Anxiety is a normal reaction to cancer. It may increase feelings of pain, interfere with sleep, cause nausea and interfere with your and your family’s quality of life. Most patients who have not had anxiety before their cancer diagnosis may not develop an anxiety disorder associated with their cancer.
It may be difficult to distinguish between normal fears associated with cancer and abnormally severe fears that can be classified as an anxiety disorder. Signs of severe fear may include panic attacks that involve a variety of distressing symptoms such as racing heart, sweating, shaking, shortness of breath, nausea, or feeling faint. Other signs of severe fear may also involve excessive avoidance of certain situations, muscle tension, intrusive thoughts and excessive rumination, recurrent nightmares, memory problems, and difficulty sleeping.
Treatment depends on how the anxiety is affecting your life. Treatment can include providing management of uncontrolled symptoms such as pain, providing information and support, counseling and/or medication.
Looking good is not a matter of vanity. Studies show that people who are pleased with how they look have more energy, more resilience and a better attitude. This helps them handle the "ups and downs" of cancer treatment more easily.
The Look Good, Feel Better Workshop is a free program at the Abramson Cancer Center provided in conjunction with the American Cancer Society. The workshop teaches beauty techniques to women who are actively undergoing cancer treatment to help them combat the appearance-related side effects of radiation and chemotherapy.
Some types of cancer treatment may affect your blood counts.
- White blood cells help to fight infections
- Platelets prevent bleeding and bruising
- Red blood cells carry oxygen throughout your body
Low blood counts can be treated, but treatment options may be different for each patient based on severity and health history. Patients should discuss treatment options with their doctors if they experience any of the following symptoms:
Symptoms of Low White Blood Cells (Neutropenia)
A fever in patients undergoing chemotherapy may be a medical emergency. Contact your health care provider or go to the emergency department if you experience fever greater than 100.5 F with neutropenia after chemotherapy.
- Chills or sweats
- Cough, increased mucous production, shortness of breath or painful breathing
- Soreness or swelling or ulcers in the mouth
- Pain, burning, urgency, frequent urination or foul smelling urine
- Redness, pain or swelling of any area of skin or drainage tubes
- Confusion or listlessness, especially in older adults, can sometimes be a symptom of infection
Symptoms of Low Platelets (Thrombocytopenia)
- Excessive bruising of the skin
- Tiny, pinpoint red spots on the skin (called petechiae)
- Bleeding gums or nosebleeds
- Excessive bleeding from a small cut, or bleeding that won't stop even after pressure has been applied
- Dark urine or blood in the urine
- Blood in stool or from the rectum after a bowel movement; black-colored stools
- Menstrual bleeding that is heavier than usual, lasts longer than usual or occurs between periods
Symptoms of Low Red Blood Cells (Anemia)
- Weakness or fatigue
- Shortness of breath
- A faster heart beat or chest pain
Feelings about close physical and intimate relationships are related to the way people think about how they look to others, their ability to handle physical activity, level of fatigue, sexuality, anxiety or stress. These can place a strain on normal expressions of sexuality and can create concern about sexual desire.
The effect of cancer treatment on sexuality is different for everyone. Some people are unaffected, while others have changes in their desired level of activity. Some find the experience brings them closer to their partner.
Others may find sexual activity to be less important for a time. These feelings are not unusual; don’t delay getting information or counseling if problems arise.
Speak to your doctor or nurse about any concerns you have. He or she can provide advice or information about people who can help. Some basic suggestions include:
- Get information, rather than worry; discuss questions or concerns with a doctor or nurse
- Share feelings with a partner
- Try different ways of expressing intimacy
Cancer counseling services at Penn Medicine’s Abramson Cancer Center offer support and information about changing feelings about intimacy and other concerns cancer patients may face as they undergo cancer treatment.
The Abramson Cancer Center offers psychological and spiritual counseling. For more information about counseling services at the Abramson Cancer Center or to make an appointment, call 800-789-7366 (PENN).
The Abramson Cancer Center at Pennsylvania Hospital also offers multiple programs for stress reduction, including psychological counseling, stress and energy management, music therapy, guided imagery, art therapy and spiritual counseling.
The Penn Program for Mindfulness is an evidence-based program that teaches patients how to manage stress with tools taught by qualified instructors. The Penn Program for Mindfulness is available to patients at the Abramson Cancer Center and the Joan Karnell Cancer Center at Pennsylvania Hospital.
Learn more about The Penn Program for Mindfulness.
A change in the way food may taste and/or smell can often be a side effect of cancer or cancer treatments.
Here are a few tips and resources for improving the taste of your meals and decreasing any unpleasant odors.
- If certain foods taste bland, experiment with spices and herbs or condiments
- Add cleaned mint, orange or lemon slices to water
- Reduce lingering unpleasant tastes by practicing good oral hygiene
- Suck on hard candies like lemon drops
- If you are bothered by smells while cooking ask for some help in the kitchen preparing meals or open a window or oven fan
- Serve foods at room temperature to reduce strong smells
Constipation can result from cancer treatments, medications or from lack of fiber, fluids and movement. Check with your doctor or nurse before using over-the-counter laxatives, stool softeners or enemas.
Dehydration can be a common but preventable side effect of many cancer treatments.
Dehydration can be the result of nausea, vomiting, diarrhea, and/or inadequate fluid intake.
Depression is a disabling illness that affects about 15 to 25% of cancer patients. Everyone who is diagnosed with cancer will react to the diagnosis in different ways and may not experience serious depression or anxiety.
Sadness and grief are normal reactions to the crises faced during cancer and will be experienced at times by most people. Major depression is not simply sadness, but has common symptoms that can be diagnosed and treated. Just as patients need to be evaluated for depression throughout their treatment, so do family caregivers, who may be an increased risk for depression.
Mild symptoms of depression can be distressing and may be helped with counseling. However when symptoms are intense and long lasting, or when they keep coming back, more intensive treatment is needed.
Symptoms can include feeling sad or empty most of the time, being tearful, losing interest in activities, weight and appetite changes, difficulty sleeping, feeling slowed down or sped up, having no energy, feeling excessively guilty or worthless, having difficulty concentrating or making decisions, or thinking about dying or suicide.
Of course, some of these symptoms may be the direct result of your treatment or disease and not due to depression, so you should discuss your concerns with your medical team.
People with cancer report memory, concentration and attention problems after chemotherapy. This is sometimes called "chemo brain." Many survivors report they have problems paying attention, finding the right words or remembering new things.
Research is starting to explore why some people develop problems with memory and concentration while others don't. People who have had chemotherapy or have had radiation to the head area are at higher risk for these problems.
Speak with your physician or nurse if you:
- Have memory and thinking problems
- Think a medicine could be causing or adding to the problem
- Suffer from depression or anxiety, which can cause problems with concentration and memory
Support groups can be helpful when transitioning from active treatment to survivorship, allowing you to talk to others who may have similar experiences. In addition, professional counseling is available at the Abramson Cancer Center.
Some cancer medications can cause diarrhea. This can be a serious side effect because it can lead to dehydration if not properly managed. It is important for you to check with your doctor or nurse to see if you should be taking any medications to manage this side effect.
Some foods are helpful for relieving diarrhea:
- White rice
- White toast
- Peanut butter
Staying hydrated is very important. Drink six to eight glasses of liquid each day, including Gatorade or coconut water to help replace minerals lost.
Dry mouth can be a debilitating side effect of many medications, cancer drugs and radiation to the head and neck. Soft or moist foods such as tuna salad, cereal, and pasta can help.
Eating well during cancer treatment can be difficult at times but good nutrition during treatment can help decrease hospitalizations and delays in treatment and general well-being.
Patients undergoing cancer treatment at Penn Medicine, or those who have completed cancer treatment, may benefit from nutrition counseling services at the Abramson Cancer Center. For more information about nutrition counseling, speak with your physician or nurse.
You may feel tired during and after treatment. Radiation therapy, chemotherapy, surgery and other treatments may cause you to have less energy. An infection, fever, poor nutrition, decreased activity, depression and stress can also cause fatigue.
Being tired can impact work, concentration and participation in family or social activities. Even after cancer treatment ends, it may be a while before you feel strong again. The following tips can help conserve energy:
- Prioritize activities
- Delegate things that are less important
- Take short rests as needed
- Walk or exercise
- Get a good night’s sleep
- Eat frequent, small, nutritious meals for more energy
- Ask about medicines to help with fatigue
Today, many patients who survive cancer can expect to live normal and productive lives. For some, returning to a "normal" life includes having children. However, cancer treatment can potentially cause infertility or problems with reproductive organs due to the effects of medical, radiologic or surgical treatments used to combat the cancer.
Penn Fertility Care has been a pioneer and today remains a leader in the treatment, services and programs offered to patients who have become infertile due to the effects of cancer.
Swelling or puffiness in the face, hands, feet or abdomen can result from the fluids administered during chemotherapy or the chemotherapy itself, and should be discussed with a doctor or nurse. Here are some tips patients can try to manage swelling:
- Limit salt intake. Salt can be present in foods such as soups, frozen or canned food, processed meats, cheese and soy sauce
- Avoid tight clothing
- Elevate your feet
- Contact a doctor if the swelling becomes uncomfortable. Patients who have had no urine output for 12 hours or dark or bloody urine should contact their doctor or nurse immediately
If you have been diagnosed with and treated for gynecological cancer, you are at risk of developing lymphedema. Lymphedema, chronic swelling, can develop when there has been damage to the lymphatic vessels and/or lymph nodes from surgery and/or radiation therapy. Lymphedema develops when the lymph fluid is not able to move out of an area that has damage to the lymphatic system. It is an accumulation of protein rich fluid (lymph) in the soft tissues. Lymphedema is not painful, although it can be uncomfortable, and it is not life threatening.
Signs and Symptoms
People who have been treated for gynecological cancer can develop lymphedema in the abdomen, genitals, buttocks and/or the legs. Symptoms of the development of lymphedema are:
- Skin feels too tight
- Clothing feels too tight
- An increase of numbness or tingling in the area
- New aching or heaviness in the area
Reducing the Risk of Lymphedema
There are some things that you can do to reduce the risk of developing lymphedema:
- Keep the skin clean and well moisturized with non-perfumed skin lotion
- Avoid pedicures
- Cut toenails carefully
- Wash cuts with soap and water as soon as possible
- Don't walk in bare feet
- Wear shoes that fit well and cover the feet
- Wear clothing that doesn't bind in the waist
- Avoid extremes of hot and cold – no saunas, hot tubs, hot packs or ice packs
- Avoid deep tissue massages to the area at risk
- Use insect repellant to avoid bug bites
- Use sunscreen when planning to be out in the sun
Who Do I Call if I Suspect Lymphedema?
If you suspect that you are developing lymphedema, call your health care team to make an appointment to be evaluated. Your health care team will refer you to a physical therapist or an occupational therapist, which specializes in treating people with lymphedema. There is a team of physical therapists at Penn Therapy and Fitness/Good Shepherd Penn Partners who specialize in treating people with lymphedema.
Although lymphedema is not life threatening, it is important to look out for signs of infection. If you notice the area feels warm or hot to touch, increased redness or rash, quick change of swelling, fever or new pain, please contact your physician.
What is Lymphedema Treatment?
Lymphedema treatment is provided by certified lymphedema, physical/occupational therapists. The treatment is referred to as Complete Decongestive Therapy (CDT). CDT includes:
- Manual lymphatic drainage – a precise, gentle stretching technique of the skin to direct fluid to flow away from the swollen area
- Compression bandaging
- Therapeutic exercise
- Measurement for and fitting of compression garments
- Careful skin care
- Patient education
Additional Treatment as Needed
Often people who have been treated for gynecological cancers have physical therapy needs in addition to treatment for lymphedema. Your health care team and/or lymphedema therapist may recommend treatment for:
- Range of motion and strength deficits
- Cancer fatigue
- Soft tissue and/or scar adhesions from surgery and/or radiation therapy
- Pelvic floor dysfunctions – incontinence, constipation, diarrhea, sexual dysfunctions, etc.
- Pelvic pain
Physical, Occupational and Speech therapy services are provided by Good Shepherd Penn Partners; a partnership between Penn Medicine and the Good Shepherd Rehabilitation Network. Good Shepherd Penn Partners provides specialized long-term acute care and inpatient and outpatient physical rehabilitation throughout the Philadelphia region.
Lymph Node Transfer at Penn Medicine
Lymph node transfer is a relatively new microsurgical, reconstructive procedure used for the treatment of lymphedema. Typically, it involves surgically removing lymph nodes from one region of the body to the region affected by lymphedema.
The goal of the surgery is to incorporate the new lymph nodes so that they begin to function on their own and drain fluid naturally.
Mouth sores can be a painful side effect of cancer treatments and/or radiation to the head and neck. Although, they usually heal within two weeks, here are some things you can do to help mouth sores.
- Avoid commercial mouthwash with alcohol
- Keep the mouth clean
- Eat soft foods when mouth sores are present
- Contact a physician if you are unable to eat or drink
You may experience different types of nausea during cancer treatment.
- Anticipatory nausea is a learned response, and can be the result of anxiety prior to coming for treatment. Stress reducing medications or relaxation techniques can help.
- Chemotherapy-induced nausea can start with the onset of treatment or be experienced several hours later.
Pain may be caused by different factors including diagnostic procedures, cancer treatment, the cancer itself, and other reasons not related to cancer. Pain, if not treated, may impact your quality of life. This is because pain is not only a physical experience but also a psychological and social experience. Pain may interfere with activities of daily living, work, and interpersonal interactions.
Pain can be controlled with effective pain medications. Let your health care team know if you are experiencing pain, so the appropriate pain treatment is implemented.
Pain treatments include a combination of modalities such as analgesics (pain medications), adjuvant medications (increase the analgesic effect of pain medications), anesthetics, massage, use of heat and cold, relaxation, exercise and more.
Pain management programs are available through the Abramson Cancer Center.
Some ovarian cancer survivors are at high risk for a small bowel obstruction. This may be due to surgical adhesions or the tumor itself. First it is important to know what the signs and symptoms are of a partial small bowel obstruction.
Some symptoms may be cramping, gas, bowel changes, nausea and vomiting. Vomiting and increasing abdominal girth and pain may indicate a total obstruction. Keep in mind that symptoms may vary by individual and severity of the obstruction. It is important to notify your doctor immediately.
With a partial small bowel obstruction, there may be dietary changes to prevent a complete obstruction. These include:
- Eat smaller meals, more frequently throughout the day.
- Follow a low fiber diet. Avoid fruits and vegetables with skins and seeds; avoid whole grains, nuts and seeds. White bread, white flour based pasta and peeled potatoes may be tolerated. Low fiber cereals include: puffed rice, Cheerios, cream of rice, cornflakes.
- Avoid fatty and greasy foods. These are much more difficult to digest and may stay in the stomach longer causing greater discomfort.
- Drink plenty of fluids: water, broth, tea, gelatin and juice may help you stay well hydrated. Some people find that full liquids: hot cereals, puddings, milkshakes and nutritional drinks are tolerated. If nausea is persistent, switching to nutritionally concentrated liquids is worth trying.
- Avoid lactose containing drinks if gas or milk intolerance is noted.
- Avoid gas-forming foods such as gassy vegetables (ex: broccoli, cauliflower), soft drinks, beans and chewing gum.
For more individualized assistance contact our registered dietitian at 215-829-6560.
Coping with the stress of cancer and treatment side effects is challenging. Many cancer patients experience anxiety and feelings of depression. Feeling overwhelmed, hopeless, isolated, tearful, and having difficulties concentrating is common. Speaking with a counselor or practicing relaxation techniques can help some people feel better. Relaxation techniques can help with sleep, energy and reducing anxiety
There are different methods to help relieve day-to-day stress. A simple relaxation exercise that can be done through the day includes:
- Finding a quiet place
- Staring at an object or closing the eyes and thinking of a peaceful scene
- Taking a deep breath in through the nose and breathing out through the mouth, pushing all of the air out of the lungs
- Placing one hand on the abdomen while taking a breath in through the nose and letting it out through your mouth, focusing on the way the muscles are working to help breathing
Cancer counseling services at Penn Medicine offer support and information about stress and concerns you may face as you undergo cancer treatment. Services also include psychological and spiritual counseling.
While friends and family may try to do everything they can to help, it’s normal to feel sad, alone or out of control. It’s normal to experience difficulty speaking to friends and family who have not had cancer and haven’t had the same experiences.
Many people who have been through cancer treatment say it helps to get a sense of connection with a support network. Support groups are usually free of charge and led by trained staff. Other patients prefer working one-on-one with someone who has special training and experience in counseling people with cancer.
Family and friends may also benefit from counseling or support groups.
Cancer counseling services at Penn Medicine offer support and information about concerns cancer patients may face as they undergo cancer treatment.
The Abramson Cancer Center offers psychological and spiritual counseling. For more information about counseling services at the Abramson Cancer Center or to make an appointment, call 800-789-7366 (PENN).