquid stool (faeces) passes
around the solid faeces (sometimes called overflow), so it may
seem as though you have diarrhoea.
What you can do:
•• Cut down on your fibre intake from cereals, fruit and
vegetables. Eat peeled and cooked fruit and vegetables
instead of raw ones.
•• Avoid milk and dairy products, such as cheese, until the
diarrhoea has stopped.
•• Drink plenty of fluids to replace the water lost with
diarrhoea, but avoid alcohol and coffee. Also avoid fizzy
drinks, which can cause wind and stomach cramps.
•• Eat small, frequent meals made from light foods,
such as white fish, chicken, eggs (well cooked), white bread,
pasta and rice.
25
Side effects of cancer treatment
•• Avoid highly spiced or fatty foods.
•• Eat your meals slowly.
•• If the diarrhoea continues for more than two days, tell your
doctor. They can investigate the cause and prescribe some
anti-diarrhoea medicines for you.
•• Acidophilus or other bacteria found in live yoghurt or
live yoghurt drinks may help ease diarrhoea caused by
antibiotics. Antibiotics can kill off the healthy bacteria
normally found in the bowel, but the bacteria found in live
yoghurt may replace them. However, you should avoid
live yoghurt while you’re having chemotherapy or if your
immunity is low.
•• If you have ongoing problems with diarrhoea, knowing
you may need to get to a toilet quickly can make going
out a source of worry and embarrassment. The National
Key Scheme (NKS), for people with continence problems,
allows you to use about 9,000 locked public toilets in the
UK. Visit radar.org.uk or call 020 7250 3222 for more
information about the scheme.
Diarrhoea caused by radiotherapy
Diarrhoea is a common side effect of radiotherapy to the pelvis,
and your doctor will prescribe medicine to help with it. If you
have diarrhoea caused by radiotherapy, changing your diet
is unlikely to help, and it’s important that you take the antidiarrhoea medicines prescribed by your doctor.
We have more information about the possible effects
of pelvic radiotherapy, which we can send you.
26
Skin changes
Skin changes
Chemotherapy, radiotherapy, biological therapies and
hormonal therapies can cause a variety of skin problems.
Depending on your treatment and how you react to it,
you may experience some of the following symptoms:
Dry or discoloured skin (caused by chemotherapy)
What you can do:
•• Try using a moisturising cream, but if you’re having
radiotherapy as well as chemotherapy, check with your
doctor or radiographer before using it.
•• Use an electric razor instead of wet shaving, to minimise
the risk of cuts.
Increased sensitivity to sunlight (caused by
chemotherapy and radiotherapy)
What you can do:
•• Make sure you’re protected if you go out in the sun.
You should use a sun cream with a high sun protection
factor (SPF) – at least factor 30. Also wear a hat or scarf
on your head, and wear loose clothes made of cotton or
other natural fibres.
27
Side effects of cancer treatment
Red or sore skin (if you have light skin) or darker
skin with a blue or black tinge (if your skin is dark)
(caused by radiotherapy)
What you can do:
•• Only use unperfumed soaps and creams.
•• Don’t use any creams or dressings unless prescribed or
recommended by your specialist or radiographer. They may
suggest using an aqueous cream, aloe vera or arnica.
Rashes or itching (caused by some biological and
hormonal therapies)
What you can do:
•• Speak to your doctor or nurse, who can prescribe medicines
or recommend creams to help.
Sore skin on the palms of your hands and the soles
of your feet (caused by some chemotherapy drugs
and biological therapies)
What you can do:
•• Let your specialist know as soon as this develops, as they
may need to adjust your treatment.
28
Peripheral neuropathy
Peripheral neuropathy
Some chemotherapy drugs and some surgery can cause
numbness or tingling in the hands or feet. This is a symptom
of peripheral neuropathy. Peripheral neuropathy is a term used
to describe damage to nerves that are outside the brain and
spinal cord – the peripheral nerves. Rarely, radiotherapy may
damage nerves within the treated area, causing symptoms
such as numbness and weakness. These may develop months
or years after treatment.
Tell your doctor if you notice any numbness or tingling in
your hands or feet. You may also notice that you have difficulty
doing up buttons or similar fiddly tasks. It’s important to let
your doctor know if you have these symptoms, as they may be
controlled by slightly lowering the dose of the drug.
This side effect usually improves slowly, a few months after the
treatment has finished. If these symptoms continue for longer,
talk to your doctor.
What you can do:
If your hands or feet are affected, it’s important to protect
them as much as possible.
•• Keep them warm by wearing gloves and warm socks in
cold weather.
•• Wear gloves when working with your hands – for example,
when gardening or washing up.
•• Use pot holders and take care to avoid burning your hands
when cooking.
29
Side effects of cancer treatment
•• Wear well-fitting shoes or boots.
•• Avoid walking around barefoot, and check your feet regularly
for any problems.
•• Test the temperature of water with your elbow to make sure it
isn’t too hot before baths, showers or doing the washing-up.
If your balance, coordination or walking is affected,
you may be at more risk of accidents and falls.
•• Keep areas that you walk through, such as halls, free of
clutter and things you could trip over, like loose rugs.
•• Get advice from a physiotherapist about walking aids
if your balance is affected.
If you feel lightheaded or dizzy when you stand up
due to problems with your blood pressure (postural
hypertension), your GP can give you advice on this.
You could also:
•• Ask your GP to prescribe you support stockings to wear
during the day. These improve circulation and can help
your symptoms.
•• Do leg exercises, such as moving your feet up and down at
the ankle and some gentle marching on the spot, before you
stand up.
•• Stand up more slowly, as this gives your body more time to
adjust to the change in position.
•• Drink plenty of fluids. Being dehydrated (dry) can make your
symptoms worse.
•• If you begin to feel lightheaded or dizzy, stop what you’re
doing and sit or lie down if possible. Drink some water.
30
Side effects of cancer treatment
31
Side effects of cancer treatment
Lymphoedema
Lymphoedema is swelling that develops because of a build-up
of a fluid called lymph in the body’s tissues. It usually affects
an arm or leg, but can sometimes also affect other parts of the
body. It can develop if lymph nodes (sometimes called glands)
have been removed by surgery, damaged by radiotherapy,
or if a cancer is blocking them.
Lymphoedema can be reduced and the swelling can often
be kept to a minimum, particularly when it’s diagnosed early.
But it’s a condition that never goes away because the causes
can’t be reversed.
What you can do (with the help of a clinical nurse
specialist or physiotherapist):
•• Take good care of your skin to help prevent injury
and infection.
•• Learn how positioning and moving your limb can help
drain fluid.
•• Compress the limb or area using compression
garments, such as sleeves, stockings, special bras
or compression bandages.
•• Do some gentle exercise and keep active, as this can
improve the flow of lymph.
•• Discuss specialised massage (manual lymphatic drainage,
MLD), or self massage with your specialist nurse,
radiographer or physiotherapist. These can help shift
fluid that’s built up.
•• Ask to be referred to your nearest lymphoedema clinic.
32
Fertility
We have several videos on our website about coping
with lymphoedema. You can watch these videos at
macmillan.org.uk/lymphoedema
Fertility
Chemotherapy, radiotherapy, surgery, biological therapies
and hormonal therapies can all affect fertility.
Being told that you have cancer and that treatment may
make you infertile can be very difficult to come to terms with.
The prospect of losing your fertility can be overwhelming,
no matter whether or not you already have children or whether
you have considered having them before.
Your doctor or specialist nurse will talk to you about the risk of
infertility before your treatment starts. It may also be helpful to
discuss whether there’s anything that can be done to reduce the
effects of treatment on your fertility.
In men, cancer treatments can stop the production of sperm,
affect the production of testosterone, or damage the nerves
or blood vessels in the pelvic area.
In women, some treatments can stop hormone production
(causing periods to stop temporarily), while other treatments
can cause an early menopause.
In some cases, effects on fertility will be temporary, but in
others they will be permanent.
33
Side effects of cancer treatment
What you can do:
•• Speak to your doctor or specialist nurse before treatment
starts about how your fertility might be affected.
•• There is a lot of practical and emotional help available
(see pages 45–46).
•• You may be able to store sperm, eggs or embryos for
future fertility treatment. If this is appropriate, a referral
will be made to the specialist fertility team for you (and your
partner, if you have one).
•• Counselling can be arranged if you think this would help.
We have further information about fertility issues
for men and women, which we can send you.
34
Changes to your sex life
Changes to your sex life
Chemotherapy, radiotherapy, surgery and hormonal therapies
can all have an effect on your sex life.
Cancer treatment can affect your sex life in many different
ways. Both men and women may find that their feelings about
themselves and how they look affect their attitude to sex.
For example, some surgery can affect how you look, which
may affect your confidence. You might find that pain or fatigue
leave you with a lowered sex drive. Some treatments will affect
how your body functions (for example, women may find their
vagina becomes drier or narrower, or men may be unable to
get or maintain an erection). These side effects may affect your
physical ability to have sex.
What you can do:
•• There are many different ways to enjoy intimacy, and
talking with your partner can help you find ways that
work for both of you. You may wish to spend some time
cuddling and touching, and exploring new ways to give
each other pleasure.
•• It can feel embarrassing to talk to your doctor or specialist
nurse about such a personal issue as sex, but it can be
helpful. There are many ways of helping with sexuality
problems resulting from cancer or its treatment – for
example counselling, medication and practical solutions.
If you don’t want to talk to anyone face-to-face, there are
confidential helplines that can help (see pages 45–46).
35
Side effects of cancer treatment
Hormonal changes
Some treatments for certain cancers can cause hormonal
symptoms. Surgery to the pelvic area, radiotherapy to the
pelvic area, chemotherapy and hormonal therapies may all
cause these symptoms. Some women may experience an
early menopause as a result of treatment. Men can also
experience hormonal symptoms.
Your doctors will explain beforehand if you’re likely to have
hormonal symptoms. Hormonal effects may be temporary
or permanent. Symptoms can include:
•• hot flushes and sweats
•• breast tenderness (in men)
•• weight gain
•• bone thinning
•• lowered sex drive
•• impotence (in men)
•• menstrual changes (in women).
While they can be distressing, there are ways to help
manage these symptoms.
36
Hormonal changes
What you can do:
•• Wear layers of light clothing, so that you can adjust them
to deal with hot flushes and sweats.
•• Use layers of bed linen, so you can adjust them during the
night to deal with hot flushes and sweats.
•• Have lukewarm baths and showers rather than hot ones.
•• Some complementary therapies can help ease symptoms.
But it’s important to check with your doctor before using
any complementary therapies.
•• For men, there are a number of medicines and devices that
can help deal with impotence. Talk to your doctors about
what may be most suitable for you.
•• For women, there may be medicines that can help manage
menopausal symptoms. Hormone replacement therapy
(HRT) may be prescribed for some women, but this is not
suitable for everyone.
37
Side effects of cancer treatment
38
How we can help you
How we can help you
Cancer is the toughest fight most of us will
ever face. But you don’t have to go through it
alone. The Macmillan team is with you every
step of the way.
Get in touch
Macmillan Support Line
Our free, confidential phone
Macmillan Cancer Support line is open Monday–Friday,
89 Albert Embankment,
9am–8pm. Our cancer
London SE1 7UQ
support specialists provide
Questions about cancer?
clinical, financial, emotional
Call free on 0808 808 00 00 and practical information and
(Mon–Fri, 9am–8pm)
support to anyone affected by
www.macmillan.org.uk
cancer. Call us on 0808 808
Hard of hearing?
00 00 or email us via our
Use textphone
website, macmillan.org.uk/
0808 808 0121 or Text Relay. talktous
Non-English speaker?
Information centres
Interpreters are available.
Our information and support
Clear, reliable information centres are based in hospitals,
about cancer
libraries and mobile centres,
and offer you the opportunity
We can help you by phone,
to speak with someone
email, via our website and
face-to-face. Find your nearest
publications or in person.
one at macmillan.org.uk/
And our information is free to informationcentres
everyone affected by cancer.
39
Side effects of cancer treatment
Publications
We provide expert, up-to-date
information about different
types of cancer, tests and
treatments, and information
about living with and after
cancer. We can send you free
information in a variety of
formats, including booklets,
leaflets, fact sheets, and
audio CDs. We can also
provide our information in
Braille and large print.
Need out-of-hours support?
You can find a lot of
information on our website,
macmillan.org.uk
For medical attention out of
hours, please contact your GP
for their out-of-hours service.
Someone to talk to
When you or someone you
know has cancer, it can be
difficult to talk about how
you’re feeling. You can call
our cancer support specialists
You can find all of our
information, along with several to talk about how you feel and
what’s worrying you.
videos, online at macmillan.
org.uk/cancerinformation
We can also help you find
support in your local area,
Review our information
so you can speak face-to-face
Help us make our resources
even better for people affected with people who understand
what you’re going through.
by cancer. Being one of our
reviewers gives you the chance
to comment on a variety of
information including booklets,
fact sheets, leaflets, videos,
illustrations and website text.
40
How we can help you
Professional help
Support for each other
Our Macmillan nurses, doctors
and other health and social
care professionals offer expert
treatment and care. They help
individuals and families deal
with cancer from diagnosis
onwards, until they no longer
need this help.
No one knows more about
the impact cancer has on
a person’s life than those
who have been affected by
it themselves. That’s why we
help to bring people with
cancer and carers together in
their communities and online.
You can ask your GP, hospital
consultant, district nurse
or hospital ward sister if
there are any Macmillan
professionals available
in your area, or call us.
Support groups
You can find out about support
groups in your area by calling
us or by visiting macmillan.
org.uk/selfhelpandsupport
Online community
You can also share your
experiences, ask questions,
get and give support to
others in our online
community at macmillan.
org.uk/community
41
Side effects of cancer treatment
Financial and
work-related support
heating bills, extra clothing,
or a much-needed break.
Having cancer can bring extra
costs, such as hospital parking,
travel fares and higher heating
bills. Some people may have
to stop working.
Find out more about the
financial and work-related
support we can offer
at macmillan.org.uk/
financialsupport
If you’ve been affected in
this way, we can help.
Call the Macmillan Support
Line and one of our cancer
support specialists will tell you
about the benefits and other
financial help you may be
entitled to.
Learning about cancer
You may find it useful to learn
more about cancer and how
to manage the impact it can
have on your life.
You can do this online on our
Learn Zone – macmillan.org.
uk/learnzone – which offers
We can also give you
information about your rights a variety of e-learning courses
and workshops. There’s
at work as an employee, and
help you find further support. also a section dedicated to
supporting people with cancer
– ideal for people who want
Macmillan Grants
to learn more about what
Money worries are the last
thing you need when you have their relative or friend is
going through.
cancer. A Macmillan Grant is
a one-off payment for people
with cancer, to cover a variety
of practical needs, including
42
Other useful organisations
Other useful organisations
General cancer and
support organisations
Cancer Black Care
79 Acton Lane,
London NW10 8UT
Tel 020 8961 4151
(Mon–Fri, 9.30am–4.30pm)
Email
[email protected]
www.cancerblackcare.
org.uk
Offers a variety of information
and support for people
with cancer from ethnic
communities, their families,
carers and friends.
Welcomes people from
different ethnic groups
including African, Asian,
Turkish and AfricanCaribbean communities.
Cancer Support
Scotland (Tak Tent)
Flat 5, 30 Shelley Court,
Gartnavel Complex,
Glasgow G12 0YN
Tel 0141 211 0122
Email info@
cancersupportscotland.org
www.cancersupport
scotland.org
Offers information and
support to people with
cancer, families, friends,
and healthcare professionals.
Runs a network of support
groups across Scotland.
Irish Cancer Society
43–45 Northumberland Road,
Dublin 4, Ireland
Cancer Helpline
1800 200 700 (Mon–Thurs,
9am–7pm, Fri, 9am–5pm)
Email [email protected]
www.cancer.ie
Operates Ireland’s only
freephone cancer helpline,
which is staffed by nurses
trained in cancer care.
Maggie’s Cancer
Caring Centres
8 Newton Place,
Glasgow G3 7PR
Tel 0300 123 1801
Email enquiries@
maggiescentres.org
www.maggiescentres.org
Maggie’s Centres offer free,
43
Side effects of cancer treatment
comprehensive support for
anyone affected by cancer.
You can access information,
benefits advice, and emotional
or psychological support.
support network and raises
funds to build teenage cancer
units in hospitals.
Tenovus
9th Floor, Gleider House,
Ty Glas Road, Llanishen,
Marie Curie Cancer Care
Cardiff CF14 5BD
89 Albert Embankment,
Freephone helpline
London SE1 7TP
0808 808 1010
Freephone 0800 716 146
Tel 020 7599 7777 (England) Tel 029 2076 8850
0131 561 3900 (Scotland) Email [email protected]
01495 740 888 (Wales)
www.tenovus.org.uk
028 9088 2060 (NI)
Provides a variety of
Email [email protected] services to people with
www.mariecurie.org.uk
cancer and their families,
Marie Curie nurses provide
including counselling and
free end-of-life care to people a freephone cancer helpline.
with cancer in their own
homes, 24 hours a day,
The Ulster Cancer
365 days a year. There are
Foundation
Marie Curie hospices across
40–44 Eglantine Avenue,
the UK.
Belfast BT9 6DX
Freephone helpline
Teenage Cancer Trust
0800 783 3339
93 Newman Street,
Helpline email
London W1T 3EZ
[email protected]
Tel 020 7612 0370
Tel 028 9066 3281
Email from the website
Email [email protected]
www.teenagecancer
www.ulstercancer.org
trust.org
Provides a variety of services
Dedicated to improving the
for people with cancer and
lives of teenagers and young
their families, including a free
adults with cancer. Runs a
telephone helpline, which is
44
Other useful organisations
staffed by specially trained
nurses with experience in
cancer care.
Counselling and
emotional support
British Association
for Counselling and
Psychotherapy (BACP)
BACP House,
15 St John’s Business Park,
Lutterworth LE17 4HB
Tel 01455 883 300
Email [email protected]
www.bacp.co.uk and
www.itsgoodtotalk.org.uk
Promotes awareness and
availability of counselling,
and signposts people to
appropriate services. Has
a database on the website
where you can search for
a qualified counsellor.
Cancer Counselling Trust
Ground Floor, Edward
House, 2 Wakley Street,
London EC1V 7LT
Tel 020 7843 2292
Email [email protected]
www.cancercounselling.
org.uk
Qualified counsellors and
psychotherapists offer free,
confidential counselling to
cancer patients, as well as
couples or families affected
by cancer.
Relationships, sex and
fertility organisations
Infertility Network UK
Charter House,
43 St Leonard’s Road,
Bexhill-on-Sea TN40 1JA
Tel 0800 008 7464
Email admin@
infertilitynetworkuk.com
www.infertilitynetwork
uk.com
A national charity that
provides information, support,
telephone counselling and
helpful contacts for people
with fertility difficulties.
Relate
Premier House,
Carolina Court, Lakeside,
Doncaster DN4 5RA
Tel 0300 100 1234
www.relate.org.uk
Offers advice, relationship
counselling, sex therapy,
workshops, mediation,
consultations and support –
45
Side effects of cancer treatment
face-to-face, by phone and
through the website.
Relationships Scotland
18 York Place,
Edinburgh EH1 3EP
Tel 0845 119 2020
www.relationshipsscotland.org.uk
Provides relationship
counselling, sex and
relationship therapy
and family support.
The College of Sexual
and Relationship
Therapists (COSRT)
PO Box 13686,
London SW20 9ZH
Tel 020 8543 2707
Email [email protected]
www.cosrt.org.uk
A national specialist charity
for sex and relationship
therapy. Has a list of qualified
practitioners and clinics
providing sex or relationship
therapy in the UK.
46
The Institute of
Psychosexual Medicine
12 Chandos Street, Cavendish
Square, London W1G 9DR
Tel 020 7580 0631
Email [email protected]
www.ipm.org.uk
Has a comprehensive list
of doctors throughout the
country who are trained in
psychosexual medicine.
The Sexual Advice
Association
(formerly the Sexual
Dysfunction Association)
Suite 301, Emblem House,
London Bridge Hospital, 27
Tooley Street, London SE1 2PR
Helpline 020 7486 7262
(Mon, Weds, Fri, 9am–5pm)
Email info@
sexualadviceassociation.co.uk
www.sda.uk.net
A charity that aims to
improve people’s sexual
health and well-being,
and to raise awareness of
how sexual conditions affect
the general population.
Further resources
Further resources
Related Macmillan
information
You may want to order some
of our other information
mentioned in this booklet.
This includes:
•• Cancer and fertility –
information for men
•• Cancer and fertility –
information for women
•• Understanding
lymphoedema
•• Understanding radiotherapy
To order, visit be.macmillan.
org.uk To order fact sheets,
call 0808 808 00 00.
All of our information is also
available online at macmillan.
org.uk/cancerinformation
Helpful books
•• Coping with fatigue
••
••
••
••
••
••
100 questions and answers
about cancer symptoms and
Coping with hair loss
cancer treatment side effects
Eating problems and cancer Kelvin JF & Tyson LB, Jones
and Bartlett Publishers, 2011,
How are you feeling?
£12.99
Managing the late effects of Written by cancer professionals
and featuring comments from
pelvic radiotherapy in men
patients, this guide provides
Managing the late effects
information to help you
of pelvic radiotherapy
understand the disease and
in women
manage treatment side effects.
Sexuality and cancer
•• Understanding
chemotherapy
47
Side effects of cancer treatment
Anni’s cancer companion:
An A–Z of treatments,
therapies and healing
Matthews A, Singing Dragon
(Jessica Kingsley Publishers),
2011, £9.99
A guide to making sense and
use of the orthodox treatments,
complementary therapies,
and psychological, spiritual
and holistic options available.
Macmillan audio
resources
Our high-quality audio
materials, based on our
variety of booklets, include
information about cancer
types, different treatments
and living with cancer.
To order your free CD
visit be.macmillan.org.uk
or call 0808 808 00 00.
Macmillan videos
There are many videos
on the Macmillan website
featuring real-life stories and
information from health and
social care professionals.
48
Useful websites
A lot of information about
cancer is available on the
internet. Some websites
are excellent, others have
misleading or out-of-date
information. The sites listed
here are considered by
nurses and doctors to contain
accurate information and are
regularly updated.
Macmillan Cancer Support
www.macmillan.org.uk
Find out more about living
with the practical, emotional
and financial effects of cancer.
Our website contains expert,
accurate and up-to-date
information on cancer and
its treatments, including:
•• our 100+ booklets,
350+ fact sheets
and videos featuring
real-life stories from
people affected by cancer
and information from
medical professionals
•• how Macmillan can help,
the services we offer and
where to get support
Further resources
•• how to contact our cancer
support specialists,
including an email form
to send your questions
•• local support groups
search, links to other
cancer organisations
and a directory of
information materials
•• a huge online community
of people affected by
cancer sharing their
experiences, advice
and support.
www.cancerhelp.org.uk
(Cancer Research UK)
Contains patient information
on all types of cancer and has
a clinical trials database.
www.cancer.gov (National
Cancer Institute – National
Institute of Health – USA)
Gives information on cancer
and treatments.
www.healthtalkonline.org
www.youthhealthtalk.org
(site for young people)
Both websites contain
information about some
cancers and have video and
audio clips of people talking
about their experiences of
cancer and its treatments.
www.nhs.uk (NHS Choices)
NHS Choices is the online
‘front door’ to the NHS. It is
the country’s biggest health
website and gives all the
information you need to make
choices about your health.
www.nhsdirect.nhs.uk
(NHS Direct Online)
NHS health information
site for England – covers
all aspects of health,
illness and treatments.
www.nhsdirect.wales.
nhs.uk (NHS Direct Wales)
www.nhs24.com
(NHS 24 in Scotland)
www.n-i.nhs.uk
(Health and Social Care
in Northern Ireland)
www.patient.co.uk
(Patient UK)
Provides non-medical people
in the UK with information
about health and disease.
49
Side effects of cancer treatment
Disclaimer
We make every effort to ensure that the information we provide is accurate, but it
should not be relied upon to reflect the current state of medical research, which is
constantly changing. If you are concerned about your health, you should consult
a doctor. Macmillan cannot accept liability for any loss or damage resulting from
any inaccuracy in this information or third-party information, such as information
on websites to which we link. We feature real-life stories in all of our articles.
Some photographs are of models.
Thanks
This booklet has been revised and edited by Macmillan Cancer Support’s
Cancer Information Development team. It has been approved by our medical
editor, Dr Terry Priestman, Consultant Clinical Oncologist.
With thanks to: Dr David Gilligan, Consultant Oncologist; Alison Keen,
Interim Head of Cancer Nursing; Jenny King, Chemotherapy Nurse Specialist;
Dr Nick Reed, Consultant Clinical Oncologist; and the people affected by
cancer who reviewed this edition.
Sources
Dougherty & Lister (eds). The Royal Marsden Hospital Manual of Clinical
Nursing Procedures. 7th edition. Wiley-Blackwell, 2010.
Eating hints before, during and after cancer treatment. National Cancer
Institute, 2011.
Olver (ed). The MASCC Textbook of Cancer Supportive Care and Survivorship.
Springer, 2011.
Supportive and palliative care for people with cancer. National Institute for Health
and Clinical Excellence (NICE), 2004.
Tobias & Hochhauser. Cancer and its management. Wiley and Blackwell, 2010.
Yarbro et al. Cancer symptom management. 3rd edition. Jones and Bartlett
Publishers, 2004.
50
Can you do something to help?
We hope this booklet has been useful to you. It’s just one of our
many publications that are available free to anyone affected by
cancer. They’re produced by our cancer information specialists
who, along with our nurses, benefits advisers, campaigners and
volunteers, are part of the Macmillan team. When people are
facing the toughest fight of their lives, we’re there to support
them every step of the way.
We want to make sure no one has to go through cancer alone,
so we need more people to help us. When the time is right for you,
here are some ways in which you can become a part of our team.
5 ways
you can someone
hElP with
cAncer
Share your cancer experience
Support people living with cancer by telling your story,
online, in the media or face to face.
Campaign for change
We need your help to make sure everyone gets the right support.
Take an action, big or small, for better cancer care.
Help someone in your community
A lift to an appointment. Help with the shopping.
Or just a cup of tea and a chat. Could you lend a hand?
Raise money
Whatever you like doing you can raise money to help.
Take part in one of our events or create your own.
Give money
Big or small, every penny helps.
To make a one-off donation see over.
Call us to find out more
0300 1000 200
macmillan.org.uk/getinvolved
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personal details
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keep your money
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Do you pay tax? If so, your gift will
be worth 25% more to us – at no
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Macmillan Cancer Support will reclaim 25p of
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Please cut out this form and return it in an envelope (no stamp required) to:
Supporter Donations, Macmillan Cancer Support, FREEPOST LON15851,
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Cancer is the toughest fight most of us
will ever face. If you or a loved one has
been diagnosed, you need a team of
people in your corner, supporting you
every step of the way. That’s who we are.
We are the nurses and therapists helping you through
treatment. The experts on the end of the phone.
The advisers telling you which benefits you’re entitled to.
The volunteers giving you a hand with the everyday
things. The campaigners improving cancer care.
The community supporting you online, any time.
The fundraisers who make it all possible.
You don’t have to face cancer alone.
We can give you the strength to get through it.
We are Macmillan Cancer Support.
Questions about living with cancer?
Call free on 0808 808 00 00 (Mon–Fri, 9am–8pm)
Alternatively, visit macmillan.org.uk
Hard of hearing? Use textphone
0808 808 0121, or Text Relay.
Non-English speaker? Interpreters available.
© Macmillan Cancer Support, 2012. 2nd edition. MAC12921.
Next planned review 2014. Macmillan Cancer Support, registered
charity in England and Wales (261017), Scotland (SC039907) and
the Isle of Man (604).
Printed using sustainable material. Please recycle.