beam radiation therapy itself is not painful and does not cause the person undergoing treatment to become a radiation source after leaving the radiation clinic. In the 1990s, external beam radiation to treat cancer covered a broad area of the body. That approach has since been replaced by more focused techniques such as 3-D conformal beam radiation therapy and Intensity-Modulated Radiation Therapy (IMRT). IMRT is a more focused type of external radiation, which spares the tissue and organs surrounding the diseased area. Typically, the woman receives radiation therapy five days a week for six or seven weeks.
Brachytherapy, the internal type of radiation therapy, is usually achieved by placing small irradiated pellets, also called seeds or capsules, into the cancerous tissue to kill the diseased cells. There are two types of brachytherapy: one where the radioactive seeds are placed in the tumor tissue, and the other where a radioactive capsule is put into a cavity such as the vagina. This is normally a one-time treatment with a short hospital stay.
Radiation therapy to the breast can cause irritation or swelling in the breast or arm. Radiation to the pelvic areas for gynecological and other pelvic cancers can cause urinary tract irritation, diarrhea, cramping, excessive bowel movements, rectal bleeding or discharge, and even a bowel obstruction or bleeding that may require surgery. It may also lead to decreased genital sensitivity, which may occur a few years after treatment when the internal scarring from radiation affects the nerves in the genital area. Radiation can also leave the skin itchy, which can be highly irritating and may affect some women’s sexuality.
Chemotherapy induces a broad range of effects, not only on the diseased tissue, but also on the body in general. Commonly reported effects such as hair loss, nausea, and diarrhea are due to the way chemotherapy drugs act. Tumors are made up of rapidly dividing cells, so the drugs have been developed to kill these cells. Unfortunately, there are normal tissues that also have rapidly dividing cells, most notably hair and the cells in the digestive tract. All of these cells are affected by the chemotherapy drugs. In younger women, early menopause may occur due to the drug(s) affecting the ovaries’ ability to produce hormones. Varying hormone levels may cause hot flashes, night sweats, and vaginal dryness.
Women in many support groups have said that hair loss is psychologically more devastating than losing their breasts. In one focus group, the women spoke with one voice, claiming that their hair defined them as women. Even Roberta, treated for ovarian cancer, was most devastated when she lost her hair.
Many women resort to wigs that are soon discarded because they are uncomfortable and too warm. Women desiring a comfortable wig that can be worn all day might be interested in the type made for Orthodox Jewish women. Jewish law prescribes that women following Orthodox tradition must cover their hair. Since these wigs are intended for constant wearing, wigmakers catering to Orthodox Jewish women have developed techniques to provide maximum comfort. These wigmakers have been crafting their techniques for hundreds of years. Anyone wanting to explore the possibility of purchasing such a wig should contact an Orthodox Jewish synagogue and ask for names of wigmakers. Handmade wigs are likely to cost several thousand dollars.
Tender Loving Care, or TLC (www.tlcdirect.org), a website and catalog of the American Cancer Society, emphasizes that a synthetic wig is the easiest type to care for, as well as the lowest priced. The organization offers synthetic wigs in a wide range of colors and styles at reasonable prices, with most costing in the $40 to $50 range. The company also sells wigs which have no crowns (tops) designed to be worn under hats, as well as a large selection of attractive scarves, turbans, and hats. Some of the hats are specifically designed for warm-weather wear. TLC also sells mastectomy bras, breast forms (prostheses), swimwear, camisoles, and more.
A complementary medical approach to dealing with nausea and pain is acupuncture. Studies have shown 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