Living With Cancer

With treatment, people with cancer may live for many years after diagnosis. However, the treatment of cancer can also have side effects, such as nausea and fatigue. Cancer symptoms, and those symptoms that occur as side effects of cancer treatment, can often be relieved, at least for a time (such as by drugs to prevent nausea). Controlling such symptoms can greatly improve quality of life. Many people find that they can carry out most of their usual activities while they are being treated for cancer.

Pain: Many people with cancer are concerned that they will have a lot of pain. However, cancer pain can often be controlled very well. A variety of pain relievers can be used, depending on the severity of the pain. For mild pain, nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be sufficient. For severe pain, opioids, such as morphine and hydromorphone, may be necessary. Some opioids can provide relief for several hours or even days. Some can be applied as patches. In addition, antidepressants, anticonvulsants, and local anesthetics can be given along with pain relievers to offer more relief.

Many people fear that they will become dependent on strong pain relievers. However, such concerns are not valid. There is no reason why a person should have to live with pain. In addition, failure to use pain relievers with sufficient regularity and at sufficient doses can allow pain to reappear; such pain then requires higher doses of pain relievers than would otherwise be required.

However, some side effects occur routinely with opioid use. Almost every older person will develop constipation. Constipation from opioids must be treated with a stimulant laxative. Many older people who take opioids will have difficulty emptying their bladder. All opioids make people tired, especially when they are just starting to take an opioid. Sometimes doses can be adjusted or different opioids can be tried to help reduce these side effects.

Nausea: Nausea, often accompanied by vomiting, can be a symptom of cancer and a side effect of treatment. Several new drugs are available to lessen nausea and vomiting.

Weight loss: The use of anti-nausea drugs has made weight loss associated with use of chemotherapy drugs less common. Food supplements can help prevent and treat weight loss. Drugs to increase muscle mass may also be given, such as dronabinol (which also can be used to reduce nausea) or megestrol. Many people with advanced cancer lose weight, in part due to loss of appetite. When cancer is advanced, weight loss is often seen as acceptable, especially when compared with the alternative of potential side effects and discomfort that may develop when drugs or feeding tubes are used to treat weight loss.

Hair loss: Some chemotherapy drugs can cause hair loss. Some people find this side effect distressing. Many people purchase wigs before beginning cancer treatment so that the wig can be made to look similar to their own hair. Other people choose to wear hats and scarves or even to leave their heads uncovered. The most important consideration is that the person be comfortable with the choice.

Fatigue: Fatigue may be related to the cancer itself or to the effects of treatment. For example, radiation therapy can cause fatigue. Many chemotherapy drugs affect the rapidly dividing cells of the bone marrow, leading to a low level of red blood cells, which results in anemia and fatigue. In some people, a drug that increases the body's production of red blood cells can reduce fatigue. People experiencing fatigue may need to adjust their activities. Some experts recommend a daily schedule that includes frequent rest periods. Activities that require a lot of energy can be planned for parts of the day when energy level is highest.

Depression: People may feel hopeless or overwhelmed by the diagnosis of cancer or by the stress of navigating the health care system. Also, the metabolic and hormonal effects of the cancer itself can contribute to depression. A cancer diagnosis is frightening, and depression can be compounded by agitation due to the fear or an attempt to hide the fear and depression. Opioids can cause or worsen depression. Regardless of the cause, antidepressant drugs can be very helpful.

Evidence has shown that a positive attitude and resilient hope are important parts of therapy. Sometimes, people benefit from sharing their concerns with others in similar situations. Support groups can provide members with advice and encouragement. Other people with depression may benefit from counseling with a psychiatrist or psychologist.

Potential challenges while living with cancer: Cancer treatment may go on for several months. Social service agencies can help coordinate the many health care services needed. They can assist with transportation to and from treatments and in arranging home health services. They can also direct people to additional sources of help. Organizations devoted to helping people with cancer, such as the American Cancer Society, can provide additional information.

People may need assistance with insurance forms, and they may also want financial and legal advice. It is important that older people with cancer update a will and prepare an advance medical directive. They may want to discuss their concerns about care with their doctors and family members. Knowing when a person with cancer is moving from living with the disease to dying from the disease is often very difficult. However, exploring options for palliative care and end-of-life care is well worth considering when the outlook for the cancer is unlikely to be altered by treatment.