1) Cancer treatments can cause long term side effects like cancer related fatigue, chemotherapy induced peripheral neuropathy, and chemotherapy-related cognitive impairment. 2) Cancer related fatigue is a daily lack of energy that is not relieved by sleep and can be caused by both the disease and its treatments. It affects about 40% of breast cancer survivors. 3) Chemotherapy induced peripheral neuropathy causes nerve damage that results in numbness, tingling, and pain in the extremities, and can progress over time or with additional chemotherapy treatments.

1. Long Term Side Effects of
Cancer Treatments
Mary Dowd & Catherine Masterson
Clinical Nurse Specialists in Breast Care
University College Hospital
Galway

2. • Cancer related fatigue.
• Chemotherapy induced peripheral
neuropathy.
• Chemotherapy-related cognitive
impairment.

3. Cancer Related Fatigue
• Fatigue is a daily lack of energy; an
unusual or excessive whole body
tiredness not relieved by sleep.
• It can be acute or chronic.
• Fatigue affects as many as 40% of breast
cancer survivors.
Andrykowski et Al, 1998

4. Causes of Cancer Related Fatigue
• No single cause.
• Cancer related fatigue may be related to
both the disease process and the
treatments.
• Other causes e.g. anaemia, stress, poor
nutrition

5. Assessment of Cancer Related
Fatigue
• Talk to your doctor.
• Correct anaemia.
• Review your medications.
• Keep a diary for one week to identify the times when you
either are most fatigued or have the most energy.
• Brief fatigue inventory.

7. Management of Cancer Related Fatigue
• Speak to your doctor
• Rest
• Stay active
• Save your energy
– Plan, prioritise and delegate everyday activities
• Get help
– Family, friends
• Get support
– Family, friends, support groups
• Eat well

8. Chemotherapy Induced Peripheral
Neuropathy (CIPN)
• It is a disorder that occurs when nerves in
your body’s peripheral nervous system are
damaged.
• Patient can develop symptoms such as
pain, numbness, tingling, burning, difficult
picking up objects and constipation.

9. CIPN
• Symptoms tend to start farthest away from
the head and move in closer over time.
• CIPN can start anytime after treatment
starts and can progress with further
treatments.
• Certain drugs are more liked to be
associated with CIPD e.g. carboplatin,
cisplatin, Taxol and Taxotere.

10. Treatment of CIPN
• Pain relief , type of pain relief will depend
on the severity of the pain.
• Steroids, only for a short period.
• Anti depressants, smaller doses than
those used to treat depression.
• Anti-convulsants.
• Other treatments such as acupuncture,
relaxation therapy

11. Treatment of CIPN
• Take your pain relief before the pain becomes
severe. Take laxatives to treat constipation.
• Avoid extremes of temperature, tight or snug
cuffs on clothing.
• Control your blood sugar if you are a diabetic.
• Be careful using sharp objects.
• Wear gloves when gardening, cooking. Wear
shoes that cover your foot completely
• Inspect your feet and hands regularly for skin
damage.

12. Definition of chemotherapy induced
cognitive impairment
• Dysfunction, weakening or impairment of
memory in patients who have been treated
with chemotherapy for cancer.

13. Signs
• Mental fatigue and mental cloudiness
• Difficulty with memory/ information process,
• Multitasking, organization and focusing attention
on tasks at hand.
• Can negative effect on personal, academic and
professional lives.
• Cognitive changes may severe enough to
interfere with a patients daily functioning,
including employment abilities
• Feelings of anxiety and fear are common

14. Symptoms of chemo-induced
cognitive impairment
• Deficits in attention
• Difficulty in comprehensions or understanding
• Inability to follow directions
• Easily distracted
• Lower processing of information
• Difficulty with numbers and finance
• Difficulty with details , names and dates
• Gait and dexterity disturbances
• Inability to recognize familiar objects
• Inability to perform multiple tasks
• Complaints of increasing memory difficulties
• Behavioral changes and socially in appropriate behavior
• American Cancer Society 2008

15. Contributing Factors
• Pain, emotional/ physical exhausting, distracting
and lead to poor concentration.
• Stress threat to survival , lack of concentration/
poor memory
• Cytokine-induced inflammatory reactions
• Dehydration and electrolyte imbalance
• Medications
• Other factors

16. What can I do ?
• Talk to breast care nurse at follow up visits
as you would for other side –effects

17. Helpful ideas
• Acupuncture, dilates cerebral blood vessels,
improving blood flow and oxygenation
• Antioxidant foods such as fruits/vegetables high
vitamin C and E
• Increasing fluid intake prevents dehydration and
helps flush toxins from the body
• Informing family and friends can generate
support/ understanding

18. Helpful ideas
• Mental exercises such as crossword and
Sudoku puzzles, creates a positive feedback
loop
• Physical exercise increases blood flow to the
brain, improves oxygenation and reduces
cytokine levels
• Relaxation activities decrease stress, listening to
music, communing with nature and pursuing
other hobbies can be soothing.