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Life after cancer

A new normal



Many survivors say they have a new appreciation for life and the people around them after facing cancer. But life after treatment does not always return to "normal."  Cancers and cancer treatments can have long-lasting effects.

"After my treatment finished, I didn't know what to expect. Physically, I felt like a wet rag. Emotionally, I was scared and truly lost."  - breast cancer survivor
Not everyone "finishes" cancer treatment. While some have treatment and move into recovery, remission, or surveillance, others stay on maintenance therapy or receive ongoing treatments. 
Last Day of Treatment

After  treatment  is  completed  you  may  have  follow‐up visits with  your  oncologist  (cancer  specialist). You will be notified of these appointments by your care team. 

For patients on the last day of radiation or chemotherapy info sheet: 

Follow-up After Treatment

Frequenty Asked Questions

Medical follow-up includes check-up appointments with your health care team, physical exams, blood tests, and imaging (e.g. x-rays, mammograms, or CT scans.) 


The purpose of follow-up is to:

  • Determine the effectiveness of your treatment
  • Assess any side effects
  • Manage any late effects
  • Detect any remaining or new disease

During treatment your health care team may have included a family doctor, nurse practitioner, specialist(s), surgeon, an oncologist, a General Practitioner in Oncology (GPO), nurses, radiation therapists and more. 


In British Columbia, long-term cancer follow-up is generally done by an oncologist, General Practitioner in Oncology (GPO) or a primary care provider (family doctor or nurse practitioner) in your home community. 

The exact schedule of tests and appointments will depend on the type of cancer you have had. But everyone who has had cancer treatment should focus on at least two appointments at the end of treatment:


1. An “end of treatment” appointment with your GPO (General Practitioner in Oncology) or oncologist (cancer specialist). At this appointment you will learn about any common late effects and who to talk to about different concerns.


2. An “end of treatment” appointment with your family doctor or nurse practitioner. At this appointment you can talk about your specific side effects and make a plan for follow-up.


At these “end of treatment” appointments you will be given a schedule of the tests and appointments you will need. 


Read more about the follow-up plan for your specific cancer on the BC Cancer Agency Types of Cancer webpages.

Pay close attention to how you feel and keep your health care team informed. If you feel unwell, seek medical attention. Your doctor may have “same-day” appointments available.

Seeing your family doctor or nurse practitioner is part of returning to normal. Family doctors and nurse practitioners use guidelines to understand cancer side effects and to determine the tests and imaging you will need over the long term. Your family doctor or nurse practitioner will consult with or refer you back to a cancer specialist if there are questions or concerns.

Your family doctor or nurse practitioner will also continue to address your health care needs that are not related to cancer, such as a sore throat or injury.

If you do not have a regular family doctor or nurse practitioner, contact the College of Physicians and Surgeons of BC to find one in your community.
You may feel nervous before your regular check-ups. You may be worried that you will be told your cancer has come back. This fear is common. It may help to:

  • Take a close friend or family member with you
  • Write down your questions before the appointment
  • Plan to do something special for yourself after the appointment, like watching a favourite movie or buying yourself a treat

When you meet with your oncologist near the end of treatment, ask for information about the treatment you had and any side effects or late effects you can expect.


Here is a list of questions from the National Cancer Institute:


  • What was my cancer diagnosis?

  • What treatments and drugs have I been given?

  • Is there a handout or document that outlines my treatment and follow-up plan?

  • What was the purpose of the treatments?

  • Which doctor should I see for my follow-up cancer care?

  • What are the chances that my cancer will come back or that I will get another type of cancer?
  • What follow-up tests should I have, and when?
  • What symptoms should I watch for?
  • If I develop any of these symptoms, whom should I call?
  • What are the common long-term and late effects of the treatment I received?
  • What should I do to maintain my health and well-being?

It is important that you tell your doctor about anything that could affect your follow-up care. For example, certain vitamins and herbs can influence the way that pharmaceutical medications affect your body.


Your doctor may ask about:


  • Any symptoms that they think may be a sign that your cancer has returned
  • Any pain that bothers you
  • Any physical problems that interfere with daily life or are bothersome, such as fatigue, changes in thinking, memory, and attention, difficulty with bladder, bowel, or sexual function, trouble sleeping, and weight gain or loss

  • Any medicines, vitamins, or herbs you are taking and any other complementary treatments you are using (such as a chiropractor)
  • Any emotional problems you are experiencing, such as anxiety or depression
  • Any changes in your family medical history, including any new cancers

A wide range of therapies are considered complementary, including natural health products and supplements, diets, exercise, yoga, acupuncture, naturopathy, and Traditional Chinese Medicine.


Complementary and alternative medicines work best when paired with a healthy lifestyle, including eating a healthy diet, getting plenty of exercise, maintaining an optimal weight, quitting smoking, and practicing sun safety.


Many people use some form of complementary or alternative medicine (CAM) during or after cancer treatment. People may use these to address side effects, or improve well being.


Talk with your health care provider if you are using CAM as part of your survivorship wellness plan. Some CAMs can influence the effect of pharmaceutical medications on your body.


For more information about complementary or alternative medicines and cancer see the BC Cancer Agency Library Recommended websites on Complementary and Alternative Therapies

Follow-up Programs

Below are brochures for follow-up after breast cancer treatments and colorectal cancer treatments. For all other cancers, please follow the advice of your health care team.

After breast cancer treatments

After colorectal cancer treatments 


Healthy Living After Cancer

Following an experience with cancer, many people reflect on how they live their lives. They may wish to make some changes. Making changes towards living a healthy life can help people recover from treatment, improve side effects, and reduce the risk of second cancers or other health problems.

Making lifestyle changes can be challenging. Start slowly and making small changes gradually. Support from your health care team, friends and family can help.

A second primary cancer is one that is not related to the first cancer, has not spread from the first cancer, and usually originates in a different tissue or organ. 

Viewed as a group, second primary cancers are the sixth most common cancer in Canada.

Once you have had a cancer diagnosis you have a slightly increased risk of developing a new cancer. Some second cancers are more common than others. You can take steps now to reduce your risk of developing many second cancers. 

Some risk factors for getting a second cancer cannot be changed (such as your age or whether you have inherited a gene mutation). 

Daily lifestyle choices matter now more than ever. This includes choices about what you eat and drink, how much physical activity you get, if you use tobacco or alcohol, and whether you protect yourself from the sun and other forms of UV radiation.

If you have had any kind of skin cancer—whether basal cell, squamous cell, or melanoma—your risk of developing another skin cancer is increased. Survivors of kidney cancer are also at higher risk of developing the most dangerous type of skin cancer, melanoma.


Read more about sun safety.

We know that being overweight or obese raises the risk of some cancers, especially those of the colon, pancreas, kidney, uterus, and breast. 


Your body may be very different after cancer treatment. Side effects of the cancer and treatment may change the way you are able to eat and exercise. 


Talk with a health care professional about ideas to help with body weight.


Read more about body weight.

You probably know the relationship between smoking and cancers of the lung, mouth, and throat. But you might not know that smoking is linked to other cancers, such as those of the kidney, bladder, pancreas, stomach, and cervix.

Quitting is not easy. Nicotine is a powerfully addictive substance. There are also emotional and social reasons why people are addicted to cigarettes. It is never too late to quit. 


Read more about help to quit smoking.


After treatment you may have mixed feelings about exercise. You may be ready to get back to good health but you may also be worried about how side effects and late side effects and symptoms will change the way you exercise.


The recommendations for cancer survivors are the same as those for anyone else:


  • Talk to your health care team
  • Start slow
  • Do what you can

Read more about physical activity and link to the free BC Physical Activity telephone line.

Cancer and cancer treatments can change the way you eat. Your appetite may have changed from the way it was before your cancer experience. You may have challenges with chewing, swallowing, or digesting some foods.

 

Talk to a dietitian who knows about cancer. An "oncology dietitian" is available by phone or email at Healthlink  BC.

Researchers are learning more about the connection between alcohol and cancer risk. There is no "safe" amount of alcohol. The less alcohol you drink, the more you reduce your risk. 


Drinking more than the recommended limit of alcohol can contribute to the development of cancers of the mouth, esophagus, and larynx, especially for tobacco users.

Drinking too much alcohol also raises the risk of other cancers, including those of the breast, colon, and liver.


Read more about alcohol and cancer.

Survivors should also make sure to get screened. Learn more about cancer screening.

 

Common experiences after treatment

You may experience both short-term side effects and longer term "late effects."


Some common side effects are:

  • Fatigue
  • Changes in thinking, memory, and attention
  • Problems with digestion, constipation, or diarrhea
  • Skin effects from radiation treatment

When side effects show up months or years after treatment they are called "late effects." As more people are living longer after cancer, we are learning more about these effects and how they can be treated and managed.

Common late and long-term effects include heart problems, hormone changes, dental problems, vision problems, and chronic pain.


Report to your health care team any signs or symptoms that concern you. It is best to have them checked out if you are worried.


More information about physical changes and recovery:

Getting back to “normal” can take time. Expect to feel positive and negative emotions. There is no “right” way to feel at this time.


Taking care of yourself emotionally and spiritually is more important than ever, so do not be afraid to seek help if you are depressed, anxious, or stressed.


More information about difficult emotions:

Cancer can affect relationships, including marriages and long-term partnerships. You may find that you and your partner’s roles have changed in unexpected ways.


Common issues in relationships after treatment are:


  • Changing responsibilities. Your partner may have taken over certain tasks or responsibilities during treatment and is now ready to give them back to you. This may be overwhelming, and you may not feel ready right away.
  • Changing roles. Your partner may have acted as a caregiver for you during treatment.
  • Changes in emotional closeness. You may look and feel different after treatment, which may lead you to withdraw from others.
  • Changes in sexual intimacy. This might include a change in desire or feelings of pain or discomfort.
  • Changes in fertility. This may include changes in your plans to have children.

Common sexual health concerns after treatment are:


  • The most common issue for women is discomfort during intercourse. 
  • The most common issue for men is erectile dysfunction. 
  • For both men and women, changes in sexual response, such as loss of libido or difficulties with arousal, can be common.

Ask your health care team if any of your medications have side-effects that impact sexual desire. Medical treatments can help. Men can be referred to a urologist to explore solutions for erection problems. Women can be referred to a gynecologist to explore ways to manage discomfort or pain.


More information about relationships and intimacy after cancer:

Some people refer to these problems as "brain fog" or "chemo brain." While we know that these problems exist, no one knows which patients will be affected in this way, or why. These types of problems can be frustrating and can cause anxiety, stress, and even embarrassment.


Your health care team may recommend using “compensation” strategies to adapt to your situation regardless of the cause of the problems. Compensation strategies include:


  • Relaxation activities, such as deep breathing or meditation
  • Organizational aids, like using a schedule or sticky notes for reminders
  • Verbal practicing, like repeating important names and numbers

More information about changes in thinking, memory and attention:

Some people find that they need to make changes going back to work. Others find that after a cancer experience they want to re-evaluate their lives in general, including their job.

Ask yourself:


  • What are the demands of my job or classes?
  • How do I know whether I can meet these demands?
  • What supports, assistance, and accommodations are available to help me return successfully?

More information about returning to work and school:


Additional Resources
Family and friends play an important role in cancer survivorship. During diagnosis and treatment, a person with cancer may rely on family and friends for emotional support or help with day-to-day tasks like cooking, driving, and child care. Sometimes family and friends take on big responsibilities.


A caregiver is anyone who provides care and support to a friend or family member who is living with a disability or chronic illness. Family caregivers provide 80% of care at home. Family caregivers have been called the “invisible backbone” of the health and long-term care system in Canada.


Through research we have learned that more women than men become caregivers. Most are age 55 or older and are related to the person who has cancer.


Why is help for caregivers more important now?

We all like to help, and most caregivers feel good about the support they provide to their loved ones. But caregiving is also stressful. Sometimes caregivers have problems with their own health and/or finances.


Caregiving can also be emotionally confusing. As a spouse, partner, child, friend, or neighbour of someone with cancer, your role is now changed.


Caregivers often put their needs “on hold” when supporting someone through cancer treatment. After treatment is a good time to rest and recharge.


Where can I get more information about help for caregivers?

  • The Truth of It. A diverse group of Canadians share their stories in this unscripted video series about cancer.
  • Survivor artwork on Cancer.net. This website by the American Society of Clinical Oncology features art by survivors and other resources for older adults living through a cancer diagnosis.
The following Survivorship Care Plans were developed as part of a research project partnership between the BC Cancer Agency and Northern Health, funded by the Public Health Agency of Canada:

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