Cancer treatment has caused me to gain weight. Is this normal?

Stacy Kennedy, board-certified specialist in oncology nutrition in Costa Mesa, California. Photo courtesy of Stacy Kennedy

STACY KENNEDY: Weight gain during chemotherapy or other cancer treatment is common, especially with certain diagnoses or treatment regimens. It may be lifestyle-driven, at least in part. While undergoing treatment, you might be less physically active than you were before. You also might find yourself craving quick comfort foods.

Often, though, weight gain has to do with the effects of treatment. For instance, if a woman is premenopausal and part of her treatment for hormone receptor-positive breast cancer occurs while she is going through menopause, a process impacting metabolism that might otherwise occur over many years can be accelerated by the treatment. For men, treatments for prostate cancer might lead to weight gain. In this instance, hormone therapy can lead to lower testosterone levels as well as loss of lean muscle mass and increased body fat.

In addition to these more direct effects of therapy, keep in mind that you also may be managing other side effects, including nausea. An empty stomach can trigger nausea. Eating more often and ingesting more carbs can help reduce nausea, but those behaviors are not always best for managing weight gain.

It’s important to think about your short-term versus long-term goals. If you are in active treatment, you might want to avoid excess weight gain rather than try to lose weight. It’s best to do this in a holistic way, which means making healthy eating choices, being active, drinking plenty of water and getting enough sleep.

Ask your doctor if you should consider adjusting what you are eating to help keep your gut healthy. Look for opportunities to eat plenty of vegetables, whether they are cooked or part of a smoothie or a soup.

It’s also really important to talk to your doctor about what exercise program might be right for you. Consider working with a personal trainer or physical therapist. Exercise is important not so much for burning calories, but for the benefits to your immune system and your strength. It can help you maintain lean body mass and keep your metabolism higher.

Remember that you want to stay well-nourished. Even if you have concerns about weight gain, you don’t want to skip meals or restrict food intake to the point that you are not nourishing yourself.

WATCHING YOUR WEIGHT // Memorial Sloan Kettering Cancer Center offers tips to manage weight gain during and after treatment. // explains how chemotherapy can lead to weight gain. 

How can I start a conversation with my partner about sex?​

Diane Cameron, author of the blog Love in the Time of Cancer in Albany, New York. Photo courtesy of Diane Cameron

DIANE CAMERON: This topic has been a passion of mine ever since my husband was diagnosed with colon cancer. When Dave was diagnosed, we’d been married less than six months, and we were romantic and sexual in our lives. One of the first things I thought was, “We will lose all of it. It will be gone out of fear, out of not knowing how the cancer would impact his body.” But what flared up in me was the idea that I was not going to lose the good in our relationship.

I started with humor, and so that may be a place for you to begin. Or if that’s not your style, perhaps you can find some outside information to help you raise the question of what this will mean for you and your sex life. This will also depend on what your sex life has been like. If you weren’t really talking about sex before, it might be hard to bring it up now.

Either way, I’d recommend that you choose your moment and location carefully. I’d say not in bed, for sure. If you are looking for an opportunity to bring up the topic, maybe look for moments on TV and use them to say, “Hey, what about us?” Ask your partner if this is something you can talk about. Tell him or her that this is something you’ve been worried about.

One thing to keep in mind is that you don’t want it to come out in anger. And even if you’ve confided in a friend first, it’s best not to say, “I was talking to so-and-so about this.”

You may want to know that you’re still attractive to your partner. Let him or her know that one way you measure that is based on what you do in bed. Ask, “Are we having sex enough? Is it good for you?” In the course of any relationship, these issues will come up. Perhaps what used to work doesn’t anymore. There may be physical changes to consider.

If you have questions you can’t answer, be brave and ask your medical professionals. Bring that information back into your relationship. Another good idea is to take advantage of support groups for caregivers and patients. A support group might help in starting the conversation and giving you tools to take home.

I remember wondering early on in Dave’s treatment whether something was wrong with me in being interested in our sex life. But there are many more injuries in cancer than just the physical body. Loss of your sex life doesn’t have to be one of them. You may never get back to where you were before cancer treatment, but you can preserve a lot of who you are as a couple if this issue isn’t swept under the rug.

SEX AND CANCER // The Mayo Clinic​ details when it’s safe to have sex while undergoing chemotherapy. // The Fred Hutchinson Cancer Research Center​ looks at the sexual aftermath of cancer treatment.

What are the most important things for me to know about my loved one’s health insurance?​​​

Anna Howard, policy expert at the American Cancer Society Cancer Action Network in Washington, D.C. Photo courtesy of Anna Howard​

ANNA HOWARD: The first thing is to make sure there are no lapses in health insurance. Make sure that your loved one’s health insurance premiums are being paid on time.

There is likely to be a lot of paperwork involved, and it’s helpful to stay on top of that to make sure your loved one is getting the right treatment at the right time. You wouldn’t want to have treatment delayed due to insurance issues.

The next thing I’d recommend is to get a list of in-network providers on their health plan. As much as possible, you’ll want to make sure that their providers are in-network to minimize your costs. Also, get a copy of the plan’s formulary. That’s the list of drugs that your loved one’s insurance will cover. Check to see that any medication your loved one is taking is covered by insurance.

It’s important to understand how much your loved one will be expected to pay out-of-pocket for treatments, tests and other services. Keep track of bills that come in, along with what’s being paid by insurance and any outstanding charges. It’s not unusual for an insurance company to deny a claim your doctor has made for treatment. However, it may be possible to file an appeal to have that decision overturned and reduce your cost.

Don’t be afraid to talk to your loved one’s health care provider about insurance. When we see the oncologist, we’re often focused on treatment regimens and side effects. We might not think to ask about costs, insurance or how to file an appeal. Many health care centers have patient navigators or others who can help you. Your loved one’s health insurance company may have a case manager who can help, too. Don’t be afraid to ask for help.

When you face a cancer diagnosis, it’s a good idea to make sure all your ducks are in a row upfront. Make sure you and your loved one understand their health insurance coverage so you’ll know what to expect. Contact the health plan and let them know that your loved one will be undergoing cancer treatment. If you’ll be helping out, make sure you are authorized to address any questions or file an appeal if the need should arise. Thinking about these issues early will help to ensure there won’t be any big surprises later. And if an issue or question does come up, you’ll know the right person to call.

UNDERSTANDING HEALTH INSURANCE // Cancer Support Community has tips on managing health insurance with cancer. // Cancer​Care has podcasts and workshops to help you understand the costs of care.​​