The physical and emotional challenges of cancer treatment

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Cancer and its treatment often lead to several physical and emotional challenges, including fatigue, muscle loss, body changes, and reduced activity levels. Additionally, the role of obesity in cancer outcomes is increasingly recognised.

The role of nutrition in cancer care

Nutrition therapy before, during, and after cancer treatment has been shown to have a significant impact on overall outcomes. Malnutrition, often resulting from cancer itself or its treatment, is one of the most common effects. Cancer-related muscle loss (cachexia) is particularly prevalent and can significantly affect quality of life.1 Working closely with a dietitian can help elevate symptoms and improve overall feeling of health and well-being. Fatigue, changes in body shape, loss of muscle mass, and inactivity often accompany malnutrition and treatment. Moreover, obesity can also influence treatment efficacy and outcomes, highlighting the importance of personalised nutrition strategies.

The challenges

Fatigue

Fatigue is one of the most frequent and distressing symptoms experienced from diagnosis through treatment and recovery. Unlike typical tiredness, cancer-related fatigue is a persistent and overwhelming exhaustion—physical, emotional, and mental—that doesn’t improve with sleep or rest.

Approximately 65% of cancer patients experience fatigue, with many facing severe fatigue lasting six months or longer. Around 30% may continue to feel fatigued years after treatment ends.

Fatigue often peaks during chemotherapy, affecting 80–90% of patients. This unique, debilitating fatigue disrupts daily life and can even lead to muscle loss, as extreme tiredness often makes eating feel like a chore. Preparing, cooking, and consuming food (like cutting and eating meat or vegetables) can seem overwhelming for someone struggling with fatigue.2

Research shows that physical activity can help alleviate cancer-related fatigue. Activities like walking and home-based aerobic or resistance exercises are beneficial.

Suggested tips

For nutrition, patients with fatigue often struggle to prepare or eat full meals.

Ask for help with grocery shopping or meal prep; online shopping is a convenient, low-effort option.

Buy ready-made meals (not takeaways) that offer complete meals with protein, starch, and vegetables.

Consider meal kit services that deliver pre-prepped meals you can simply heat and eat.

Use nutritional supplements; these pack nutrients into small volumes. Consult your dietitian to choose the best one.

Eat when you feel best; have your largest meal during the time of day when you’re most alert.

Opt for soft, easy-to-eat foods; these require minimal chewing and make eating less tiring.

Loss of muscle mass

Muscle loss in cancer patients stems from two primary causes: the cancer itself and the effects of treatment. Cancer cells trigger systemic inflammation, which promotes increased gluconeogenesis (breaking down muscle for energy), fat mobilisation (shifting stored fat for energy), and early satiety signals in the brain (feeling full quicker, leading to reduced food intake).

Additionally, heightened proteolysis (muscle breakdown) and reduced protein synthesis (inhibited muscle building) create a high catabolic state in the body.

Cancer treatments further exacerbate this by causing side effects, such as nausea, vomiting, mucositis (sores in mouth and GI tract), taste changes, loss of appetite, malabsorption (impaired nutrient uptake), and dysphagia (difficulty swallowing). Together, these reduce kilojoule intake.

Consequently, a combination of increased energy needs (high catabolic state) and reduced energy intake results in malnutrition, which progresses to loss of muscle mass.

Suggested tips

The most critical step is consulting a dietitian for a personalised nutrition plan. Screening for malnutrition before, during, and after treatment is essential for better treatment outcomes and quality of life.

Eat when you feel your best. If mornings are better for you, have your biggest meal then. On treatment-free days, aim to eat as much as possible.

Have small, frequent meals. Eating 5–6 times a day (or more) can help manage meal size while meeting energy needs.

Create a pleasant eating environment. Open windows, sit outside, or eat with family and friends to make meals more enjoyable.

Eat foods you like. Prioritise balanced meals, but if you prefer one food over another, it’s better to eat more of what you enjoy than to struggle with foods you dislike.

Use supplements. Your dietitian can recommend supplements tailored to your specific needs.

Talk to your doctor. They can prescribe medications to manage nausea, stimulate appetite, or treat mucositis.

Stay physically active. Exercise helps prevent muscle loss; use it or lose it.

Body changes

Changes to your body can deeply impact your self-image, how you feel about intimacy (your sex drive or comfort with physical affection), and your confidence in relationships, or career. These shifts may influence your sense of identity and ability to do what you have always done.

Cancer can cause a variety of external and internal changes. External changes may include hair loss, skin rashes, splitting nails, scarring (or skin grafts), swelling, amputation, or having a stoma.

Other changes might involve feeding tubes (temporary or permanent), weight fluctuations (prominent bones, excess skin), speech alterations, or difficulties with eating and swallowing.

Internal changes can include infertility, changes in your senses (sight, taste, smell), and disruptions to bowel or bladder movements. These changes can feel overwhelming and affect how you navigate daily life.

Suggested tips

Cancer Research UK suggests these strategies:

• Educate yourself: learn what changes to expect so you can prepare emotionally and practically.
• Build a support network: talk openly with loved ones or friends who can provide emotional support.
• Seek peer support: connecting with someone who has faced similar challenges can help you feel less alone.
• Consider counselling: professional guidance can help you process these changes.
• Go at your own pace: take steps that feel right for you and prioritise your comfort.
• Use accessories and make-up: wigs, hats, scarves, and make-up can help you feel more confident. Camouflage make-up can also hide scars or skin discolouring.

Inactivity

There are several reasons why you might become less active during treatment. These include fatigue, loss of muscle mass (leading to weakness that makes standing or moving difficult), physical changes (amputation), and safety concerns like a high fall risk due to balance issues.

While these challenges can discourage activity, being inactive can actually worsen these symptoms.

Suggested tips

Aerobic and resistance training are recommended if you are undergoing active cancer treatment. These exercises help combat fatigue, improve physical function, maintain muscle mass, boost cardiovascular fitness, and enhance overall quality of life. They can also alleviate symptoms of depression and anxiety.

Additionally, pre-operative exercise in lung cancer patients has been shown to shorten hospital stays and reduce post-operative complications.3

Proactive steps

Dealing with fatigue, muscle loss, body changes, and inactivity during cancer treatment presents numerous challenges that can deeply affect your physical and emotional well-being.

However, understanding these issues and taking proactive steps, such as maintaining a balanced nutrition plan, staying physically active, and addressing body changes with support, can significantly improve your quality of life.

Personalised strategies, including working with a dietitian, utilising supplements, and staying engaged with supportive networks, offer hope for managing symptoms and improving overall outcomes. By embracing these approaches, you can navigate your cancer journey with resilience, enhancing treatment effectiveness and ultimately recovery.

References

1. Aprile, G., Basile, D., Giaretta, R., Schiavo, G., La Verde, N., Corradi, E., Monge, T., Agustoni, F., & Stragliotto, S. (2021) ‘The Clinical Value of Nutritional Care before and during Active Cancer Treatment’, Nutrients, 13(4), p. 1196. Available at: https://doi.org/10.3390/nu13041196 .
2. Fabi, A., Bhargava, R., Fatigoni, S., Guglielmo, M., Horneber, M., Roila, F., Weis, J., Jordan, K. & Ripamonti, C. I., on behalf of the ESMO Guidelines Committee, 2020. Cancer-related fatigue: ESMO Clinical Practice Guidelines for diagnosis and treatment. Annals of Oncology, 31(6), pp.713–723. Available online: 12 March 2020.
3. NHS Inform (n.d.) Body changes and cancer. Available at: https://www.nhsinform.scot/illnesses-and-conditions/cancer/practical-issues/body-changes-and-cancer/ (Accessed: 14 October 2024).