Why Princess of Wales' return to royal duties may be challenge, according to cancer doctor, Professor Thomas

It's great to hear the announcement from the palace, with the emotive and honest video revealing, the Princess of Wales has finish chemotherapy and will be returning royal duties over the next month - we have all been deprived of her friendly charm and elegance. As an oncologist who specialises in survivorship and integrative care after cancer, despite her enthusiasm, it will not be a straight forward task for Kate.

Preventative chemotherapy after abdominal surgery is often a long and gruelling process. Typically, it involves six cycles given every three weeks, stretching over 18 weeks of intense treatment. While physical fitness can play a crucial role in recovery, it’s essential to understand the lingering side effects that can last long after chemotherapy ends—sometimes for as much as a year. These effects often require proactive lifestyle adjustments and a slow, steady return to work.

I always recommend a phased return to professional life, allowing for gradual readjustments. This approach helps manage fatigue and gives the body time to recover. Flexible hours or modified duties may be necessary, which can present additional challenges. Here's a look at some of the most common lingering side effects of chemotherapy, particularly with drugs like taxanes and platinum agents which are often given after abdominal cancers.

Physical fatigue and weakness

Chemotherapy can leave patients feeling exhausted, making even simple tasks feel monumental. Regular exercise is important for long-term recovery, but in the short term, the fatigue can be overwhelming, particularly after physical activity so exercise regimens need to be well structured and supported with optimal nutrition.

Cognitive impairment ("chemo brain")

This often includes problems with memory, focus, and decision-making. It can make work tasks more challenging and can last for up to six months—or even longer if hormonal therapies are also part of the treatment plan. Here are some tips to improve brain function:

• Avoid processed sugar, 
• Exercise more
• Ensure a healthy gut, 
• Increase intake of nitrate rich foods
• Boost dietary intake of phytochemical rich foods 
• Try to maintain a regular sleep pattern

Menopausal symptoms

Chemotherapy can damage ovarian function, leading to early menopause. Symptoms like hot flashes, joint pain, mood swings, and weight gain can be more intense when menopause occurs suddenly and at a younger age. Thankfully, hormone replacement therapy (HRT) is generally safe following cancers originating in the abdomen.

Emotional and psychological impact

The emotional toll of cancer is undeniable. Survivors often face anxiety, depression, and a fear of recurrence. These feelings can sap motivation, cloud focus, and make daily work feel overwhelming.

Sleep disruption

Post-chemotherapy, sleep can be difficult to come by. Worries about the diagnosis, coupled with physical discomfort like joint pain and indigestion, can disrupt rest. However, with good sleep hygiene habits, and some dietary interventions normal sleep can gradually return.

Nerve damage

Chemotherapy can cause neuropathy, leading to pins and needles or a burning sensation in the hands and feet. This discomfort can interfere with everyday tasks and diminish productivity at work. This usually recovers in time but in some people can be permanent. Exercise and dietary interventions can help recovery.

Rebuilding physical strength and stamina

Chemotherapy often results in muscle loss and diminished physical endurance. Regaining strength takes time and effort, and the road to full physical recovery can be slow.

Body image and confidence

Hair loss, weight changes, and damage to nails can all take a toll on body image. Treatment can alter body image including hair loss, weight gain and damage to the nails. These physical changes can affect self-confidence, especially when transitioning back to the workplace and interacting with colleagues.

In conclusion, while these effects do improve with time, it's important to acknowledge them and not rush the recovery process. Thoughtful lifestyle changes and workplace accommodations can help ease the return to a normal routine, ensuring a smoother, more sustainable recovery. I am sure Kate has been informed about the benefits of a healthy lifestyle after cancer, not only to speed up recovery but to reduce the risk of relapse.