Managing symptoms
Helpful materials > Managing symptoms
On this page you can find information on the side-effects of cancer and treatments. You may be familiar with some of this information and, depending on your type of cancer, some of this information may not be relevant to you. However, some of this may help you to understand what it is that you are dealing with.
Below, we provide the answer to 4 common questions people have regarding symptoms and their side-effects.
Question 1: What are the symptoms and problems associated with the illness and treatment?
As a person with cancer you may experience various symptoms and side effects associated with both the illness and its treatment. A number of these problems are described below, along with some tips on how to best manage them.
Pain
People with cancer are often worried that they will experience pain. Not everyone who experiences cancer will feel pain, but if you do it can usually be controlled with painkillers (analgesic medicines). If you are experiencing pain, you should discuss this with your GP or treatment team as soon as possible. The earlier treatment begins the better the chance that the pain can be relieved. A useful role that can be undertaken by the family caregiver is to help the person with the cancer to monitor when they are experiencing pain. You can both monitor any pain you might be feeling using the distress thermometer.
Carefully reporting your pain will help the doctors to prescribe you the right
dose and type of medicines. Analgesic medicines are normally used and may be increased in strength and dosage according to the severity of the pain. In the first instance paracetamol and anti-inflammatories will be administered for mild pain. Weak opioids may then be given for slight to moderate pain; however, this can cause drowsiness, confusion, constipation and lethargy. Stronger opioids may also be prescribed. The pain medication may be administered in different ways, by mouth, via patches, suppositories, injections, pain pumps or through an intravenous drip.
Chemotherapy, surgery, radiotherapy and hormone therapy can also relieve
pain by shrinking or removing the tumours. Electrotherapy or permanent neurostimulation may also be applied. In electrotherapy the nerves are stimulated by electric current, which causes the body to produce morphine, which relieves the pain. Permanent neurostimulation involves implanting an electrode for relief depending on the intensity of the pain. Injections around the nerve cells can also relieve the pain.
There are also non-pharmacological pain treatments (i.e. pain treatments that do not involve medication) that can be provided by themselves or in combination with medications. Examples include physiotherapy, acupuncture, psychological support and relaxation or diversion.
Do you want more information on pain?
You can also contact the cancer nurse helpline on Freephone 1 800 200 700 if you would like more information (https://www.cancer.ie/cancer-information-and-support/cancer-support/find-support/cancer-nurseline )
Palliative care: https://www.cancer.ie/cancer-information-and-support/cancer-information/cancer-treatments-and-side-effects/palliative-care
Nausea
Sometimes, people with cancer may also feel sick (nausea). This may be due to cancer treatments (e.g. chemotherapy and/or radiotherapy) or, it may be due to the cancer itself (e.g. the cancer may cause a blockage in the stomach and/or intestines, fluid retention or stress or fear, all of which can make you feel sick).
To find out why you are feeling sick, it is a good idea to record some information: When did you feel sick; did you vomit; is there a particular food or drink that makes you feel sick; when you vomit, what does it look like, what colour is it; do you have any other complaints, such as headache, loose bowels, thirst, or a swollen stomach? These are all things that you should note down together with your family caregiver and show this information to your medical team. This information will help them to decide which anti-sickness drugs may help you.
Again, anti-sickness medicines may be administered in various ways. Via an oral tablet, suppository or intravenous drip. It is important that you discuss your symptoms with your doctors to help them decide the most appropriate way to administer your medication.
Some tips when you are suffering with nausea
Eat small meals or snacks 5 to 6 time per day. Not eating for long periods can increase nausea.
Eat food served cold or at room temperature.
Eat or drink sufficient amounts and/or something that contains ginger, this can reduce nausea.
Avoid fried or fatty foods.
Good oral and dental hygiene can also help to reduce feelings of nausea.
Control your breathing, use stress-reducing techniques such as meditation.
Do you want more information about nausea and what you can do yourself?
Changed appetite & weight loss
Cancer treatment may cause changes in your sense of taste, smell or, how we experience food. Sometimes, the cancer or its treatments may make swallowing difficult.
It’s also possible that you will unintentionally lose weight, as the cancer may change the way your body uses food. Weight loss and associated malnutrition may cause other side effects, so it is important to try to eat well and use dietary supplements if necessary.
If you are concerned about weight loss, you should speak to your GP or other member of your medical team. They will be able to advise you and may be able to refer you to a dietician.
Shortness of breath
Feeling short of breath is common among people with cancer. Family caregivers may also feel short of breath if they are under pressure or stressed. There are many reasons why someone with cancer may feel breathless such as: fluid on the lungs, having an infection, the cancer itself, formation of wound tissue through radiotherapy, swelling in the stomach, low red blood cells or some other chronic condition such as asthma.
Being short of breath is an unpleasant feeling and can cause anxiety. Breathlessness can be treated, and different methods will be used depending on the underlying cause. Treatments can range from drug-based treatments to oxygen therapy, or through minor surgical procedures, for example to drain fluid from the lungs.
Fatigue
Cancer related fatigue is a common symptom and feels different to normal feelings of tiredness. Cancer related fatigue results in you feeling exhausted and totally lacking in energy. This may be due to the cancer itself, or it may be a side effect of your treatment. The emotional burden associated with having cancer and side effects such as anaemia or pain can also contribute to feelings of fatigue. If you are experiencing fatigue, it is important that you inform your doctor.
If you are suffering from fatigue you may be inclined to stay in bed longer, but this may not be most helpful. The more you rest the more tired you will feel. So, try to alternate periods of rest with some gentle physical activity. A little stroll or some form of not too strenuous physical activity may really help. Several brief rest periods will be better for you than one long rest period. Trying to get a good night’s sleep is also important if you want to start the next day feeling refreshed.
Writing down the activities you need to do on a particular day can help you manage your energy levels. It is important to prioritise what is important over what can be left to another day, that way you can plan your activities. You can record your activities in a diary and estimate how much energy each task has taken so that, in the future you can decide what tasks are important and focus on them.
Asking for help can also help you to manage your energy. Getting support from your carer or from other family and friends will allow you to save your energy for things that are important to you.
Some more tips to deal with fatigue
Try to avoid stress, as it will leave you feeling drained. Try to meditate or control your breathing when stressed.
Limit visits. You may find that people visiting you, or you visiting others, can be exhausting. It’s okay to cancel visits or reschedule them for another time.
Limit your alcohol or caffeine intake. Alcohol is a known depressant and caffeine is a stimulant which can make you feel agitated.
Don’t be afraid to eat ready meals. These can be nutritious and are easy to prepare.
Keeping your mind engaged can also help you deal with fatigue. For example, reading, writing or listening to music are relaxing activities that can improve your mood and take your mind off feeling tired.
Do you want more tips to manage fatigue?
Some tips to avoid shortness of breath
Breathe in a controlled way: this is a technique involving active breathing from the diaphragm and lower chest, instead of breathing from the upper part of the body. This can help you to breathe more gently and more effectively.
Try a relaxation technique: for example, just close your eyes, breathe deeply and slowly. Pay attention to your thoughts, sounds, the sensation of breathing or how different parts of your body are feeling. After practicing this a few times, you should be able to relax and stabilize your breathing.
Make sure there is good ventilation, open a window or sit near a small fan.
Sit with your back up straight or lean forwards with your arms over a cushion/table to relax your respiratory muscles.
Wear loose clothing.
Drink fluids. Being dehydrated can cause thickening of mucous membranes in your mouth, throat and lungs and make it difficult to breathe.
If you are feeling breathless you should rest; perhaps complete day-to-day activities sitting in a chair rather than standing
Question 2: What are possible problems or symptoms that family caregivers can experience?
Family caregivers may also experience a variety of symptoms.
Sometimes, family caregivers experience problems due to the physical strain associated with providing care; these can include: back pain, headache, high blood pressure, anxiety, dizziness and changed appetite. Sometimes, new pressures cause the family caregiver to neglect their own physical and mental well-being. In fact, it is common for family caregivers to forget or delay their own healthcare appointments.
As a caregiver, you might feel a lack of energy or motivation. You may find it hard to be interested in social activities, and not want to take part.
Often, family caregiver’s report that they find it difficult to relax at night and it can be difficult to get a good night’s sleep. Caregivers also report feelings of depression, fear, shame, guilt, concentration problems, and mood swings.
You may notice changes in your behaviour. You may feel agitated or frustrated more often. Perhaps you feel less tolerant towards others, or you react angrily. As you are now spending time caring for someone else you may feel that you have less time or energy to spend on your own interests, appearance and personal care. Some caregivers report that they have tried to cope with the pressures of their new role by self-medicating with alcohol and or drugs.
Some general tips to help you look after yourself
As a family caregiver it is vital to take care of yourself.
When you are feeling stressed or burdened you should talk things over with family and/or friends. Talking can help you to make sense of things and can often help relieve the pressure you are feeling.
Take regular breaks. Family caregivers need to have some time in their lives where they can relax and recharge their batteries. Try to set a regular time each day when you can just do something for yourself that will help you unwind.
Use your social network. Think of other people who could help you with your caring responsibilities. Perhaps there are other family members, friends, neighbours or volunteers who could help and give you a little time to yourself. Often, other people want to help and support you but wait for you to ask for help. Try to delegate some activities and schedule which activities will be done by whom.
Respect your own limits. Let people know if things are starting to get on top of you and that you would like some help.
Don’t be afraid to ask for professional help. Local healthcare providers are there to help and support both of you.
Question 3: How can we keep track of our symptoms and concerns?
Exercise: Use the distress thermometer yourselves!
Use the distress thermometer by indicating in a diary (or on your computer) what level of discomfort you have experienced in the last 24 hours. First indicate for each of the possible problems whether it has been a problem for you and then for those for which you answered ‘yes’ also fill in a score on a scale of 0 (no discomfort by the symptom or problem) to 10 (maximum degree of discomfort by the symptom or problem).
It can be useful to also make notes about when the problem occurred (e.g. in the early morning, at 3pm, after taking certain medication), how you felt or experienced it and how long it lasted. Try to complete the information every day for a whole week. You can repeat this exercise if you feel the need to.
Emotional
Handling emotions Remembering things
Self-confidence
Fears
Sadness/depression Stress
Loneliness
Difficulty concentrating Guilt
Loss of control
Boredom
Physical
Hair loss
Constipation
Diarrhea
Difficulty eating
Feeling swollen
Fever
Nausea
Dry, stuffy nose
Pain
Sexual problems
Sleep problems
What should we do with the scores for the problems?
Once, you have filled out the scores for a whole week, discuss the results with each other.
The following interpretation of scores can help you with that discussion:
The scores for the problem range between 0-4: distress levels for this problem seem to be under control.
The scores for the problems were between 5-7: It looks like you are experiencing some distress that may be significantly affecting your life. It could be worth discussing this with your health care team and identify ways to get some additional support.
If your scores are between 8-10 you may be experiencing high levels of distress. It is important that you talk with a health care professional about what may be contributing to your distress.
Both of you may find it helpful to monitor your symptoms. By doing this there is a better chance that you will be able to find a solution for your problems. You may want to use a distress thermometer (see illustration below). You can use this individually or together to show each other and your health care professionals how you are feeling. Keeping a record of this in a diary will also help you to keep track of the symptoms that have caused you both most concern.
Question 4: What is palliative care and how can we access it?
Palliative care is a type of care that is aimed at maintaining and improving your quality of life by anticipating, managing and preventing suffering for people who have a life-limiting illness. In palliative care, physical, psychological, social and spiritual care needs are addressed.
Physical: by providing relief from persistent pain and suffering from other symptoms.
Psychological: by providing support for the person with cancer and their family caregiver in dealing with the illness and the sense of loss.
Social: by providing support in connecting and communicating with the social environment.
Spiritual or existential: by offering spiritual relief around key questions about hope, dying, meaning and identity.
Palliative care can begin at any time during the disease process.It is not only provided to people who are approaching the end of their life. This is a common misunderstanding. Palliative care is provided alongside other treatments that you may still receive. Discussing palliative care (e.g. with your GP) can help to ensure that you receive the care you need at the earliest possible stage. Many people provide palliative care. In fact, people with cancer and their family caregivers often provide palliative care to one another by addressing each other’s physical, psychological, social and spiritual needs. GPs, nurses, hospital specialists and many other health care providers can also provide palliative care.
There are also services that specialise in providing palliative care. They can deal with situations which are more complex and require specialist knowledge.
In the UK, specialist palliative care services vary from region to region, but they may include:
Palliative home care teams: support family physicians and community nurses in providing palliative care to patients at home. The Palliative home care team will aim to support you and your family and use their specialist knowledge to reduce symptoms such as pain and tiredness. The team may provide educational information as well as emotional, social and spiritual support with the aim of ensuring that you have the best quality of life possible.
Palliative care units are separate wards in a hospital which specialise in providing palliative care. They are designed to care for patients and families with more complex physical, psychological and/or spiritual needs that cannot be met in the home or care home setting, either on a temporary basis or until the patient dies.
Hospice care aims to improve the quality of life and wellbeing of patients with a life-limiting or terminal condition. You can receive hospice care as a day patient or as a resident. Hospice care helps people to live as full a life as possible by meeting their physical, emotional, social and spiritual needs. Hospice care also supports carers during the illness. People can use hospice care at any point in their illness, it is not just for people who are approaching end-of-life.
Palliative (or supportive) day care centres provide palliative support to support the person with cancer and give the main caregiver some spare time so that patients can remain in the community for as long as possible. One or more days a week, patients can meet other patients, talk to staff and become involved in activities.
Both of you can request palliative care via your GP. They will be able to discuss the services that are available in your area.