Quality of Life
Having a potentially life-threatening disease like cancer often leads people to examine their lives and look for meaning. In fact, this search for meaning may be the aspect of cancer that most often has a positive influence on life. The fear of death that affects most people when they are diagnosed with cancer, often leads us to think about what we leave behind and what we would like to do with the time we have left. It can make you feel like it’s the quality of life, not just the quantity, which matters most.
Quality of life means different things to different people. What’s most important is that you figure out what it means for you.
When cancer interferes with sex, it can create a lot of distress. Despite the many types of cancer and cancer treatments, most sexual problems after cancer fall into the following categories:
- Loss of sexual desire in men and women
- Trouble getting and keeping an erection for men
- Having pain with genital caressing or vaginal penetration for women
Ten Tips to Help You Regain Your Desire for Sex after Cancer:
1. If healthy exercise and nutrition help you feel less tired and reduce physical pain, they will also give you more energy to be in the mood for sex.
2. If you think that you are depressed, see if short-term, specific counseling can help lighten your mood. People who are depressed often lose interest in sex. Although antidepressants can help your mood, and may be important for more serious depression, they can interfere with sexual desire and make it hard to reach orgasm (especially for women). If you can benefit from counseling and avoid medication, it would be ideal.
3. Discuss with your doctor if the medication you take could decrease your desire for sex. You may be able to try a different version or lower your dose.
4. If you are feeling unattractive, consider what you can do to feel better about your body and your looks. Pamper yourself with a bubble bath or a massage. Find some sexy lingerie to cover a surgical scar during lovemaking, or wear a nice scent. Try to lose some post-chemo weight by exercising and improving your diet. You do not have to work hard to feel sensual.
5. Many men and women find they have distracting thoughts about cancer during sex that interfere with being able to relax and enjoy good physical feelings. You can try giving yourself the luxury of just focusing on your own sensations during lovemaking. Another way to let go of anxious thoughts about cancer, is to practice focusing on a detailed sexual fantasy. You don’t have to imagine sex with a movie star (although you can…) you can remember a time when sex with your partner was especially exciting or romantic.
6. If you feel comfortable with self-touch or masturbation, take some time to relax in private, perhaps after a bath or shower. It may take some patience and practice to feel sexual pleasure again.
7. If you are a man with an erection problem, see an urologist to explore medical treatment: pills, penile injections, or even surgery to have a penile prosthesis. For men, being able to have firm erections can be the biggest boost to interest in sex.
8. If you are a woman who is having pain during sexual touching or intercourse, it is crucial to get some help. A first step is usually to use a vaginal moisturizer regularly and use lots of thin, water- or silicone-based vaginal lubricant when you have sex. If your pain persists, see your gynecologist for help.
9. If the problem with desire is focused on a loss of attraction between you and your partner, couples or individual counseling can help pinpoint what is going on.
10. Not all doctors have experience with sexual intimacy. You may want to ask your doctor for a referral to a medical gynecologist with expertise in treating women who have had cancer or a urologist who specializes in helping men with erection problems.
Cognitive Problems: Chemo-Brain
Cognitive changes are problems with thinking, including memory, concentration and behavior. These can be caused by cancer and its treatments as well as other medicines or health problems.
Cognitive difficulties can affect your ability to work or complete everyday tasks. It can be very upsetting to realize that your cancer has been successfully treated, but that due to the treatments that treated it you now have problems with your thinking, memory, or concentration.
Not everyone who has chemotherapy, radiation or surgery develops cognitive difficulties. Even so, you should know what to look for.
Chemo-brain is a term cancer survivors who received chemotherapy coined to describe the changes in their ability to remember or concentrate. Symptoms of chemo-brain may include
- Difficulty concentrating
- Difficulty remembering things that occurred recently
- Difficulty completing tasks
- Inability to think clearly
Whether cognitive changes will improve or be permanent depends on their cause.
- Acute cognitive changes (delirium) that occur because of certain medicines often improve when you stop taking the medicine.
- Chronic changes (dementia) are often not reversible, but may be improved if the cause of the problems can be corrected.
If you notice changes in your thinking, memory or behavior, keep a record of the problems that you have and ask your family or friends to watch for additional problems. Make an appointment to talk to your health care team about these symptoms as soon as possible. Treating the underlying condition often reduces or removes cognitive problems.
Treatment for cancer—surgery, chemotherapy, radiation therapy and targeted therapies—can cause pain and discomfort. Because cancer can also cause pain, the pain can be distressing, raising concerns about recurrence. That’s why relief for pain can include addressing your fears as well.
Pain can keep you from living your life as fully as possible. Yet studies show that pain among cancer survivors is not often reported, recognized, or treated well. You do not have to suffer in silence. In most cases, treatment can help.
If you begin experiencing new pain or severe pain, it is important that you tell your doctor immediately. Your doctor may ask questions about how often you have pain and how much the pain hurts. Using a Pain Rating Scale will help your doctor better understand the pain you have and provide an appropriate course of treatment.
Pain Management Tips
Keep track of when you have pain and how much pain you have.
This will help you accurately describe it to your doctor. You can also write down additional information such as:
- Where it hurts: What are the exact places? Does the pain stay there or radiate out?
- Was the onset sudden or gradual: Is the pain constant or does it come and go?
- How does it affect your life? Does it interfere with your usual activities such as, working; household chores; exercise; eating; socializing with family and friends?
Relief of pain may involve one or more of the following:
- Complementary medicine such as meditation and acupuncture
- Massage therapy
- Physical or occupational therapy
- Prescription or non-prescription drugs (Fewer than 1% of cancer patients on pain medication become addicted)
- Surgery or nerve blocks
Lymphedema and Nerve Damage
Lymphedema is pain and swelling that develops in the arms, legs or trunk due to a buildup of lymph fluid. Lymphedema stops the lymph fluid—which carries cells that help fight infections and other diseases—from flowing freely in your body. Watch for even a slight increase in size or swelling of the arm, hand, fingers, chest wall, trunk or legs. Contact your doctor if you notice these symptoms.
You are at risk of developing lymphedema if you had any of the following procedures:
- Lumpectomy or mastectomy
- Surgery that disrupts lymph flow in the groin or axilla (armpit); these may include surgeries for prostate and gynecological cancers and melanoma
- Sentinel lymph node mapping procedures (use of dyes and radioactive substances to identify lymph nodes that contain tumor cells)
Other risk factors include:
- Being seriously overweight
- Having diabetes
- Taking certain medications, such as steroids
Strategies to lower your risk of lymphedema include
- When possible, avoid injections, finger sticks, blood pressure checks, or blood draws in the “at risk” arm.
- Keep the skin of the “at risk” limb clean and gently moisturized
- Make sure the “at risk” arm or leg gets proper circulation
- Lift the arm above the heart occasionally
- Select a light weight prosthetic, if required
- Wear only loose fitting clothing and jewelry around the affected area
- Avoid heavy lifting, rigorous movements or excessive pressure on the affected limb
- Establish a safe exercise program (if there is discomfort, elevate the affected limb)
- Avoid extreme temperature changes (saunas, hot tubs…)
- Minimize the chances of injury and infection (bruises, cuts, insect bites, scratches…) to the affected limb
- Take special precautions when traveling—ask for guidance from a lymphedema specialist
Nerve Damage (Neuropathy)
Nerve damage from treatment—also called neuropathy—can cause odd sensations such as tingling or numbness in your hands, arms, feet, or legs.
This type of damage raises your risk for burns and falls. For example, if your sense of touch is impaired, you can scald your skin in the shower without realizing it, and if your legs are numb, you are more likely to stumble.
If nerve damage is a problem for you, there are practical steps you can take to make your environment safer:
- Check water temperature
- Be sure to use gloves and potholders
- Keep rooms, outside paths and stairs well lit
- Clear walkways and floors
- Use non-skid mats in showers and bathtubs
- Ask your doctor or nurse what actions make sense for you, at home and at work