Understanding cancer survivorship: Life After Treatment

What is cancer survivorship?

Cancer survivorship refers to the full continuum of cancer survivors from an initial cancer diagnosis to those living free of cancer. The term cancer survivorship includes the prevention and detection of cancer (returning and new), the management of symptoms and long-term follow-up care.

Common challenges after cancer treatment

Cancer and cancer treatments can cause numerous side effects on every system in your body, including the lymphatic system.

Physical effects that may last or appear later

Individuals who have undergone cancer treatment, particularly radiation and lymph node removal, are at an increased risk of developing lymphedema.

Lymphedema is a disease of the lymphatic system, which aids your immune system in the transport of fluids and infection-fighting cells throughout your body. It is a progressive, long-term condition that can develop days, months or even years after an initial injury to your lymphatic system. Chronic swelling from lymphedema can also limit one’s mobility and daily activities.

Emotional and mental health concerns

Lymphedema can impact an individual’s ability to participate in daily life activities due to pain and discomfort. Living with lymphedema can feel isolating and exhausting, leading to mixed emotions, anxiety and depression. If you are experiencing mental health concerns, your doctor can refer you to a mental health professional.

Monitoring your health after cancer

Recognizing symptoms that need medical attention

Lymphedema creates a weakened immune response in the affected limb. Because of this, individuals living with lymphedema are at an increased risk of skin infections, known as cellulitis, that occur when bacteria enter the skin. Cellulitis can worsen lymphedema and lead to potentially life-threatening medical complications.

With lymphedema, symptoms of cellulitis include a sudden increase in swelling, flu-like symptoms and a patchy rash or redness, called erythema. It is important to recognize these symptoms early to prevent further complications. If you have a fever or possible signs of cellulitis, contact your doctor right away. Your doctor can prescribe antibiotics to treat cellulitis.

Keeping track of symptoms over time

One simple way to manage and monitor changes in lymphedema symptoms is through a daily symptom tracker or journal. Perform regular visual inspections of the areas affected by lymphedema and document these three simple questions:

• Is there swelling or has swelling increased?
• Do I have discomfort or pain?
• Are there changes in my skin's texture?

It is also important to note any daily activities that may be triggering your symptoms.

Whole-person wellness in cancer survivorship

Everyday habits that support long-term health

• If you wear compression garments to manage your lymphedema, replace every 6 months for day garments and replace every 12 months for nighttime garments.
• Medical procedures, including blood pressure measurements, injections and blood draws or IVs should be avoided in the affected limb with lymphedema.
• Maintain strict skin hygiene through daily cleansing with mild products. Moisturize regularly with low-pH lotion to prevent dryness, cracking and skin breakdown.
• Monitor signs of infection (redness, warmth, pain, swelling, flu-like symptoms) and notify your doctor immediately if you suspect any new signs.
• Exercise with caution if there is a risk of sun exposure that could cause skin injury or breakdown (sunburns).
• Wear sunblock SPF 30 or greater when outside to prevent sunburns.
• If you regularly wear compression garments, those should also be worn during air travel. When flying, attempt to move around during your flight (ankle pumps, knee flexion and extension, arm pumps, arm flexion and extension), drink lots of water and elevate limbs if possible.
• Avoid the use of saunas.

Self-care strategies for cancer survivors

Exercise can be beneficial before, during and after cancer treatments. Regular exercise can offer a variety of benefits, including strengthening your immune system, helping maintain a healthy weight and reducing treatment side effects like lymphedema.

The American Cancer Society (ACS) guideline recommends that cancer survivors:

• Take part in regular physical activity.
• Start slowly and increase physical activity over time.
• Build up to a minimum of 150-300 minutes of moderate-intensity activity or 75-150 minutes of vigorous-intensity (or a combination of these). Getting even more activity is ideal.
• Include muscle-strengthening exercise at least 2 days per week.

Proper nutrition during and after cancer treatment is important. It can help survivors maintain their energy levels, aid in healing and stay strong. Eating well includes:

• Eating a variety of plant-based foods: vegetables, fruits, whole grains and beans
• Choosing foods rich in nutrients. Avoid foods high in added sugar, fat or calories.
• Limiting red and processed meats, sugar-sweetened beverages and highly processed foods.
• Choosing healthy protein sources such as fish, poultry, beans and lentils.

Dietary needs can be specific to each person and related to their specific cancer or treatment side effects. For example, foods with increased sodium or salt can increase swelling in those living with lymphedema. Because obesity can worsen cancer-related lymphedema, it is critical to maintain a healthy weight. Your doctor can provide guidance for an individualized plan that addresses your exercise and nutrition needs.

Emotional, social and community support

Cancer can affect your overall well-being and those around you. It can feel isolating and lead to new concerns about work, money and returning to your usual activities. While it may be difficult to cope and talk about your feelings, there are community resources that can help, including counseling, spiritual support and group support among cancer survivors.

Lymphedema can be different for each person. Living with lymphedema can feel exhausting, leading to mixed emotions, anxiety and depression. If you are experiencing mental health concerns, your doctor can refer you to a mental health professional. In addition, there are lymphedema organizations that can provide information and assist in connecting you to the necessary resources such as the Lymphatic Education & Research Network (LE&RN) and the National Lymphedema Network (NLN).