Coping with the symptoms

Photo of a woman doing yoga in a park
PantherMedia / wernerimages

Everyday life with a serious disease involves learning to cope with certain symptoms and trying to relieve them as much as possible. Adjusting your diet and getting regular exercise can help.

If you have a disease like metastatic breast cancer, it’s particularly important to pay attention to your own physical and emotional wellbeing every day. Things you can actively do for your health and quality of life include getting regular exercise if possible and eating an easily digestible, balanced diet. This can also help to reduce problems like exhaustion, changes in weight, nausea and constipation.

The physical symptoms of the disease often reduce your sexual desire. But physical contact and affection is still important for most women. There are various things you can do to help you to stay in touch with your own body and needs.

What can help to reduce fatigue?

Metastatic breast cancer and the associated treatments can lead to . Some women are hardly affected by it, but others may have very severe or persistent , or it might come back again and again.

Severe can significantly affect your everyday activities and quality of life. It can be accompanied by problems sleeping, concentrating, and remembering things, as well as feeling down. It is not known what exactly causes . A great deal of physical and emotional stress is assumed to be responsible. For instance, the disease and associated treatments can lead to weight loss and weakness.

Unlike normal tiredness, is hardly improved by rest and sleep. Although it might sound contradictory, certain types of physical activity actually tend to reduce . Things like going on regular walks or doing light exercises may be suitable. It is sometimes possible to do strengthening or aerobic exercises too. The following approaches might also help to cope with :

  • Planning your day: Watch how your energy levels change over the course of the day and plan activities and breaks accordingly
  • Setting priorities: Delay things that are less urgent and let other people take care of less important tasks
  • Doing one thing after the other: Break up activities into small steps, only concentrate on one task at a time
  • Organizing practical help: For instance, get support in everyday life from a domestic helper
  • Distracting yourself: Do things you enjoy, like listening to music, reading, and watching television
  • Don't sleep too much during the day: Only take very short naps if you have to, and try not to spend too much time sleeping during the day – doing so will disturb your nighttime sleep

What should you know about physical exercise?

Regular exercise can help some women to maintain or improve their physical fitness. An individualized exercise program is one way to reduce exhaustion, improve sleep, lighten your mood and see your body in a more positive way again. Special exercises led by a can help improve flexibility and muscle strength after surgery. Exercise also seems to have a positive effect on lymphedema-related problems.

If your cancer is at an advanced stage, it's important to talk with your treatment team about what physical activities are possible and suitable. These may include things like going on regular walks, swimming, hiking, dancing, floor exercises or even strengthening exercises. It's important that you enjoy the exercise and feel good during it, and that you don't overdo it.

You can also participate in special sports activities offered as part of cancer follow-up care. If they are prescribed by a doctor, they are covered by statutory health insurers. Organizations like cancer information services and local support groups can help you to find out what sports courses are offered in your area.

Some women find it hard to do exercise, or they find it depressing if they don’t see any progress. If you feel that way too, one option is to take a break for a while. You might feel more like doing exercise after some time, and then start up again. The important thing is to make sure that what you do feels good.

Can your diet help?

Many people think that certain diets can prevent cancer or speed up recovery. But research on the influence of diet in breast cancer has not yet found any direct effects on the risk of developing cancer or on how the disease progresses. In other words, there are no foods or diets that can cure the cancer or slow down its progression.

There's usually no need to take dietary supplements. You can normally get all the nutrients that your body needs by eating a normal diet. The recommended amount of calories for people who have cancer is generally no different from the amount that healthy people need.

In advanced cancer, though, it can be difficult to regularly eat and drink enough. The disease and treatments can sometimes reduce your appetite and thirst, and your sense of taste might change.

It's important to eat what you feel like eating and enjoy. If you sometimes find it hard to eat anything at all, you can try the following:

  • Drink a lot of water, as well as fluids like milk, tea, warm broth, vegetable juices or fruit juices. It can be helpful to make yourself a big pot or jug of the drink and aim to finish at least a whole one per day.
  • Instead of having three main meals a day, eat several smaller meals.
  • Eat easily digestible foods such as white bread, clear broth and yogurt – even if you are feeling nauseous (sick).
  • Replace solid foods with liquid foods, blended foods or easy-to-chew foods (such as smoothies, oatmeal drinks, semolina pudding, mashed potatoes, scrambled eggs, creamy desserts).
  • Prepare small snacks that you can eat as soon as you start feeling hungry (e.g. nuts, granola bars, dry fruits, cheese cubes).

If you are unable to eat solid food for several days, you should talk to your doctor.

What can you do if you have constipation or weight problems?

People who have advanced cancer often have constipation. This may be caused by side effects of medication, getting too little movement, eating a low-fiber diet or not drinking enough fluids.

Not having a bowel movement every day generally isn't a problem in itself. It becomes more of an issue if you develop things like abdominal pain or the feeling that you can't empty your bowels properly – or only if you strain a lot.

If you're suffering from constipation, you could try to drink a lot of fluids and, if possible, eat more high-fiber foods such as whole grain products, vegetables, fruits, nuts or seeds. It's best to talk to your doctor about whether treatment with laxatives is an option.

If you experience discomfort, put on a lot of weight or lose weight without trying to, a professional nutritional consultation could help you to find the right kind of food. In Germany, dietary advice and support is often offered by cancer centers (Krebszentren), rehabilitation facilities, some hospitals, statutory health insurers and nutritional advice centers (Ernährungsberatungstellen).

Keeping a food and drink diary can help you to keep track of exactly what – and how much, you actually eat or drink. To find out how much energy you use up, you can also use the diary to make a note of how much movement you get and whether, for instance, you go on a walk or do exercises. You can write down whether you have problems like nausea or constipation too. It can also be helpful to take your food and drink diary along when you go to doctor's appointments or nutritional consultation appointments.

How does the disease affect your sex life?

It is normal for women to feel less sexual desire as a result of the cancer and the treatments they have. Sexual needs often become a lower priority due to things like the pain and physical limitations, tiredness and exhaustion, a new body image, and emotional distress. What's more, the treatment affects key aspects of femininity: One breast may have been removed or it might now have scars on it. Hormone therapy or chemotherapy may lead to loss of and hormonal changes before menopause.

Some women also withdraw sexually because they think that they're no longer attractive enough – for their partner or a new partner. But the fear of being rejected for physical reasons is usually unfounded.

Rediscovering sexuality

Over time, it is often possible to accept the changes caused by the disease and to rediscover any sexual desire that might have been lost. A satisfying sex life is good for the body and soul. It is more than just sexual intercourse, which might not always be possible, or less pleasurable at times. Also, sexual preferences and habits differ from couple to couple, and can change over time even without an illness being involved. For instance, sexuality can become gentler with age, and you may need more time to get in the mood.

Possible ways to improve your body image and stimulate your senses include pleasurable body care or beauty treatments, as well as exercise – be it walking, yoga, dancing or pelvic floor exercises. Pampering each other with massages is relaxing and can help you feel closer (again).

Some problems have simple, practical solutions: If your range of movement is limited, cushions can give support. Lubricants can help with vaginal dryness, which is sometimes a side effect of hormone therapy.

It is not always easy to change habits and find new ways of doing things. It may help to take your time and talk openly with each other about your needs, fears and feelings.

If sexual desire does not return

Even if you don't have the energy or feel any desire for sexuality, physical contact and tenderness are usually still important and pleasant. These things can help couples to feel intimate and close. It is easier if the partner understands the changes the woman has gone through and is sensitive to them.

A partner might also lose the desire for sex – perhaps because he or she may also feel burdened by the cancer, the new situation or concerns about their partner. Some might be afraid that their own sexual needs could put too much additional strain on their partner.

It doesn't necessarily have to be a problem if sexuality ends up not playing a major role in your relationship for some time. As long as you feel close as a couple and accept that the breast cancer has changed this aspect of your relationship too, there's no reason to worry. But if you feel that the lack of desire is affecting your relationship, it might help to talk openly about your feelings and worries with your partner.

It's not always easy to talk about sexuality, and may take a little courage. Sexual health centers, cancer information centers and psychosocial counseling centers offer help here. If you like, you can get advice from them anonymously too. Support groups give you the opportunity to talk to women who are in a similar situation to you. They can also put you in touch with other women who have advanced breast cancer. Some support groups provide online forums too, where you can chat anonymously and informally with others affected by the disease.

Arends J, Bertz H, Bischoff SC, Fietkau R, Herrmann HJ, Holm E et al. Klinische Ernährung in der Onkologie (S3-Leitlinie). AWMF-Registernr.: 073-006. 2015.

Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (DGGG), Deutsche Krebsgesellschaft (DKG). Interdisziplinäre S3-Leitlinie für die Früherkennung, Diagnostik, Therapie und Nachsorge des Mammakarzinoms. AWMF-Registernr.: 032-045OL. August 2019. (Leitlinienprogramm Onkologie).

Deutsche Krebsgesellschaft (DKG), Deutsche Krebs-Hilfe (DKH), Deutsche Gesellschaft für Palliativmedizin (DGP). S3-Leitlinie Palliativmedizin für Patienten mit einer nicht heilbaren Krebserkrankung. AWMF-Registernr.: 128-001OL. August 2019. (Leitlinienprogramm Onkologie).

Deutsches Krebsforschungszentrum (DKFZ), Krebsinformationsdienst (KID). Ernährung bei Krebs. August 18, 2014.

Frauenselbsthilfe nach Krebs Bundesverband. Soziale Informationen. January 2019.

McClelland SI. "I wish I'd known": Patients' suggestions for supporting sexual quality of life after diagnosis with metastatic breast cancer. Sex Relation Ther 2016; 31(4): 414-431.

Mosher CE, Daily S, Tometich D, Matthias MS, Outcalt SD, Hirsh A et al. Factors underlying metastatic breast cancer patients'perceptions of symptom importance: A qualitative analysis. Eur J Cancer Care 2018; 27(1): 1-6.

National Cancer Institute (NCI). Eating Hints: Before, during and after Cancer Treatment. January 2018.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

Comment on this page

What would you like to share with us?

We welcome any feedback and ideas. We will review, but not publish, your ratings and comments. Your information will of course be treated confidentially. Fields marked with an asterisk (*) are required fields.

Please note that we do not provide individual advice on matters of health. You can read about where to find help and support in Germany in our information “How can I find self-help groups and information centers?

Updated on March 18, 2021
Next planned update: 2024

Authors/Publishers:

Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

How we keep you informed

Follow us on Twitter or subscribe to our newsletter or newsfeed. You can find all of our films online on YouTube.