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II. Symptoms and Strategies |
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Symptoms and Strategies
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In keeping with Plato's discovery over 2,000 years ago that the physical and psychological elements of man are inextricably linked, health professionals today believe that a combination of medical therapy and supportive care offers the best chance to maintain a patient's quality of life. Such comprehensive care addresses a wide range of needs.
For example, obtaining relief from pain, nausea, or fatigue restores a feeling of calm and well-being. Getting sufficient sleep, appropriate exercise, and good nutrition are energizing. Discussing one's negative feelings candidly with others who have cancer can empower us. It can help alleviate the feeling of being alone. Attention to each of these components can help restore the freedom to act and to choose life.
This section touches on some potential problem areas where advice and support from cancer professionals and other cancer patients can be useful. We have also tried to share with you how supportive care services can alleviate the side effects of treatment, help you maintain your quality of life, and allow you to continue with new hope and strength.
Pain, difficulty sleeping, nausea, increased forgetfulness, sexual problems, and muscle atrophy can have a negative impact on a person's quality of life. For cancer patients, who may experience several or all of these difficulties at once, the pleasures can seem to drain out of life. Whether these problems are caused by the disease itself, or its treatment, diminishing or eliminating them is an essential part of achieving a better quality of life.
The good news is that many of these issues can be addressed through medication, open communication, and adjustments to your daily routine. If you are experiencing one of these problems, talk with your health care team, a family member, a friend, or a member of the clergy. There are solutions!
Pain
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Will I be in pain? (Not all patients experience pain!)
In a movement that has gained increasing momentum in
the last twenty-five years, the medical community is giving pain
the special attention it deserves. Today, many hospitals have
special pain centers and pain-management programs and the
American Pain Society urges that pain be considered a fifth vital
sign, along with blood pressure, pulse, temperature, and
breathing rate.
Pain can seriously compromise a patient's quality of life by interrupting normal sleep patterns, making daily activities difficult, affecting cognitive functioning, and eroding a patient's energy. When pain occurs, it must be continually assessed and evaluated by the medical team or a pain management specialist, if available. During this ongoing process, these professionals determine whether the source of the pain is somatic (throughout the body), visceral (related to organs), or neuropathic (related to the nervous system). They then define the pain according to its intensity, quality, and frequency and recommend the appropriate means of intervention. Effective pain management can include biofeedback and other stress reduction techniques, oral medications, injections (including nerve blocks), patches, or pumps. With modern technology, it is now possible to have effective pain control.
Fatigue
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Why am I so tired?
Fatigue is described as unusual or excessive whole-body
tiredness not easily dispelled by sleep or rest. Fatigue is
unquestionably the most common, as well as one of the most
debilitating, side effects experienced by cancer patients. It can be
generated by the disease itself or by depression, fear, frustration,
pain, sleep disturbances, poor nutrition, lack of exercise, or
concern for the future. Fatigue is also a frequent side effect of
surgery, radiation, chemotherapy, or immunotherapy.
Another cause of fatigue is anemia (low hemoglobin). Fatigue that is caused by anemia resulting from either the cancer itself, or its therapy, can be treated with blood transfusions and/ or drugs, such as erythropoietin (Procrit®, Epogen® or Aranesp®) Cancer patients who are hypothyroid-a condition resulting from low thyroid hormone production-also experience additional fatigue and sluggishness. This condition can be treated with thyroid hormone replacement therapy.
- Some signs of fatigue include:
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- A feeling of weariness or exhaustion
- A sense of heaviness, particularly in your limbs
- Disinterest in daily activities, such as eating
- Difficulty maintaining your personal appearance
- Problems concentrating or thinking clearly
- Fatigue from all causes may be reduced by various methods. By controlling the symptoms of therapy, ensuring adequate sleep and rest periods, exercising daily, getting and receiving psychological support, you can begin to manage fatigue. Fatigue can also be managed by learning to set priorities, delegate, and modify your daily activities. For example, ask others to help you with meal preparation and household chores.
Sleep Disorders
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How important is sleep? Sleep disorders such as insomnia, multiple awakenings, and early waking can be attributed to many side effects of cancer or its treatments. These include depression, anxiety, stress, pain, and medication side effects.
Whatever the reason you suffer from prolonged lack of sleep, it is important that you put your efforts into learning techniques to sleep better. Lack of sleep can undermine your healing process and your ability to function. Developing good sleep patterns includes common sense practices such as maintaining a regular time for going to bed and waking up, and avoiding naps during the day. Exercise often promotes a better night's rest, while alcohol and caffeine are not recommended. Try keeping your bedroom as a sanctuary from work; use it only for sleep and intimacy.
If you are experiencing sleep difficulties, it may be beneficial to review your prescription medications with your doctor. Pain medications may cause daytime drowsiness, while some antidepressants cause insomnia.
We cannot emphasize enough the importance of getting adequate rest. The physical and chemical processes that take place during sleep allow the mind, the body, and the psyche to replenish.
Nutrition
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How will my diet be affected?
Nausea, loss of appetite, and changes in taste perception
are common side effects of cancer and its treatment. These
symptoms can reduce your enjoyment of food, and may result
in decreased nutrition. Diarrhea and constipation also negatively
affect your ability to obtain adequate nutrition. Fortunately,
most of these side effects can be controlled through medications
or changes in your diet.
Good nutrition is an essential part of cancer treatment. Quite simply, well-nourished people are better able to recover from surgery, and may even tolerate higher doses of chemotherapy and radiation. A well-balanced diet also prevents the breakdown of body tissue, helps rebuild the tissue that cancer may harm, and helps maintain the body's immune system.
Remember that diet is one area that you can control fairly easily. You can make changes to your diet at any time to help alleviate nutritionally related symptoms or improve your nutrition. It may be helpful to assess your present diet with a registered dietitian. This can be arranged through your health care provider.
Exercise
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It not only makes you feel better; it helps you fight better!
Many patients find that their level of physical activity
diminishes due to their disease, its treatment, or some
combination of both. This is particularly true for patients who
are hospitalized or bedridden. It can also be an issue for all
patients suffering from pain, lethargy, or depression. One of the
best ways to combat these symptoms is to exercise. No matter
how seemingly insignificant, move your body!
Exercise is essential to good health; it is even more important if you have cancer. The better the condition of your body, the better you will tolerate the side effects of chemotherapy, radiation, and surgery. For example, scientific research has documented that walking or bicycling three to five days per week produces the following benefits: decreased nausea, decreased fatigue, increased physical endurance, and improved quality of life. These benefits derive from increased muscle strength, improved gastrointestinal motility, and the increased production of endorphins, which elevate mood. Exercise has another plus: it relieves boredom. When performed with others, exercise can invariably produce laughter and feelings of camaraderie. It is important to remember that just as fatigue is cumulative, so is energy!
Starting a new exercise program or returning to physical activities that have been pleasurable in the past can have an immediate positive impact on your health. If you have specific concerns or questions about this, it may be helpful to consult a physical therapist. Physical therapists can design exercise programs to meet any stage of physical fitness. Therapists can teach exercises that can be performed in a bed or a chair, or semi-strenuous exercises for the partially ambulatory. There are also exercises for those who are ready for a full workout. In designing these programs, physical therapists consider each patient's cardiovascular endurance, joint flexibility, and muscular strength.
Cognitive Functioning
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Are you forgetting something?
Many cancer patients undergoing chemotherapy or brain
radiation experience increased forgetfulness, a decreased
attention span, and problems concentrating. These symptoms,
which some patients call chemo brain, used to be attributed to
stress and fear. Recent extensive studies, however, have shown
that patients undergoing either chemotherapy or brain radiation
are susceptible to neurocognitive effects from these treatments.
Such dysfunction, however, is not a given, nor is it typically
long-lasting. If it occurs with chemotherapy, it usually does so
during or immediately after treatment and generally dissipates
three to six months after the patient has completed the course of
therapy. If diminished cognitive functioning occurs as a result of
brain radiation, it often improves following treatment.
In most cases, cognitive dysfunction is minimal and limited to simple forgetfulness or loss of coordination. People with this level of impaired function can benefit from physical, occupational, and speech therapies as well as group support and individual counseling. If possible, they should resume their regular routines as soon as possible (including returning to work). Mental exercises such as doing mind games, crossword puzzles, playing chess or other games of strategy can keep the mind sharp and focused. It may be helpful to use a calendar or another organizational aid to keep track of appointments and other commitments.
Stress
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Cancer is an added stress!
Stress is an inherent component of a cancer diagnosis for
both the patient and the family and friends. The mind's natural
tendency is to run off in an infinite number of directions, each
with its own stress and fear. This can cause strain that adversely
affects the body, mind, and spirit.
Mindful meditation is the practice of bringing the mind into the finite experience of the present moment, of breathing and feeling the body as it breathes. This settles the mind and reduces stress. Mindfulness meditation does not require any special state of mind other than a presence with ourselves that is honest and direct. Even if we are anxious or frightened, we respond to ourselves in a soothing way. We can respond with kindness, concern, and even peace.
Stress reduction techniques, such as self-hypnosis, yoga, biofeedback, meditation, tai chi, qi gong, acupuncture, acupressure, healing massage, or keeping a journal cultivate inner peace and may even benefit your immune system. Some of these techniques may be unfamiliar to you. Biofeedback training can help a patient alter physiological responses, such as the stress response and its immunosuppressive effects. By electronically monitoring these responses, the patient can get immediate feedback about small changes in his/her response. The patient learns to control how he/she react to stress. Tai chi is a gentle mind/body exercise program, which can strengthen muscles, improve coordination and balance, and promote peace of mind. Qi gong, which combines movement with meditation and breath awareness, strives for conscious control of the body's energetic system. Acupuncture is a traditional Chinese medicine, which involves inserting very tiny needles into the body. It has been endorsed by the National Institutes of Health to reduce the symptoms of nausea, vomiting, and chronic pain. Using these and other relaxation techniques can be very helpful in improving your quality of life.
Sexuality
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How will I deal with intimacy?
The emotional and physical ramifications of cancer and
cancer therapy can adversely affect a person's sexuality. Anxiety
survival, changes in body image, the welfare of family
members, or finances can inhibit the expression of sexuality.
These feelings can create concerns about desirability.
Other sexual problems may be the result of a physical problem related to either the cancer itself or its treatment. Fortunately, there are medical treatments that can alleviate these concerns. A decline in erectile function, common in men with prostate cancer, can be treated with external penile vacuum devices, injections, prosthetic penile implants, or prescription medication such as Viagra, Cialis, or Lavitra. In women, problems include increased or decreased vaginal discharge caused by chemo-hormonal therapy drugs or a narrowing of the vagina due to radiation of the pelvis. Such conditions can be treated using medical creams, lubricants, hormone replacement therapy, or vaginal dilations.
If you are experiencing emotional or physical problems with your sexuality, you can take charge by discussing them with your partner and/or consulting your physician or a sex therapist. With proper counseling and/or appropriate medical intervention, the chances are excellent that you will be able to maintain or regain a healthy sexual self-image despite the temporary or permanent changes wrought by cancer.
First appeared July 10, 2005; updated April 17, 2009