Six common side effects of cancer treatment and what you can do about them.
Their story began like a fairy tale. Regina Jones met a man at her best friend’s wedding in Hawaii. They hit it off, and before long, they were planning a wedding of their own. Jones decided to get a mammogram since she would be moving from her hometown of Charlotte to Durham to join her soon-to-be husband, Tavaris.
“We lived in separate cities, and before I moved, I wanted to be sure to get all my checkups done,” she says. “I was only 36 at the time, and I thought, ‘What could happen?’”
Cancer is what happened.
Jones was diagnosed with breast cancer following her mammogram. Four months later, instead of planning her wedding, she underwent treatment for breast cancer, which included surgery, radiation and chemotherapy.
It’s been eight years since Jones had that mammogram. Today, she and Tavaris have twin 3-year-old daughters, Alex and Kayla. But life after breast cancer is far from a fairy tale, she says.
She now suffers from a common side effect of breast cancer treatment called lymphedema, or swelling caused by an accumulation of lymph, a protein-rich fluid found throughout the body. The swelling can range from mild and hardly noticeable to obvious changes in affected areas and can cause heaviness, tightness or aching in the arms or legs.
“Here I am thinking I’ve gone through treatment, I’ve beat cancer, but I have this third wheel always hanging around,” she says.
In Regina’s case, it caused extreme pain in her left hand and arm.
“The pain level was a 6 to a 10 daily and would wake me up in the middle of the night,” Jones says. “The side effects from this condition make it so hard to do the simple things, like lift a cup of coffee.”
Jones finally found relief when she sought out the assistance of UNC REX lymphedema therapist Valerie Hunsel, an occupational therapist. She and physical therapist Connie Nehls help cancer patients like Jones cope with the side effects of cancer treatment at UNC REX Healthcare Outpatient Rehabilitation Services.
We talked to them about common struggles after cancer treatment and what people can do about them.
1. Range of Motion
Like Jones, people with breast cancer often experience limitations with their range of motion after treatment. As a result, everyday tasks such as brushing hair, reaching into a kitchen cabinet, raising an arm to put on a jacket and putting on shoes are difficult.
“Just everyday tasks that involve using your arms in more extreme ranges of motion are a struggle now,” Nehls says. “They have to actually work to get that movement back.”
Nehls helps people do this through stretching and range-of-motion exercises. She says it’s easier for them if they can begin this type of therapy during treatment.
“This will allow them to maintain their motion closer to normal, keeping loss of everyday arm use at a minimum,” she says.
Hunsel says sometimes she and Nehls work with people following a mastectomy to increase their range of motion before they can undergo radiation.
“You have to be able to get your arms above your head and maintain that position during radiation, so we work with people so that they can comfortably get through radiation,” she says.
People who have been treated for cancer of the head and neck also experience problems with their range of motion after treatment.
“They can have difficulty moving their neck after radiation, so a physical therapist can help them regain motion in a safe way, allowing the person to turn their head to see traffic while driving,” Nehls says.
2. Dry Throat and Difficulty Swallowing
Radiation can kill cancer cells and shrink tumors, but it also may affect nearby healthy cells. This damage can cause a variety of side effects. For instance, because there’s not a lot of tissue in the neck to absorb the radiation, people with head and neck cancers may experience dry throat and difficulty swallowing. Speech therapists can help improve these issues.
“If they’ve been treated for head or neck cancer, they might not be able to eat the same food that they could eat before because meats and bread are tough to swallow,” Nehls says. “So, they have to find a new norm, and a speech therapist can help them do that.”
Like Jones, many people experience lymphedema after cancer treatment. If you or a loved one is experiencing symptoms of lymphedema, Hunsel says it’s important to ask your doctor for a referral to a certified lymphedema therapist for treatment. Most insurance plans also require a doctor’s referral for lymphedema services.
“A certified therapist will cater treatment and educate you based on your particular needs,” Hunsel says.
Treatment options for lymphedema depend on severity and include:
- Patient education about risk reduction and treatment options.
- Manual lymph drainage, a gentle massage technique that stimulates lymphatic circulation and assists in redirecting the flow away from disrupted areas.
- Compression therapy using either multilayered compression bandages that move lymph fluid from the affected areas or compression garments fitted by a lymphedema specialist.
- Therapeutic exercise that assists with improving circulation and moving lymph.
- Pneumatic compression therapy that uses a vasopneumatic compression pump, or a garment worn over an affected body part that is connected to a pump that periodically inflates the sleeve. The sleeve puts pressure on the limb and helps move lymph fluid.
A common struggle for many different types of cancer is fatigue, a side effect that can last long after treatment is complete. A 2011 review published in the Annals of Oncology estimated that 50 percent to 90 percent of people who have experienced cancer report feeling fatigued.
To ease fatigue, Hunsel says she teaches energy conservation and work simplification techniques. For example, “Break an activity up into smaller parts. A 30-minute bathing, dressing and makeup activity can be three 10-minute activities. Perform one task for 10 minutes, take a break, perform the next task for 10 minutes, take a break and so on,” she says.
Both Hunsel and Nehls also recommend exercise to help combat fatigue.
“I encourage them to find an activity that they enjoy doing, maybe just walking with a neighbor, because they’re going to find that being active will help them feel better overall,” Nehls says.
But one word of caution about exercise: A possible side effect of chemotherapy is an increased resting heart rate, so be sure not to overexert yourself. Hunsel says she monitors heart rates to make sure they are within a healthy range.
“It’s always good to have a baseline, so when we introduce exercise, we can monitor for any problems,” she says.
5. Peripheral Neuropathy
Another possible side effect is chemo-induced peripheral neuropathy. Often described as a burning or tingling sensation, peripheral neuropathy is weakness, numbness or pain in the feet or hands as a result of nerve damage.
“If somebody’s dealing with peripheral neuropathy, they often can’t do fine motor coordination activities, such as buttoning a shirt,” Hunsel says. To help with these activities, occupational therapists will introduce adaptive equipment, such as buttonholers, to assist.
If people experience peripheral neuropathy in the feet, balance can also become an issue. If you don’t have the sensation in the bottom of your feet, you’re more likely to trip and stumble.
“So we might talk to the patient about their home setup to help with fall prevention,” Hunsel says. This includes removing throw rugs and adding guardrails to bathtubs, which all can increase a person’s risk of falling.
6. Decreased Lung Capacity
A decreased lung capacity is possible after radiation to the chest wall. For people who experience this complication, breathing exercises to open up the lungs, such as belly breathing, can be helpful.
“I’ll have the people put their hand on their belly button, lie down, close their eyes, breathe and feel their hand rise and fall,” Hunsel says.
She also recommends yoga. “Restorative yoga poses are very helpful because a lot of yoga is just breathing,” she says.
Living with a New Norm
Cancer can be a turning point in a person’s life, and they may view life differently after treatment, Nehls says.
“They’ve seen a point in their life that could have been a life-ending experience, but when they get through it, they want to have a good quality of life,” Nehls says. “We can be a player in their after-cancer care and help them find a new norm that they’re happy with, so they can live the life they want to live.”
For Jones, that means finding a way to live with her lymphedema while spending time with her loved ones. She recently celebrated her 45th birthday with a spa trip.
“Birthdays are so important now,” she says. “They’re amazing.”
Talk to your doctor if you have concerns about side effects from cancer treatment. If you need a doctor, find one near you.
About the Experts
Valerie Hunsel, OT/L, CLT, is an occupational therapist and a certified lymphedema therapist with UNC REX Healthcare Outpatient Rehabilitation Services.
Connie Nehls, MS, PT, CLT, is a physical therapist and a certified lymphedema therapist with UNC REX Healthcare Outpatient Rehabilitation Services.