Treatment for advanced cancer

Sunday 1 December, 2013

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On this page:  ChemotherapySurgeryRadiotherapyHormone therapyPalliative careRehabilitationComplementary and alternative therapiesKey points


Some people believe that nothing more can be done if they receive a diagnosis of advanced cancer. However, treatment can keep some advanced cancers under control for months or years. In other cases, palliative care can help to control and relieve symptoms such as pain, fatigue or digestive problems.

Although most advanced cancers can’t be cured, something can almost always be done to help maintain or improve your quality of life. New drugs are constantly becoming available, so if your current treatment stops working or you are finding it hard to cope with the side effects, ask your doctor about other options. Also, ask if you are eligible to be part of a clinical trial.

Some people with advanced cancer use the internet to thoroughly research proposed treatments. The internet can be a useful source of information, but not all websites are reliable. You can check the accuracy of information you find online with your doctor or call Cancer Council on 13 11 20.

This section explains the treatments that can ease the symptoms of advanced cancer or keep disease progression under control.

Chemotherapy

Chemotherapy is the most commonly used treatment when cancer has spread. The drugs kill cancer cells or slow their growth. There are many types of chemotherapy drugs, which are often used in different combinations and strengths. Treatment is usually given over a few hours or days, followed by a rest period of 2–3 weeks. Most people usually have several courses of treatment.

The chemotherapy drugs are usually given by injecting the drugs into a vein (intravenously), but can also be given as tablets or capsules (orally). Ask your doctor which combination of drugs is best for you, and how long your treatment will last.

Side effects of chemotherapy can include nausea, depression, tiredness and hair loss. Many of these are temporary and can be prevented or reduced. Different types of chemotherapy have different side effects – for instance, not all of them cause hair loss.

For more information see the chemotherapy section.

Surgery

Surgery can remove tumours from affected areas, for example the bowel or lymph nodes. It can also relieve discomfort caused by tumours that obstruct organs or cause bleeding, such as unblocking the bile duct to relieve jaundice in pancreatic cancer.

Your doctor might suggest surgery on organs that stimulate tumour growth because of the hormones they release, for example, removing the testicles to reduce testosterone levels and slow the growth of prostate cancer.

Radiotherapy

Radiotherapy uses radiation, such as x-rays, to kill cancer cells or injure them so that they cannot multiply. This can be precisely targeted at cancer sites in your body. Treatment is carefully planned to do as little harm as possible to your normal body tissues.

Radiotherapy can shrink tumours or stop them from spreading further. It can also relieve symptoms such as pain from secondary cancer in the bones. External beam radiation or internal radiation (brachytherapy) may be offered.

Side effects from radiotherapy can include fatigue, skin problems or loss of appetite. These may be temporary or longer lasting.

For more information see the radiotherapy section.

Hormone therapy

Cancer that grows in response to hormones can often be slowed by taking drugs to suppress the body’s production of the hormone. Other treatments interfere with the effect of hormones on tumour cells.

If you have prostate, breast or uterine cancer, you may be offered hormone therapy. This may cause some side effects.

For women, certain hormonal drugs will cause menopausal symptoms, regardless of your age. Hormonal drugs called aromatase inhibitors may be used if you have been through menopause, and these may cause thinning of the bones (osteoporosis) and vaginal dryness. For men, hormone treatments can produce hot flushes.

Palliative care

Palliative care allows people with advanced cancer to maintain their quality of life. It helps you cope with the symptoms of cancer or its treatment, as well as the practical problems of daily life.

Many people think that palliative care is just for people that are dying, but it is appropriate at any stage of advanced cancer. People can receive palliative care for many months or even years.

Palliative care also involves spiritual care and the support of relatives and carers. It incorporates a range of services offered by medical, nursing and allied health professionals, as well as volunteers and carers.

You can have palliative care while you are having active treatment.

What palliative care workers do

  • provide relief from pain and other distressing symptoms to maintain your quality of life, without prolonging or shortening life
  • help you feel in control of your situation and make decisions about your treatment and ongoing care
  • coordinate your care and treatment with your treatment team – they do not take over treatment and care
  • offer support for families and carers during your illness
  • make the time you have as valuable as possible for you and your family

Contacting the palliative care team early in your illness means that you can find out what the different team members do to see which services might be useful now or in the future. This will vary according to how you feel, what problems you have and how your carers are managing. If you are not linked in with a palliative care service and would like to be, speak to your doctor or nurse.

For more information, see the palliaitve care section section.

Palliative care units

A palliative care unit or hospice provides inpatient and outpatient care to people with a limited prognosis. The palliative care unit has hospital facilities but a home-like atmosphere. The staff are specially trained in palliative care.

A person may go into a unit to have pain or other symptoms, such as severe constipation or breathing difficulties, brought under control. They may also go there to give the person caring for them a break (respite care).

Many people go into a palliative care unit for a short time, for instance, about a week. This may be until symptoms are under control and family or carers feel confident to resume their supportive role.

You can also receive palliative care in your home. A palliative care service can coordinate all your medical, practical, social, emotional and spiritual needs.

This service is mostly free. There may be charges for some services, such as hiring specialised equipment, massage therapy or nursing staff for home.

Call 13 11 20 for more information about palliative care, how to access it and how it can benefit you.

"I’ve been having palliative treatment for five years. I’m not trying to get rid of the disease, just keeping it under control. My quality of life is excellent."
Kate

Rehabilitation

It is frustrating to find that cancer can limit your activities. Rehabilitation is a way of improving your quality of life between or after treatment. It may involve restoring physical functioning with the use of physiotherapy, occupational therapy, speech therapy or artificial body parts (prostheses). It can also include emotional support, such as counselling.

Returning to work is another form of rehabilitation. You may find you need to start back at work with reduced hours. If you can no longer work, or choose not to, you may need something to do that helps you feel involved in life and connected with people.

For most people, rehabilitation is organised through their treatment centre. If you have been treated in a private hospital, ask your doctor about the availability of these services. Your GP can also organise rehabilitation for you.

For more information on the availability of rehabilitation services in your area, contact Cancer Council on 13 11 20 or the Commonwealth Rehabilitation Services on 1800 277 277 or visit www.crsaustralia.gov.au.

Complementary and alternative therapies

Many people with advanced cancer want to know more about complementary and alternative therapies. They may seek therapies to help with different symptoms and side effects, or they may hope to find a cure for the cancer. Often, people want to feel that they’ve tried every available option. For many people, complementary or alternative therapies give them a sense of control.

"I was given three months to live. I was a mess, but decided my lifestyle, diet, mental attitude and work needed to be modified anyhow."
Richard

Complementary therapies

Complementary therapies are sometimes called natural therapies. They can be used in combination with conventional medicine, such as chemotherapy or radiotherapy. Therapies include acupuncture, massage, hypnotherapy, herbal medicine, nutrition and relaxation. These may help you cope better with side effects and feel as well as possible. They may also reduce your feelings of helplessness, stress and anxiety.

Some complementary therapies may reduce the amount of medication needed for pain control. Many people benefit from relaxation techniques, meditation and hypnotherapy. Massage can also be a great release, but check with your medical team if there are areas of your body that are too fragile to touch. Your massage therapist will need to make adjustments for you.

While some cancer treatment centres and palliative care units offer complementary therapies, such as massage, meditation or art therapy, as part of their services, you may have to see a private practitioner. If you go to a private practitioner and have private health insurance, check if your health fund provides a rebate.

Most complementary therapies cost money, but some community centres offer group therapies, for example tai chi or yoga, for free or a small charge. You can also use self-help CDs or DVDs to guide you through techniques. Call 13 11 20 for more information on complementary therapies, meditation or relaxation.

Let your doctor know if you plan to use complementary therapies. This is important, as some therapies may not be appropriate, depending on your conventional treatment or what is happening in your body. For example, some herbs and nutritional supplements may interact with your medication, resulting in harmful side effects.

Alternative therapies

Alternative therapies are commonly defined as those treatments used instead of conventional medicine. Many alternative therapies claim to stop cancer growing and to cure the disease, but they are not scientifically tested or proven to be effective.

When cancer has spread and you’ve been told there’s no cure, one reaction is to reject regular medical treatment, feeling that it has failed you. You may hope that an alternative therapy offers a cure.

However, some alternative therapies can be harmful – for example taking high-dose vitamins or eating an unusual diet that doesn’t provide all the nutrients you need. Some may also be costly despite having no effect. Be wary if any treatment:

  • claims to cure all cancers
  • costs a lot of money or requires you to travel overseas
  • claims the medical/pharmaceutical industry wants to stop its use
  • requires major changes in lifestyle
  • claims to have positive results with few or no side effects.

Information on alternative therapies is available from many sources, such as books and the internet. Friends and family may also tell you about cancer cures they’ve heard of. Some of this information may be confusing or wrong. Try and think carefully about it and find supporting information from other sources. Ask questions, and only go to a qualified, trustworthy practitioner.

Check with your doctor if you’re planning to use alternative therapies to make sure they won’t cause any harm.

Key points

  • Improved treatments mean that some advanced cancers can be kept under control for months or years, like a chronic disease.
  • If your current treatment is no longer working or the side effects are hard to cope with, ask your doctor about other options. New drugs are constantly becoming available.
  • There are different types of treatment for advanced cancer that may be used separately or in combination.
  • Chemotherapy is the most commonly used treatment when cancer has spread.
  • Surgery can be used to remove tumours that might be causing symptoms such as pain.
  • Radiotherapy is used to kill cancer cells or injure them so that they cannot multiply. It is also used to relieve symptoms such as pain.
  • Hormone therapy is used for cancer that grows in response to hormones. It can slow tumour growth.
  • Palliative care helps you cope with the symptoms of cancer or its treatment and can help maintain your quality of life.
  • Contacting a palliative care team early in your illness means that you can find out what may help now and in the future.
  • Rehabilitation is another way of improving your quality of life between or after treatment.
  • Let your doctor know if you plan to use complementary or alternative therapies to make sure they do not result in harmful side effects.

Reviewed by: Dr Kathy Pope, Radiation Oncologist, Peter MacCallum Cancer Centre, VIC; Jessica Abbott, Cancer Care Dietitian, Alexandra Hospital, QLD; Frances Bellemore, Clinical Care Nurse, St Vincent’s Hospital, NSW; Gabrielle Gawne-Kelnar, Telephone Support Group Facilitator, Cancer Council NSW; Helpline and Cancer Counselling Service staff, Cancer Council QLD; Di Richardson, Consumer; Dr Mary Brooksbank, Philip Plummer and Claire Maskell Gibson on behalf of Palliative Care Australia.
Updated: 01 Dec, 2013