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You will be aware of many different symptoms at different times. Some symptoms are a side effect of treatment while others are caused by the cancer itself.
Remember that not all symptoms will be related to cancer. Here we discuss some common symptoms: nausea, pain, tiredness, breathlessness and lack of appetite. There may be times when you will need immediate advice about any of these that you may be experiencing. For this reason, it is essential that you know which doctor or nurse you can contact at any hour of the day or night for the help you might need.
As with any symptom, it is necessary to find out what is causing the nausea before deciding on the best way to deal with it.
Nausea is an unpleasant symptom that can be caused by:
Many people talk about anticipatory nausea, the response your body learns and then recalls when you know it is chemotherapy time again. Even much later, there can be a surge of nausea when you're just driving past or walking around the place where you once had chemotherapy.
You do not have to put up with nausea. Tell your doctor or nurse: they will identify the cause of the nausea so the right treatment can be given. Treatments for nausea include:
The great majority of people with advanced cancer experience pain, but it is always possible to reduce it or alleviate it completely.
People with cancer do not necessarily experience increasing pain as the cancer progresses. Pain depends on the location of the cancer and its size. If you do experience pain, in most cases it can be controlled. It may take a little time to find the correct pain-control measure.
Pain management is a specialised field for doctors and nurses. Palliative care services specialise in pain management.
Pain may come and go. It may be worse on some occasions than others or it may be always present. Keeping a record of your pain can help your doctor work out the best way to relieve your pain. Is the pain worse at certain times? Does the pain relief work at all? How bad is the pain? Try scoring your pain on a scale of one to ten, with one being no pain and ten being the worst pain you can imagine. Generally, pain can be controlled.
There are many ways to manage pain, including:
A combination of these methods may achieve the best results. How and where the pain is felt, and how it affects one's life, can change. Regular reviews by pain-management experts will ensure the best results are achieved.
Each method is briefly described below.
Pain-relieving drugs (analgesics) may be mild, like aspirin or paracetamol; moderate, like codeine; or relatively strong, like morphine. Pain-relieving drugs may be taken as tablets, other oral mixtures, suppositories, patches and injections.
Other drugs may also be prescribed, like non-steroidal anti-inflammatory drugs (NSAIDs) and anti-depressants.
The doctor will aim to find the right drug, dose, frequency for taking the drug and delivery means (for example, tablet or injection), and aim to control any side effects. This may involve trying one drug at different doses and then trying another drug at different doses.
‘There does come a time when common analgesics are no longer sufficient and I found the decision to begin taking morphine on a regular basis very difficult to make. Having made it, I have been taking the slow release morphine tablets for 18 months with no appreciable side effects. Without the morphine the pain would now be too debilitating for me to continue doing all the things I do now.'
Morphine is one of the most common drugs used to control moderate to severe cancer pain. It comes in quick-acting and long-acting forms.
Morphine has been used for centuries as a pain reliever. Unfortunately, morphine has an undeserved reputation, because some people associate it with drug addiction and people often think that morphine is only used for people who are dying.
A small number of people taking morphine have hallucinations. This means thinking that you see (or sometimes hear) something that isn't real. Hallucinations can be strange and frightening. Tell your doctor if this happens. They will be able to prescribe other methods of pain control.
I finally came to terms with the concept of being morphine dependent when the oncologist pointed out that nobody thinks that diabetics are drug addicts because they need insulin.'
Chemotherapy, radiotherapy and surgery are used to cure primary cancers. They are also used in advanced cancer to reduce symptoms such as pain.
Chemotherapy can sometimes shrink cancer that is causing pain because of the cancer's size and location. Radiotherapy can relieve some symptoms, such as headaches caused by increased pressure in the brain due to brain metastases. When used for symptom control, courses of radiotherapy are usually much simpler and shorter than when treating early cancer. Surgery may be done to improve outcomes from chemotherapy and radiotherapy by reducing the size of the cancer. It may also be used to treat a serious condition, such as a bowel obstruction, that is causing pain.
For many people, extreme and constant tiredness (‘fatigue') can be a significant problem. It can be very distressing for the person experiencing it and for those around them. Some people say their tiredness is worse than any pain or nausea they experience.
Tiredness can be caused by a range of things such as:
Unfortunately, treating tiredness successfully is not as straightforward as treating some of the other symptoms. It can be very difficult to describe: what one person experiences as extreme fatigue may be simple tiredness for another person.
‘It was a strange tiredness ... It was a feeling of being totally drained of energy: as if someone had pulled out the plug connecting me to my power source ... Words cannot describe this tiredness.'
Good things to do when you experience tiredness are:
Tell the doctor or nurse if you become weaker or more fatigued. The cause may be something treatable, like anaemia or a mineral imbalance.
Some people with advanced cancer experience breathlessness. It is likely to be frightening for you if you find yourself feeling breathless at some time. Your breathing rate goes up or you feel you can't catch your breath. Your doctor or nurse should be called and told what is going on.
Treatment will depend on the reason for the breathlessness. You can be short of breath if there is fluid around your lungs. This may need to be drained or medication may be prescribed if there is an infection. Or it could be caused by the cancer itself, scarring from radiotherapy or pressure from a swollen abdomen. Asthma or emphysema might be present. Whatever the cause, feeling anxious can make it worse.
While you wait for treatment to take effect, you could make a few simple changes. First, try to relax. Have a fan in the room or open a window and get a draught of air moving near your face. Sit up to ease your breathing or lean forward resting on a table. If you don't own a reclining chair, beg or borrow one so you can sleep in a more upright position. You may want to practise breathing techniques, alone or with someone else. Try breathing with someone else, especially slowing your breathing. This can be done during a breathless episode and at other times, to practise.
Some breathing problems respond to oxygen, and this is usually available if needed. A wheelchair can help if you want to move around more freely. As well as being useful for pain, morphine in small doses is very effective in relieving breathlessness and coughing. It is important to discuss any fears you have about your breathing with your doctor or another member of your treatment team.
Lack of appetite is a common problem faced by people with advanced cancer. It can result from illness, treatment, tiredness, an altered sense of taste, pain, lack of activity, depression, nausea and vomiting.
You may go through phases of not wanting to eat. These phases may last a few days or weeks or it could become the ‘norm' for you: you may just be unable to eat the way you used to.
Some ideas that may be useful to promote your appetite are:
Speak to a dietitian with a special interest in cancer-ask your doctor, your hospital or the Cancer Council Helpline .
