Cancer treatments and medications have become more advanced in the past decades. However, many cancer survivors still face physical problems due to the late effects that occur months or years after their cancer treatments. These include cancer-related fatigue, lymphoedema, numbness and tingling (peripheral neuropathy), pain and incontinence.
- Cancer-related fatigue
More than 50% of cancer survivors experience different levels of fatigue, which may persist for years after treatment. Mere rest or sleep does not relieve cancer-related fatigue and can give rise to a vicious cycle of sleeplessness. On the other hand, simple exercises such as walking, lifting a dumbbell or sit-to-stand training can help. If you experience significant fatigue, diminished energy or an increased need to rest that is disproportionate to any change in activity level, please consult your physician and physiotherapist for further investigation and management. - Lymphoedema
Lymphoedema is most commonly caused by the removal of or damage to the lymph nodes as a part of cancer treatment, including surgical excision and radiation therapy. Generally, about 30% of cancer survivors are affected, particularly among breast, gynaecological and prostate cancer survivors. Lymphoedema can develop several months or even years after initial cancer treatment.
Lymphoedema can be divided into four stages. Symptoms can be reversible and under control if it is detected and managed early.
Cancer survivors are advised to have a regular bioimpedance measurement to measure the amount of fluid in a limb.
Lymphoedema management includes manual lymphatic drainage (MLD) and the use of equipment to improve lymphatic circulation. Application of compression stockings or bandages, laser and exercise can also help.
- Stage 0 (latent)
There are no visible changes at this point. You may notice some differences in feeling, such as mild tingling, unusual tiredness or slight heaviness. It can be confirmed by a bioimpedance measurement. This condition is reversible. - Stage 1 (mild)
Skin appears mildly swollen with protein-rich fluid that starts to accumulate. When you press the skin, a temporary small pit appears (pitting oedema). This condition is reversible. - Stage 2
Skin is more swollen at this stage. The swelling will not be relieved by elevating the affected limb. There is no pitting oedema. There are changes in the skin, such as hardening, thickening or inflammation. This condition is non-reversible but controllable by treatment. - Stage 3 (severe)
This is the most advanced stage. The affected body part becomes very large and misshapen. The skin takes on a leathery and wrinkled appearance. This condition is non-reversible but controllable by treatment.
Many research studies show that exercise can improve lymphatic circulation without any adverse effect. You can exercise safely by wearing a prescribed properly fitted compression garment.
- Stage 0 (latent)
- Numbness and pain
Cancer and its treatment can sometimes cause compression and damage nerves in the body, i.e. peripheral neuropathy. It is characterised by numbness, weakness, tingling, pain or a burning sensation in the hands and feet. Around 30 – 50% of cancer survivors are affected.
These symptoms can last for years, affecting daily functions and quality of life.
Neuropathy of the upper and lower limbs can cause much inconvenience in daily life, affecting balance, writing, buttoning clothes and picking up small objects. Even touching cold objects can cause severe pain. Training and exercise for strength, balance, fine hand function and desensitisation can help survivors improve their daily function, reduce the risk of falling and improve their quality of life.
If you cannot feel your hands or feet, you are at risk of injuries and infection. Exercise under supervision is recommended. - Incontinence
Cancers in the pelvic region, including prostate cancer, uterine cancer or bladder cancer, can lead to incontinence. The older the survivor, the higher the risk. The best treatments depend on the cause, type, duration and severity of incontinence. Pelvic muscle exercises, biofeedback and urge suppression techniques are usually effective. - Self-care
Those who are in a stable condition and have good exercise compliance need only consult their physiotherapist for a reassessment, revision and enhancement of exercise goals when necessary.