that acupuncture can be used to block pain and lessen nausea. Some women have indicated that acupuncture increases the effectiveness of anti-nausea medication such as Ondansetron (Zofran). Acupuncture is further discussed in Chapter 11.
Other chemotherapy side effects that affect daily quality of life include lack of appetite, bladder problems, bowel difficulties, mouth sores, muscle pain, urinary tract infections, vaginal bleeding, lack of sexual desire, anemia, possible weight gain or weight loss, and a side effect called “chemo brain.”
The Dreaded “Chemo Brain”
A major annoyance for many cancer survivors is what has come to be known as “chemo brain,” when they have difficulty with short-term memory, are unable to concentrate, and have difficulty performing mental tasks that previously gave them no trouble. Donna, 49, an accounts receivables clerk with a facility for numbers, says, “I could remember everything. When my boss used to ask me about an account, I would give her the answers without any hesitation. Now, even an hour after I looked at the statement, I have to tell her, ‘I’ll have to look.’”
With the general acceptance of the reality of chemo brain, the health care community is continually devising approaches that patients can use to improve their cognitive functioning. Most of these methods are used by executives and others who, while they have no specific problem, feel they need to track details of daily activities. They can provide hope to women whose response to chemo-brain is like Rachel’s: “I’m not going to let chemo-brain do me in.”
Commonly repeated suggestions include:
Focus on the task at hand. This includes simple things such as where you put your keys or your slippers, as well as more complex tasks such as handling the bills or working on office assignments.
1.Make a list of things you need to do. A great many people keep “To Do” lists all the time because with many things happening during the day, it is easy to forget important items. People prepare shopping lists for the same reason.
2.Get clarity on the things other people ask you to do. Ask them to repeat what they have said, perhaps stating the request in another way. You might even tell them your understanding of their request.
3.To better handle complicated actions and activities, people with severe chemo-brain problems find it helpful to practice the activity so that the process is clearer in their mind.
4.Maintain a daily organizer or keep a journal for easy reference.
5.Regularly challenge your memory in order to retain good mental capability. Activities such as crossword puzzles and memory games can help.
Sexual effects of different cancer treatments
Along with understanding the effects of various treatments on sexuality, women should know that the side effects differ in severity from one woman to the next. One woman may have nausea and another vaginal pain. And even if both of them have vaginal pain, it may be more painful for one than the other. Age, the level of wellbeing and many other factors contribute to how much a woman may feel the side-effects. Even the degree to which a given woman’s sexuality will be affected varies among women. Table 2 lists the likely effects of different cancer treatments.
A 2007 booklet from the American Cancer Society, Sexuality and Cancer for the Woman Who Has Cancer and Her Partner, has a guide, shown in Table 3, that shows how frequently some of the common cancer treatments cause sexual problems. The chart lists six fairly common sexual problems. For example, as shown, chemotherapy sometimes causes low sexual desire and reduced vaginal size, but rarely affects achieving orgasm. Of course, the effect of inducing premature menopause can result in a broader range of sexual problems. A woman may have serious psychological issues related to body image and identity after a mastectomy, but the mastectomy itself causes few physical sexual problems, as shown in the table. However, arousal issues and the relation of breast arousal to arousal of other sexual organs should not be minimized. Combinations of treatments may make some of the side effects more difficult to handle.
Many women noted that they continued to have sexual relations during the treatment period. Side effects did cause sexual problems that reduced the frequency of sexual relations. The two primary reasons women gave for continuing to have sexual relations during treatment were that they needed physical bonding with their partners and that they wanted to take care of the sexual needs of their partners.
Psychological Effects
Table 4 is an overview of the emotional landscape of women and their partners, showing the range of psychological effects that each may experience. Dealing with these feelings plus the physiological changes can put a couple under considerable pressure and disrupt their daily balance. In effect, the couple must adjust to a new status quo.
In looking at the table, you may notice that quite often, the partner expresses emotions similar to those of the patient. Yet the two may have widely different perceptions and mismatched expectations. For instance, both partners may feel frustrated in their attempts to get on with life. One example may be intimacy. One partner may want to do what he or she believes the partner wants, except that “feeling sexual” cannot come at will. Unrealized expectations can kill the romance. Unfortunately, adjustments must come in the heat of battling the side effects. It is analogous to trying to rebuild a town while the shelling is still going on.
The situation is more difficult for those couples that had problems with intimacy prior to cancer. Incompatibility that has not been worked through is still there. Couples must deal with the related issues to have a good foundation for an intimacy that works.
The effects of cancer and its treatment can impact the whole person. Prominent psychological side effects may include mood swings, anxiety, and depression. The change in appearance due to the loss of one or both breasts as the result of a mastectomy often has a profound effect on the woman. The loss of reproductive organs may have a similar effect on a woman with gynecological cancer. Her perception of herself as a woman and as a sexual partner may be drastically altered, resulting in a negative body image and in withdrawal from contact with other people, especially her partner. Breast reconstruction surgery may alleviate some of the negative feelings about her appearance for the mastectomy patient, but since reconstruction does not restore normal sensation, she may still feel that intimacy is different than before.
Four psychological side effects of cancer therapy may undermine the confidence and self-esteem of women during and after treatment for cancer. These conditions effectively create barriers to restarting the couple’s physical intimacy. Together, these conditions can be represented by the acronym ARID. The ARID Complex consists of anxiety disorder, feelings of rejection, identity disorder, and depression. Individually, these are psychological ailments; if they come in combination, patients may experience trauma-related symptoms of stress akin to post-traumatic stress disorder (PTSD). According to the National Cancer Institute, cancer patients may be at risk for PTSD because “the physical and mental shock of having a life-threatening disease, of receiving treatment for cancer, and living with repeated threats to one's body and life are traumatic experiences for many cancer patients.” Whether a person suffers some form of PTSD related to cancer treatment depends on many factors and is being studied at research facilities throughout the country.
Anxiety Disorder
Will the treatment work?
Will the disease recur?
Will I die from this cancer?
How
