Managing your symptoms and the side effects of treatment
Both ovarian cancer itself and the treatment for it can result in various symptoms and side effects. These vary from woman to woman, at different times of the illness and from one cycle of chemo to another.
This section includes many practical tips from other women and health professionals to help you deal with symptoms and side effects that may affect you.
Always let your doctor know if you develop any new symptoms or side effects, if they are severe, or if they are not improving.
Use the ‘Treatment record’ in the next section to keep a record of your symptoms and side effects and to make a note of the ideas that have helped. This can be a good way to remind yourself of the help you need to ask for and any special foods, drinks or medicines you need before your next chemo treatment.
Fatigue is a very common problem, both during treatment and beyond. Fatigue is a complex thing and can have many different causes: it is often a side effect of chemo, radiotherapy or medicines, can be caused by the cancer itself, or may result from difficulty sleeping or eating, pain, infection, emotional distress, anaemia and being less active. Travelling to and from chemo, going back to work and caring for a house and family can all eat up your available energy.
Many women expect to feel very tired during treatment, but may be surprised when that weary, worn-out feeling continues. Some women find that it takes 1–2 years to feel really well again.
Realising that this tiredness is normal and asking for help are important first steps in coping with it. If ongoing fatigue is a problem, it’s important to talk to your doctor: there may be some causes that you haven’t thought of that you can address.
What can help?
Ask for support and help whenever you can. People often find it difficult to know how to help, so be specific. Tell your good friend that the best help in the world would be a pot of soup… or to pick the kids up from school this week… or to take a basket of ironing. If the situation were reversed, you would be relieved to know that you could provide exactly the help that your friend needs.
It’s easy to focus on what you can’t do. Instead, switch your thinking to what you have achieved each day and how far you have come. Some days that may be returning a phone call or walking to the local shop to buy a paper.
Your body and mind are in survival mode. Nurture yourself in every way you can. Do the little things that make you feel good, like having a laugh with friends, spending time in the garden with children or grandchildren, or going for a walk with your partner or a friend. Housework, shopping and cooking are way down the bottom of the priority list right now. Sure, everyone in the house still needs to eat and wear clothes, but you can relax your standards and delegate more.
Gentle physical activity can help to raise your energy levels. Always ask your doctor about the level of activity that’s suitable for your stage of recovery.
It can be helpful to use your ‘Treatment record’ in the next section to record your energy level from 0–10 each day. Keep an eye on how your levels change at different times of the day or week and different stages of your treatment. This may help you to see some patterns that will help you to plan rests when you most need them and to make the most of times when your energy levels are likely to be higher. It may also help you to pinpoint activities, foods, drinks (and possibly people!) that sap your energy.
Nausea and vomiting
Nausea and vomiting are some of the more uncomfortable side effects of chemo and radiotherapy. Nausea and vomiting may also be caused by the cancer itself, constipation, a bowel obstruction or by pain relief medicine. Always talk to your doctor if nausea is a new symptom for you or is becoming worse.
What can help?
All women are given anti-nausea medicine (called anti-emetics) before each cycle of chemo begins and then given medicine to take home to use for the next few days. These medicines may cause constipation. Your doctor or oncology nurse can give you ideas on preventing and relieving constipation.
Find out who you should call if you have any problems or you are worried about symptoms or side effects of treatment — including who you can call at night or on the weekend. It’s a big weight off your mind when you know who you can call on.
Sip ginger beer or ginger tea, suck ginger lollies, nibble ginger cookies or try burning ginger aromatherapy oil — ginger has anti-nausea properties that may help.
Salty foods can often help with nausea — try dry, salty crackers or pretzels.
Eat small amounts often and slowly — and try to eat before you get too hungry (an empty stomach can make you feel sicker).
Don’t lie down soon after eating.
Avoid fatty or fried foods.
Try foods and drinks at cooler temperatures, as hotter foods and drinks may make nausea worse. Heat also increases food smells, which can make nausea worse.
Acupuncture can help with nausea.
The chemo drug paclitaxel affects the healthy cells involved in hair growth and causes temporary hair loss, which usually starts about 2 weeks after your first treatment. Hair loss is usually very rapid and you may lose hair all over your body, including eyebrows, eyelashes, arms, legs and pubic hair. Your hair will grow back once you finish chemo, usually within weeks or months.
If you are only receiving carboplatin without paclitaxel, you will not experience hair loss.
What can help?
Women often struggle with hair loss because hair is an important part of their physical identity, and losing hair is what makes cancer obvious to others. It is normal to feel frightened, angry and upset about losing your hair, but it helps to remember that hair loss is almost always temporary.
When it comes to hair loss, it’s a great help to be prepared and think about ways to lessen the shock before you start chemo. Options that have worked for other women include:
Cutting your hair very short before treatment.
Finding a wig that you love (it may be something similar to your current hairstyle or something very different — just for a bit of fun). You can borrow a wig for a small fee from some hospitals and cancer care units. If you would prefer to buy your own wig and have private health insurance, part of the cost may be covered.
Expressing your personal style by buying or borrowing colourful scarves, turbans or hats.
Remember to treat your existing hair gently and to protect your skin throughout and after treatment: bald heads are very sensitive to the sun and to cold! You may find that hair and skin products without added chemicals or perfumes will suit your hair and skin better at this time.
After having chemo, many women have problems with their short-term memory, concentration and processing information. This is often called ‘chemo brain’ and health professionals may call it ‘cognitive impairment’.
This problem can be very frustrating, especially if you have previously had a good memory or if you need to concentrate carefully for work or study.
It’s not clear if chemo brain is caused by chemotherapy alone or by a combination of factors — including chemo, the stress of living with cancer, hormonal changes and the natural aging process. Regardless of its exact cause, it is a real and distressing problem. It can help to know that many other women experience the same problems, that you can do practical things to help and that the problem will usually get better with time.
What can help?
Use a calendar, planner or mobile phone to keep track of appointments, birthdays and important tasks.
Write lists of things you need to remember: phone calls to make, emails to return, items to buy. If there is something really important you need to remember before leaving the house, try putting a reminder note on the inside of your front door.
Schedule tasks that require the greatest concentration for times of the day when you feel most alert.
Keep your brain active with crosswords, puzzles, reading, interesting conversation and hobbies. Don’t push yourself though. If you find activities that you used to enjoy require more concentration than you have (like reading complex novels), switch to reading something lighter (like magazines and short stories) for a while.
Enjoy plenty of gentle exercise at a level that’s suited to your stage of recovery. Exercise is great for your brain and helps you to sleep well too (which is important for memory).
Let your manager, teacher or lecturer know if chemo brain is affecting your work or study. When others know what you are dealing with, they are much more likely to be understanding and find ways to accommodate your needs.
Talk to your doctor or another member of your healthcare team if you have ongoing concerns about your memory or concentration.
Constipation may be caused by anti-nausea or pain relief medicines. It can also be a result of moving around less when you are unwell, or the cancer affecting your bowel.
What can help?
Drink plenty of liquids — aim for around 8 glasses (2 litres) of clear liquids a day.
Do something active every day, even if it’s just a gentle walk around the block.
Increase the fibre in your diet by eating wholegrain breads and cereals, vegetables and fruit.
If simple self-help ideas don’t work, talk to your doctor, nurse or dietitian about recommending a suitable laxative.
Some chemo drugs, radiotherapy and antibiotics can cause diarrhoea. Stress, anxiety and infections can also cause diarrhoea.
Always contact your doctor if you experience severe diarrhoea, stomach pain or cramps.
What can help?
Drink plenty of fluids to prevent dehydration.
Eat and drink small amounts more often.
Reduce insoluble fibre: avoid grainy breads and cereals, nuts and seeds, and raw fruit or vegies.
Increase soluble fibre found in oatmeal, potatoes, bananas and rice.
Try reducing dairy products or trying low or no lactose alternatives.
Ask your doctor about anti-diarrhoea medicine that may be suitable for you.
The bowel can become blocked as a result of surgery or as a result of the cancer growing. This blockage is called a bowel obstruction. Symptoms include nausea, vomiting, and abdominal pain and cramps.
What can help?
Be aware of any symptoms that are new, different or more severe for you and contact your doctor as soon as possible. A bowel obstruction can often be relieved with a simple treatment in hospital. Sometimes a further operation may be necessary.
Our Ovarian Cancer Australia Connect online forum gives you access to a community of compassionate and supportive women who have been affected by ovarian cancer. The forum includes lots of discussions about the side effects of ovarian cancer treatment; click here to explore further.
Lymphatic fluid usually drains from your legs via lymph glands in your pelvis. If you have had lymph glands removed from your pelvis during surgery, then lymph fluid may not drain properly. This can cause a build-up of fluid and swelling in one or both legs, called lymphoedema.
Lymphoedema can also be a side effect of radiotherapy and sometimes may be caused by the cancer itself.
Lymphoedema usually develops gradually — sometimes months or even years after you have finished treatment. Lymphoedema can’t be prevented and there isn’t a known cure. But by being aware of the signs of lymphoedema, you can start treatment early to reduce swelling, improve movement and prevent infections.
Signs to be aware of
See your GP or another member of your healthcare team if you notice any of these changes after the initial side effects of your treatment have settled down:
- A feeling of heaviness, tightness or tension in your leg or foot.
- Swelling in your leg — you may see dents in your skin when you take off tight socks or shoes.
- Aching in your leg or foot.
What can help?
If you develop any signs of lymphoedema, talk to your GP, oncology nurse or physiotherapist who can provide advice and treatment. Treatment may include gentle exercise, elevation, compression, lymphatic drainage and paying special attention to skincare.
Cancer Australia has a booklet on lymphoedema which provides more detailed information. You can download the booklet here.
Recurrent ovarian cancer can cause ascites — a build-up of fluid in the abdomen that causes bloating, swelling and discomfort. Fluid can also build-up in the lungs, called pleural effusion. This can be painful and make you short of breath.
What can help?
Talk to your doctor if you have any symptoms that suggest fluid is building-up in your abdomen or lungs. There is a simple procedure that your doctor can use to drain away the fluid and relieve your discomfort.