Pain
Other Ways To Treat Pain
Anxiety
Fatigue
Nausea and Vomiting
Constipation
Loss of Appetite and Body Changes
Sleep Problems
Confusion

"The nighttime is harder than during the day. There's not all that routine going on to take my mind off of things. Sometimes I fall asleep, but then wake up in the middle of the night sweaty and shaky." - Susan

Cancer and its treatment affect people differently. Some have symptoms, while others have no symptoms for a long time. As we said earlier, you have a right to comfort care throughout your illness.

Sometimes people assume their symptoms will get worse as their cancer progresses. But with good supports in place and good care, your symptoms should always be managed. So don't downplay your symptoms if you're having them. It's important to report how you are feeling. Tell your doctor, members of your health care team, and your loved ones. If you feel very sick or tired, your doctor may be able to adjust your treatment or give you other medicine.

Following are some of the symptoms you may have.

Pain

Having cancer doesn't always mean that you'll have pain. But if you do, you shouldn't accept pain as normal. Most types of pain can be treated. Your doctor can control pain with different medicines and treatments.

You may want to ask your doctor if you can talk to a pain specialist. Many hospitals have doctors on staff who are experts at treating pain. They may also have palliative medicine specialists.

Managing your pain helps you sleep and eat better. It makes it easier to enjoy your family and friends and focus on what gives you joy.

There are a few different ways to take pain medicine, including:

• By mouth
• Through the skin (like with a patch)
• By shots
• Through an I.V. or an S.C. pump

Your medicine, and how you take it, will depend on the type of pain and its cause. For example, for constant pain you may need a steady dose of medicine over a long period of time. You might use a patch placed on the skin or a slowrelease pill.

• Mild to medium pain
• Medium to very bad pain
• Breakthrough pain
• Tingling and burning pain
• Pain caused by swelling

You should have regular talks with your health care team about the type and extent of your pain. That's because pain can change throughout your illness. Let them know the kind of pain you have, how bad it is, and where it hurts.

You may want to keep a "pain diary." Write down the information that's noted in "Controlling Pain: What to Tell Your Doctor". Include the time of day that the pain occurred and what you were doing. Rate the pain on a scale of 0 to 10. (Zero means no pain, and 10 is the worst pain you could have.) Use the diary when you talk to your doctor about your pain.

Unlike other medicines, there is no "right" dose for many pain medicines. Yours may be larger or smaller than someone else's. The right dose is the one that relieves your pain and makes you feel better.

Other Ways To Treat Pain

Cancer pain is usually treated with medicine and other therapies. But there are also some non-drug treatments. They are forms of complementary and alternative medicine (CAM). Many people have found the methods listed below helpful. But talk with your health care team before trying any of them. Make sure they are safe and won't interfere with your cancer treatment.

• Acupuncture is a form of Chinese medicine that stimulates certain points on the body using small needles. It may help treat nausea and control pain. Before using acupuncture, ask your health care team if it is safe for your type of cancer.
• Imagery is imagining scenes, pictures, or experiences to feel calmer or perhaps to help the body heal.
• Relaxation techniques include deep breathing and exercises to relax your muscles.
• Hypnosis is a state of relaxed and focused attention. One focuses on a certain feeling, idea, or suggestion.
• Biofeedback is the use of a special machine to help the patient learn how to control certain body functions. These are things that we are normally not aware of (such as heart rate).
• Massage therapy brings relaxation and a sense of well-being by the gentle rubbing of different body parts or muscles. Before you try this, you need to check with your doctor. Massage is not recommended for some kinds of cancer.

These methods may also help manage stress. Again, talk to your health care team before using anything new, no matter how safe it may seem. Ask your health care team for more information about where to get these treatments. To learn more, see the NCI booklet Thinking About Complementary and Alternative Medicine: A Guide for People With Cancer.

Anxiety

Cancer takes a toll on both your body and your mind. You are coping with many different things now. You may feel overwhelmed. Pain and medicines for pain can also make you feel anxious or depressed. And you may be more likely to feel this way if you have had these feelings before.

Here are some signs of anxiety:

• Feeling very tense and nervous
• Racing heartbeat
• Sweating a lot
• Trouble breathing or catching your breath
• A lump in your throat or a knot in your stomach
• Sudden fear

Feeling anxious can be normal. But if it begins disrupting your daily life, ask for help from the members of your health care team. They can recommend someone for you to talk to. Counseling from a mental health professional has been shown to help many people cope with anxiety. Your doctor can also give you medicines that will help. Some of the complementary and alternative medicine choices for pain may work for your anxiety as well (see "Other Ways to Treat Pain"). Art therapy and music therapy have also helped people cope.

Fatigue

Fatigue is more than feeling tired. Fatigue is exhaustion - not being able to do even the small things you used to do. A number of things can cause fatigue. Besides cancer and its treatment, they include anxiety, stress, and changes in your diet or sleeping patterns. If you are having some of these problems, you might want to:

• Tell your health care team at your next visit. Some medicines can help with fatigue.
• Ask about your nutrition needs.
• Plan your daily activities. Do only what you really must do.
• Hand over tasks to others who are willing to help you.
• Include short periods of rest and relaxation every day.
• Take naps (no longer than 15-30 minutes).
• Ask others for help, especially when you are feeling fatigued.
• Do light exercises that are practical for you.

Nausea and Vomiting

Nausea and vomiting may be a problem for cancer patients. Both can make you feel very tired. They can also make it hard to get treatments or to care for yourself. If you feel sick to your stomach or are throwing up, there are many drugs to help you. Ask your health care team which medicines might work best for your nausea and vomiting.

You also may want to:

• Make small changes in your diet. Eat small amounts 5-6 times a day.
• Avoid foods that are sweet, fatty, salty, spicy, or have strong smells. These may make nausea and vomiting worse.
• Drink as much liquid as possible. You'll want to keep your body from getting dried out (dehydrated). Water, broth, juices, clear soft drinks, ice cream, and watermelon are good choices.
• Choose cool foods, which may help more than hot ones.
• Try acupuncture.

Constipation

Constipation is a problem in which stool becomes hard, dry, and difficult to pass, and bowel movements do not happen very often. Other symptoms may include painful bowel movements, and feeling bloated, uncomfortable, and sluggish. Chemotherapy, as well as other medicines (especially those used for pain), can cause constipation. It can also happen when people become less active and spend more time sitting or lying down.

Here are some ways to help manage constipation:

• Drink plenty of fluids each day. Many people find that drinking warm or hot fluids helps with bowel movements.
• Be active. You can be active by walking, doing water aerobics, or yoga. If you cannot walk, talk with your doctor or nurse about ways you can be active, such as doing exercises in bed or a chair.
• Ask your doctor, nurse, or dietitian if you should eat more fiber. He or she may suggest you eat bran, whole wheat bread and cereal, raw or cooked vegetables, fresh and dried fruit, nuts, and popcorn and other high-fiber foods.
• Let your doctor or nurse know if you are in pain or discomfort from not having a bowel movement. He or she may suggest you use an enema or take a laxative or stool softener. Check with your doctor or nurse before using any of these.
• Ask your doctor about giving you laxatives when you start to take pain medications. Taking a stool softener at the same time you start taking pain drugs may prevent the problem.

Loss of Appetite and Body Changes

Eating and appetite changes are common in the later stages of cancer. As your cancer progresses, your appetite may become poor.

On the other hand, you may be eating enough, but your body can't absorb the nutrients. This can cause you to lose weight, fat, and muscle.

Nutrition goals may become less important at this time. Even if your family members think you should have food, let your body be the judge. The goal should not be weight gain or improving your eating but rather comfort and symptom relief.

Your nurse, dietitian, and other members of your health care team can help. They can help you decide on changes to your diet that may be needed to keep you as healthy as possible. There are also new drugs to improve appetite and get rid of nausea. Ask your health care team about them.

Sleep Problems

Illness, pain, drugs, being in the hospital, and stress can cause sleep problems. Sleep problems may include:

• Having trouble falling asleep
• Sleeping only in short amounts of time
• Waking up in the middle of the night
• Having trouble getting back to sleep

To help with your sleep problem, you may want to try:

• Reducing noise, dimming the lights, making the room warmer or cooler, and using pillows to support your body
• Dressing in soft, loose clothing
• Going to the bathroom before bed
• Eating a high-protein snack 2 hours before bedtime (such as peanut butter, cheese, nuts, or some sliced chicken or turkey)
• Avoiding caffeine (coffee, teas, colas, hot cocoa)
• Keeping regular sleep hours (avoid naps longer than 15-30 minutes)
• Talking with your health care team about drugs to help you sleep. These may give relief on a short-term basis.

Confusion

You may start noticing signs that you feel confused. This can occur in some people with advanced stage cancer. It can also be caused by some medicines. Confusion may begin suddenly or come and go during the day. Possible signs include:

• Sudden changes in feelings (such as feeling calm then suddenly becoming angry)
• Having trouble paying attention or concentrating (such as feeling easily distracted, having trouble answering questions, or finding it harder to do tasks that involve logic, such as math problems)
• Memory and awareness problems (such as forgetting where you are and what day it is or forgetting recent events)

If you notice these signs, talk to your health care team to try to find out the cause. Meanwhile, try one or more of the following to help relieve confusion:

• Go to a quiet, well-lit room with familiar objects.
• Reduce noise.
• Have family or loved ones nearby.
• Put a clock or calendar where it can be seen.
• Limit changes in caregivers.
• Ask your health care team about drugs that may help.

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