Treatment for advanced cancer

Thursday 1 December, 2016

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On this page:  ChemotherapySurgeryRadiotherapyHormone therapy | Targeted therapy | Immunotherapy | Palliative care | Rehabilitation | Complementary and alternative therapies | Key points


The aim of treatment for advanced cancer is to control the cancer for as long as possible. Controlling the cancer might mean shrinking the size of the cancer or stopping it growing for a while. In some cases, this may be months or years. If treatment is no longer controlling the cancer, the aim of treatment is to relieve symptoms.

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 join a clinical trial.

Treatment choices for advanced cancer will depend on where the cancer started and how much it has spread. Usually cancer that has spread needs systemic treatment. This means treatment is taken by mouth or injected into the blood to reach cancer cells throughout the body. Examples include chemotherapy, immunotherapy or hormone therapy. Treatment that affects only a certain part of the body might also be used to relieve some symptoms. Examples include surgery or radiotherapy. Palliative treatment can also help to maintain or improve quality of life.

A range of health professionals will work as a multidisciplinary team to treat you. See the table below.

Health professional
 Role
GP continues to see you for day-to-day health care issues
medical oncologist*

prescribes and coordinates the course of chemotherapy

radiation oncologist* prescribes and coordinates the course of radiotherapy
nurses give the course of treatment, and support and assist you through all stages of your treatment
cancer care coodinator supports patients and families throughout treatment and liaises with other staff
dietitian recommends an eating plan for you and helps with digestive issues, such as nausea
palliative care team specialise in pain and symptom control to maximise wellbeing and improve quality of life
social worker links you to support services and helps you with emotional and practical issues
counsellor, psychologist, clinical psychiatrist* provide emotional support and help manage any feelings of depression and anxiety
spiritual adviser, chaplain, pastoral carer talk about spiritual matters and help you reflect on your life and search for meaning

*Specialist doctor

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 have several cycles of treatment.

The chemotherapy drugs are usually given by injecting the drugs into a vein (intravenously), but can also be taken 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

Some chemotherapy drugs cause 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 Understanding Chemotherapy or call Cancer Council 13 11 20.

Surgery

Surgery can remove tumours from affected areas, such as 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.

Some organs release hormones that stimulate tumour growth, so your doctor might suggest surgery on these – for example, removing the testicles will reduce testosterone levels and can slow the growth of prostate cancer.

For more information see Understanding Surgery or call Cancer Council 13 11 20.

Radiotherapy

Also known as radiation therapy, radiotherapy uses radiation, such as x-rays, to kill cancer cells or injure them so they cannot multiply. Radiotherapy can be precisely targeted at cancer sites in your body. Treatment is carefully planned to have the greatest effect on the cancer cells and to limit damage to the surrounding healthy body tissues.

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

Side effects

Common side effects from radiotherapy include fatigue, skin problems or loss of appetite. These may be temporary or longer-lasting.

For more information see Understanding Radiotherapy or call cancer Council 13 11 20.

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

Side effects

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

Targeted therapy

Targeted therapy may be used instead of, or together with, chemotherapy. This treatment uses drugs that work in a different way to chemotherapy drugs. While chemotherapy affects all rapidly dividing cells and works by killing cancerous cells (cytotoxic), targeted therapy affects specific molecules within cells and often works by blocking cell growth (cytostatic).

Not all cancers respond to targeted therapy, and the drugs are sometimes hard to access because they are expensive, not yet developed for all types of cancers, and sometimes available only in clinical trials.

Side effects

These vary depending on the targeted therapy used, but may include fevers, allergic reactions, rashes, diarrhoea, blood-clotting problems, and blood pressure changes.

Immunotherapy

This is the use of drugs to alter the immune system’s response. New immunotherapy drugs are being rapidly developed, and several of these are approved for the treatment of some cancers. These new drugs work by permitting the immune system to bypass ‘checkpoints’ set up by the cancer that block the immune system.

Side effects

The side effects of immunotherapy drugs are different to chemotherapy. If the drugs inflame organs, it may cause symptoms, for example, in the lungs (shortness of breath), bowel (diarrhoea) or thyroid gland (abnormal thyroid hormone levels).

Palliative care

Palliative care allows people with advanced cancer to maintain their quality of life. It also provides support to families and carers.

Many people think that palliative care is just for people who are dying, but it is appropriate at any stage of advanced cancer. Some people live comfortably for months or years after their diagnosis of advanced cancer, and they can be supported by palliative care services throughout this time.

The role of palliative care is to:

  • help you achieve a good quality of life for as long as possible
  • make sure your physical, practical, emotional and spiritual needs are catered for
  • help you feel in control of your situation and make decisions about your treatment and ongoing care
  • make the time you have as valuable as it can be for you and your family.

Your palliative care may be coordinated by your GP or community nurse or by the specialist palliative care team in your area. These different professionals work together to give you relief from pain and other symptoms of cancer. They will also try to help you live your life as fully as possible.

Contacting the palliative care team early in your illness means that you can find out what the different team members do and 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 about what palliative care is and how it helps, visit the Palliative Care Australia website. You can also use the directory on this website to find a palliative care service in your local area.

"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
Working together: holistic care

Palliative care is holistic care: it involves a range of people with different skills and roles working on a range of issues (physical, practical, emotional and spiritual) across a range of settings (home, residential aged care facilities, hospitals and palliative care units), and at all stages of advanced cancer.

For more information see Understanding Palliative Care or call Cancer Council 13 11 20.

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 treatments. 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 13 11 20.

Complementary and alternative therapies

You may wonder whether there are any complementary and alternative therapies you could try. You may want help managing different symptoms and side effects, or a treatment for the cancer. You may want to feel that you’ve tried every available option and have some control over your treatment.

Complementary therapies

Complementary therapies can be used in combination with conventional medicine, such as chemotherapy or radiotherapy. Therapies include acupuncture, massage, hypnotherapy, nutrition and relaxation. These may help you cope better with side effects and feel as well as possible.

In clinical trials, some therapies have been shown to be helpful for managing the various emotional and physical effects of cancer and its treatment. Examples include:

  • anxiety – meditation, relaxation, counselling, support groups, art therapy, music therapy, massage, hypnotherapy
  • fatigue – meditation, relaxation
  • pain – hypnotherapy
  • stress – meditation, relaxation, counselling, support groups, spiritual practices
  • nausea and vomiting – acupuncture, hypnotherapy.

While some cancer treatment centres and palliative care units offer complementary therapies as part of their services (e.g. art therapy, massage or meditation), 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, such as tai chi or yoga, for free or a small charge. For more information see Understanding Complementary Therapies or call Cancer Coucil 13 11 20.

Let your doctor know if you plan to use any other 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 treatment options are limited, some people consider alternative therapies. However, alternative therapies can be harmful – for example, taking high-dose vitamins can have side effects, and eliminating food groups could mean that your diet no longer provides all the nutrients you need. Some therapies may also be costly. Be wary if any treatment:

  • claims to cure all cancers
  • requires you to travel overseas
  • claims the medical/pharmaceutical industry wants to stop its use
  • claims to have positive results with few or no side effects.

Information on alternative therapies may be misleading. It can come from many sources, such as the internet. Friends and family may also tell you about alternative treatments. Look for information from reliable sources such as Cancer Council or government websites, ask questions, and check a practitioner’s qualifications.

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 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 manage 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 treatments.
  • Let your doctor know if you plan to use any other therapies to make sure they do not result in harmful side effects.

Reviewed by: Dr Maria Ftanou, Lead Clinical Psychologist, Peter MacCallum Cancer Centre and Research Fellow, Melbourne School of Population and Global Health, University of Melbourne, VIC; Dr Kathryn Dwan, Senior Policy Officer, Palliative Care Australia; Alison Hocking, President-Elect, Oncology Social Work Australia, VIC; Philippa Kirkpatrick, National Policy Manager, Palliative Care Australia; Prof Liz Lobb, Professor of Palliative Care (Allied Health), Calvary Health Care, Kogarah, NSW; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA; Hamish Park, Consumer.