Recovery & Rejuvenation

Numb, tingling or painful hands and feet after taxanes, platinum or bortezomib have no proven preventive treatment. Small trials suggest acupuncture may ease the symptoms, but they are too small and inconsistent to be sure, so it is an option to try inside a trial or with careful tracking rather than an established treatment.

Radiotherapy to the head and neck can permanently dry the mouth. A randomised trial in the United States and China found that acupuncture given during radiotherapy reduced dry mouth a year later compared with standard care, an effect that needs confirming.

In a randomised placebo-controlled trial of 364 people, eight weeks of Wisconsin American ginseng modestly improved cancer-related fatigue, mainly in those still on treatment. The 2024 fatigue guideline says it may be offered during treatment; quality of the product matters.

Because hair thinning on endocrine therapy follows the pattern of androgenetic alopecia, the drugs used for that pattern are sometimes added. The evidence in cancer survivors cannot separate them from minoxidil, the one guideline that addresses spironolactone says not to use it routinely, and an expert panel advised against finasteride and dutasteride in breast cancer.

Eyelashes and eyebrows often fall out with chemotherapy and can be slow to return. Bimatoprost, a glaucoma eye drop approved for thin lashes, applied along the lash line each night increased lash length and thickness in a randomised trial that included people after chemotherapy.

Hormone treatments, chemotherapy that stops the ovaries and long courses of steroids all thin the bones, fast enough to measure within a year. Some of it comes back when the treatment stops, and the drugs that prevent fracture while it is going on are well proven.

Zoledronic acid and denosumab reduce fractures, spinal cord compression and bone pain from bone metastases and myeloma, prevent treatment-induced bone loss, and in postmenopausal breast cancer modestly reduce recurrence in bone.

New bowel symptoms after radiotherapy to the prostate, cervix, womb, bladder or rectum are common and are often treated as something to live with. They usually have several separate and treatable causes, and a trial showed that working through them with a written algorithm, delivered by a nurse or a gastroenterologist, improved symptoms more than a self-help booklet.

When density has not come back, the options are to hide the gap or to move hair into it. Keratin fibres and scalp micropigmentation are cheap, immediate and reversible; hair transplantation and surgical reconstruction have been reported in cancer survivors only in small numbers, and no trial compares any of them.

Cardio-oncology builds heart risk assessment, monitoring and prevention into cancer care so patients can finish curative treatment without trading cancer for heart failure. It targets anthracycline and trastuzumab damage, checkpoint-inhibitor myocarditis and radiation heart disease using echocardiography, troponin tests and protective drugs; specialist clinics are concentrated in large centres.

Chemotherapy and radiotherapy do not select blood stem cells at random. They favour the ones carrying mutations in DNA-damage genes, which then expand. Most people with such a clone never develop a blood cancer, but the clone is a measurable mark of what treatment did, and in a minority it is the seed of a later leukaemia.

Cancer-related fatigue and anxiety respond to structured talking therapy that targets the thoughts and habits that keep them going. Randomised trials show benefits during treatment and, for persistent fatigue, years afterwards; guidelines recommend it.

Insomnia is one of the most persistent problems after cancer treatment. A short structured talking therapy that retrains sleep habits works better and for longer than sleeping tablets, and digital versions bring it to people who cannot reach a therapist.

Pellets of compounded oestrogen and testosterone are implanted under the skin and sold as a way to feel young again. The National Academies reviewed the evidence and told prescribers to restrict their use: the claim that compounded preparations are safer or more effective than approved hormone products is not supported, and nobody checks what is in them.

Arm or leg swelling after lymph node surgery or radiotherapy is managed with compression garments, specialised massage, skin care and exercise. Weight lifting, once forbidden, was shown in a randomised trial to reduce flare-ups rather than cause them.

Several drugs have been put on the scalp to stop chemotherapy hair loss before it starts: minoxidil lotion, vitamin D analogues, and others. The trials were done and they did not work. Scalp cooling remains the only method cleared by a regulator to prevent it.

The staging CT scan every cancer patient already has can be measured for muscle and fat at the level of the third lumbar vertebra; low muscle predicts chemotherapy toxicity and shorter survival across cancers, and software now does the measuring automatically.

Radiotherapy to the head and neck damages the salivary glands and, through the dry mouth that follows, the teeth. Planning that steers dose away from the parotid glands roughly halves lasting dryness and lets saliva recover over a year or two. Teeth need a dental assessment before treatment starts, because extractions afterwards risk the jawbone failing to heal.

Instead of starving patients before and after an operation, modern surgical pathways feed them early, give carbohydrate drinks the night before, and get them walking the next day. Complications and hospital stays fall.

An epigenetic clock reads chemical marks on DNA and estimates how old the body looks, which is not always the age on a birth certificate. In survivors of childhood cancer the clock runs ahead of chronological age, and the gap is larger after radiotherapy and after certain chemotherapy drugs. What the gap means for any one person is not yet known, and the clocks do not agree with each other.

Structured exercise during and after treatment, which the CHALLENGE trial showed improves survival in colon cancer.

Moderate exercise while on chemotherapy is safe and reduces fatigue, helps people finish their planned doses, and may protect the heart and nerves.

Exosomes are real biology and a serious research field. Exosome injections sold in clinics are neither. There are no approved exosome products anywhere, and the FDA issued a public safety notification after patients in Nebraska were seriously harmed by them.

Taking fat from one part of the body and injecting it to fill a defect left by surgery is routine reconstructive practice. The question survivors ask is whether it wakes anything up. Matched studies have not found higher recurrence, but they are not randomised trials, and the grafted area can produce changes on a mammogram that need to be told apart from a recurrence.

Fatigue is the commonest thing left behind by cancer treatment and the least treated: about a third of women in two large breast cancer cohorts still had severe fatigue years after diagnosis. What works is exercise, cognitive behavioural therapy and mindfulness programmes. What does not is the stimulant tablet people most often ask for, and the 2024 guideline says so.

For young women with the earliest, low-grade endometrial cancers, progestin pills or a hormonal IUD can clear the cancer and allow pregnancy before a later hysterectomy.

The clearest evidence that treatment ages people is not a laboratory marker, it is what happens to survivors decades later. In the St Jude Lifetime Cohort, one in eight women who had cancer as a child met the clinical definition of frailty at a mean age of 33, a rate usually seen after 65. Frailty predicted new chronic conditions and death.

Wearing frozen gloves and socks, or tight surgical gloves, during taxane infusions reduces nail damage and may reduce numbness in the hands and feet, by narrowing the blood vessels while the drug is at its peak. Trials are small but consistent, and it is cheap.

Oral glutamine, an amino acid that gut and mouth lining cells use for fuel, may reduce the severity of mouth ulcers during head and neck chemoradiation; mucositis guidelines suggest it for that use. Intravenous glutamine in transplant patients is not recommended, and evidence for preventing nerve damage is thin.

Cisplatin kills the hair cells of the inner ear, starting at the high frequencies, and the loss does not come back. In children, sodium thiosulfate given six hours after each dose cut hearing loss from 63 to 33 per cent in one randomised trial and from 56.4 to 28.6 per cent in another. Nothing equivalent is licensed for adults.

Most heart damage from anthracycline chemotherapy appears within the first year after it finishes, and most of it improves at least partly when it is caught and treated. Heart muscle weakened by trastuzumab usually recovers when the drug is stopped. Radiotherapy to the chest raises the risk of coronary disease years later, in proportion to the dose the heart received.

Breathing pure oxygen in a pressurised chamber, over 30 to 40 sessions, helps heal radiation damage to the jaw, bladder and bowel that appears years after treatment. A Cochrane review found moderate-quality evidence of benefit for these sites, and little for others.

Hyperbaric oxygen has real randomised evidence for a short list of late radiation injuries, and none at all for the general claims made for it in wellness clinics. The distinction is worth holding, because the clinics use the real indications to sell the invented ones.

An NAD+ drip takes several hours, is sold in courses, and has never been tested against placebo for anything a cancer survivor would recognise. The published human literature on intravenous NAD+ amounts to retrospective series and narrative reviews.

Red and near-infrared light from a cap, comb or in-clinic device, sold for hair growth and tested twice in breast cancer. Adding it to scalp cooling did not improve on scalp cooling alone, and a separate caution applies to shining light at tissue where a tumour may be.

Two things have changed. Measuring the limb regularly after surgery, so that a month of compression can start before swelling is obvious, cut progression to full decongestive treatment from 19.2 to 7.9 per cent in a randomised trial. And joining lymphatics to small veins during the node operation cut new lymphoedema from 32 to 9.5 per cent, in a trial not yet finally reported.

Treatment can bring on menopause in a week rather than a decade, and the usual answer, hormone replacement, is often unavailable. The non-hormonal options now have real trial evidence: elinzanetant cut moderate to severe hot flushes by three and a half episodes a day more than placebo in women on endocrine therapy, and venlafaxine and oxybutynin also beat placebo.

There is one licensed mesenchymal cell product in oncology and it is for one narrow use: children whose graft-versus-host disease has not responded to steroids. Everything else sold as a mesenchymal or stromal cell infusion for repair or rejuvenation is unlicensed and untested, and it is worth knowing the difference because the clinics rely on it being blurred.

Metformin is cheap, old and safe enough that it is the obvious candidate for a drug that slows ageing. The largest cancer trial ever run on it, in 3,649 women with breast cancer, found nothing. The trial designed to test whether it slows ageing itself has not been run.

Structured eight-week mindfulness courses reduce anxiety and low mood during and after cancer treatment, with dozens of randomised trials behind them. Guidelines from ASCO and the Society for Integrative Oncology recommend them as a first option alongside, not instead of, psychological care.

Most hair grows back after chemotherapy, but a minority, especially after docetaxel, are left with thin hair, and tamoxifen and aromatase inhibitors cause gradual thinning. Minoxidil lotion or low-dose tablets, the same treatment used for pattern hair loss, improved regrowth in most patients in dermatology series and shortened regrowth time in an early randomised trial.

Muscle lost during treatment is usually regained with resistance training and enough protein, over months rather than weeks. Muscle lost to cancer cachexia is different: while the cancer is active, training and food slow the loss but rarely reverse it, and the consensus definition says so plainly.

NAD+ falls with age, and swallowing a precursor raises it in the blood. That much is established. Whether raising it does anything for a person who has had cancer is not. The one B3 compound with a real cancer result is plain nicotinamide, for preventing skin cancers in people who keep getting them, which is a different claim entirely.

Taxanes lift the nail from its bed, leave transverse ridges that mark each cycle, and discolour it. Reported rates across studies range from none to forty-four per cent. Cooling the hands during the infusion reduced nail damage in a pooled analysis, but the one properly randomised trial was negative and six in ten participants stopped because the cold was too uncomfortable.

Numbness, tingling and pain in the hands and feet are common on platinum, taxane, vinca and proteasome-inhibitor treatment, and most of it fades. In a meta-analysis of 4,179 patients it was present in 68 per cent in the first month, 60 per cent at three months and 30 per cent at six months or later. Only duloxetine has evidence for the pain, and no drug prevents it.

Protecting the ability to have children before cancer treatment that damages eggs, sperm or the womb: sperm and egg or embryo freezing, ovarian tissue freezing, ovarian shielding and, for some breast cancers, temporary ovarian suppression.

Sucking ice chips for half an hour around a bolus dose of fluorouracil or high-dose melphalan roughly halves the risk of painful mouth ulcers. It costs nothing and is recommended in international mucositis guidelines.

Whether periods return after chemotherapy depends mostly on age and on which drugs were given. In the one study that recorded bleeding daily, about two thirds of women who stopped bleeding for six months after an anthracycline regimen started again, usually within a year. Of those who went two years without a period, one in ten bled again and none regained regular cycles.

Ozone is sold to survivors as an infusion of ozonated blood, a rectal insufflation or an injection, for immunity, energy and detoxification. The United States regulation on the subject opens with a sentence worth reading in full: "Ozone is a toxic gas with no known useful medical application in specific, adjunctive, or preventive therapy."

Shining low-power red or near-infrared light on the inside of the mouth before and during treatment prevents severe mouth ulcers in people having head and neck radiotherapy or high-dose chemotherapy for transplant. Mucositis guidelines recommend it, though few centres yet have the equipment.

Blood is spun to concentrate platelets and injected into the scalp. It is sold widely for hair loss and is expensive. The one randomised study in people treated for cancer injected one half of the scalp and left the other half alone: both halves improved by the same amount.

Platelet-rich plasma is the person's own blood, spun down and injected back. It is sold for hair, skin and vaginal dryness after treatment. The two trials that have actually been run in cancer survivors are small, and the better designed of the two found no difference between the treated and untreated side of the same scalp.

Prehabilitation is a few weeks of structured exercise, nutrition and psychological preparation between diagnosis and surgery to make patients fitter for the operation and speed recovery.

Dexrazoxane, given with the chemotherapy, cuts clinical heart failure in adults by about four fifths in pooled trials without reducing how well the chemotherapy works. Beta blockers and blood-pressure drugs given preventively protect the ejection fraction by a point or two during treatment, and in the one trial that followed patients for two years that difference had gone.

Rapamycin extends life in every species it has been properly tested in, which is why people take it off-label. In humans there are two randomised results worth knowing: a related drug improved the flu vaccine response in older people by about a fifth, and a year of low-dose rapamycin in healthy adults did not change its primary endpoint. That is the whole of it.

This is rejuvenation in the literal sense, and it is the part that is actually documented. Chemotherapy, transplant and CAR-T leave a person's immune memory thinner than it was, sometimes for years. Revaccination schedules exist, they work, and they are the single most useful thing on this page that is free at the point of use.

Lifting weights and eating enough protein is the only treatment shown to build muscle in people with cancer wasting, but most are too unwell to do it alone and the trials are small.

A bare scalp burns in sun it has never met, loses heat fast in cold, and is more easily irritated while treatment is going on. The measures are small and free, and they are the part of hair loss a person can act on from the first week.

A tightly fitted cap chilled to a few degrees above freezing, worn before, during and after each chemotherapy infusion, narrows the blood vessels of the scalp so less drug reaches the hair roots. In a randomised trial about half of women on taxane-based chemotherapy kept most of their hair, compared with none who went without.

A surface electrical device that is said to replace pain signals with signals the brain reads as normal. People treated with it often feel better, but in the only trial that compared it with a dummy device there was no difference between the two, so what is being felt may be the attention and the expectation rather than the machine.

Chemotherapy pushes cells into senescence: they stop dividing but stay alive and keep releasing inflammatory signals. The usual marker, p16INK4a in blood T cells, rises sharply during treatment and is still raised a year later. In one study the rise matched about fifteen years of ordinary ageing, in another the gap in survivors was larger still.

Senolytics are drugs meant to kill the worn-out cells that chemotherapy leaves behind. The idea is good and the animal work is striking. The human evidence is four small trials in other diseases, none in cancer survivors, and the one properly randomised trial missed its main target. Nobody should be buying these.

Chemotherapy leaves behind zombie cells that will not divide but poison their neighbours. Senolytics aim to clear them.

Sexual difficulty is among the losses people report most after cancer treatment and among the least often asked about. The guideline says a member of the care team should raise it, and that counselling should be offered to everyone. The treatments are real but modest, and the clearest finding is that a tablet taken only when needed does not restore erections after prostate surgery.

Skin reactions in the treated area peak around the end of radiotherapy and heal. A thin silicone film applied from the first day cut moderate or severe reactions from 45.6 to 15.5 per cent in a randomised trial in breast cancer, and an international guideline recommends it. Permanent changes, such as fine broken veins and firmness, come later and do not reverse.

Clinics at home and abroad sell stem cell infusions and injections to people finishing cancer treatment. The FDA has recorded blindness, tumour formation and infections from these products, and says plainly that if you are being charged for one outside a clinical trial you are likely being deceived. Two of the harms are written up in the New England Journal of Medicine.

An ordinary heart ultrasound analysed by software that tracks how far each segment of heart muscle shortens with every beat; a fall of more than about fifteen per cent from baseline warns of chemotherapy heart damage months before the usual ejection fraction measurement moves.

A supervised, coached exercise programme for three years after bowel cancer treatment cut recurrence and death in a large randomised trial. It is the first lifestyle intervention proven to work like an adjuvant drug.

Biotin, marine-protein and multi-ingredient capsules are advertised directly to people whose hair has thinned after treatment. No randomised trial of any of them has been run in chemotherapy or endocrine-therapy hair loss. High-dose biotin also distorts hospital blood tests, including the one used to diagnose a heart attack.

Organised follow-up for the 18 million US and 50+ million global cancer survivors: watching for recurrence and second cancers, managing long-term side effects such as heart damage, infertility, neuropathy and fatigue, and helping people return to work and life.

Slow, low-impact movement practices from Chinese tradition improve fatigue, sleep and balance in people with cancer. Randomised trials are moderately sized and positive, and the 2024 fatigue guideline recommends them during treatment.

Telomeres are the caps on chromosomes that shorten each time a cell divides. They are the oldest and best known measure of cellular ageing, and the one with the least to show for itself in cancer survivors so far: the measurements exist, the associations are inconsistent, and nothing follows from a result.

Low testosterone is common after cancer treatment and is rarely looked for: it was present in 38.5 per cent of 491 men treated for testicular cancer, in about half of a separate cohort whether or not they had chemotherapy, and in a third of adults given cranial radiotherapy. Replacement is straightforward where it is indicated; men with a prostate cancer history are the uncertain group.

Exercise is the best-evidenced thing a person can do for their own recovery, and the guidelines put a number on it: moderate aerobic exercise at least three times a week for at least thirty minutes, for eight to twelve weeks, plus resistance training twice a week, two sets of eight to fifteen repetitions at sixty per cent or more of the heaviest weight you can lift once.

Trouble with memory, concentration and word-finding after chemotherapy is real and measurable, and what a person reports and what a test shows often do not match. Cognitive rehabilitation is the approach with the best trial evidence, exercise helps on some measures and not others, and every drug tried so far has failed, including a large trial of donepezil.

Two routine blood tests, troponin for heart muscle injury and natriuretic peptides for heart strain, taken before and during heart-toxic cancer drugs so that damage is caught weeks or months before the heart's pumping falls on a scan.

BPC-157, ipamorelin, thymosin, CJC-1295 and the rest are sold online and by clinics for healing, energy and recovery after treatment. The FDA has placed several of them on the list of substances that may present significant safety risks in compounding, and names immunogenicity, impurities and, for some, deaths in studies.

Vaginal dryness and painful sex after cancer treatment are common, lasting and under-treated. Low-dose vaginal oestrogen is the usual answer outside cancer, and for women on an aromatase inhibitor the guidance disagrees: American and British bodies read the same cohort studies differently. A reader deserves to be told that rather than given one confident answer.

If this front could only say one thing, it is this. Exercise, sleep, not smoking, treating what is treatable and keeping up surveillance outperform everything currently sold as rejuvenation, by a wide margin and with randomised trials behind them. The measurable ageing that treatment causes is real and is a reason for research, not a reason to buy something.

A wig, scarf or cap restores privacy and confidence during hair loss. In the UK wigs come on NHS prescription, free in Scotland, Wales and Northern Ireland and in England for children, students under 19 and people on qualifying benefits; in the US a prescription for a 'cranial prosthesis' lets some insurers reimburse one, and charities give wigs free.