Treatment for advanced cancer

Chemotherapy is the most commonly used treatment when cancer has spread. It circulates throughout the body to affect cells that divide rapidly such as cancer cells. It can kill cancer cells or slow their growth.

There are many types of chemotherapy drugs, and these are often used in different combinations and strengths. Treatment is usually given over a few hours or days, followed by a rest period of 1–4 weeks.

Most people have several cycles of treatment. Chemotherapy drugs are usually given by injection or drip into a vein (intravenously) in hospital, but some can also be taken as tablets or capsules (orally) at home.

Side effects – some chemotherapy drugs can cause tiredness, bowel changes, nausea and hair loss. Most side effects are temporary and can be prevented or reduced. Different types of chemotherapy drugs have different side effects – for instance, not all of them cause hair loss.

Some cancers grow in response to particular hormones. These cancers are known as hormone-dependent cancers.

Hormone therapy (also called endocrine therapy) uses synthetic hormones to block the effect of the body’s natural hormones. The aim is to lower the amount of hormones the tumour receives. This can help slow down the spread of the cancer.

If you have breast cancer or uterine cancer, you may be offered hormone therapy. If you have prostate cancer, the therapy is known as androgen deprivation therapy (ADT). 

Side effects – common side effects include tiredness, hot flushes, mood changes, osteoporosis, weight gain and sweating. Other side effects may impact your sex life, including changes in sex drive, trouble getting or keeping erections or vaginal dryness. Hormone therapy can also affect your fertility. It may bring on menopause symptoms in females. If you have been through menopause, hormone drugs called aromatase inhibitors may be used.  

Targeted therapy is a drug treatment that targets specific features of cancer cells to stop the cancer growing and spreading.

The drugs circulate through the body like chemotherapy, but they work in a more focused way and may have fewer side effects than chemotherapy. Targeted therapy has led to improved survival rates for people with some types of cancer.

These drugs are becoming an important part of cancer treatment and may help:

• after surgery to destroy any remaining cancer cells
• to treat advanced cancer that hasn’t responded to other treatment, or cancer that has come back
• as maintenance treatment for advanced cancer.

Targeted therapy drugs often cause the signs and symptoms of cancer to reduce or disappear. This means many people can return to their usual activities.

The drugs may need to be taken long term, and you will need to have regular tests to monitor the cancer.

Some targeted therapy drugs have been approved for use in Australia for the treatment of a range of cancers including bowel, breast, cervical, kidney, liver, lung, ovarian, stomach and thyroid, as well as melanoma and some forms of leukaemia, lymphoma and myeloma.

Targeted therapy has been effective in treating some people with these cancers, but it may not be the best treatment for everyone with advanced cancer.

The Pharmaceutical Benefits Scheme (PBS) subsidises the cost of some targeted therapy drugs for certain cancers. Targeted therapy drugs not on the PBS are usually expensive, but you may be able to have them as part of a clinical trial.

Side effects – These vary depending on the targeted therapy used, but may include fevers, sensitivity to the sun, rashes, headaches, diarrhoea, bleeding and bruising, and blood pressure changes.

This is a type of drug treatment that uses the body’s own immune system to fight cancer cells. Different types of immunotherapy work in different ways. The most commonly used drugs are called checkpoint inhibitors.

These drugs help the immune system to bypass “checkpoints” set up by the cancer that block the immune system. They often need to be taken for a long period of time.

Checkpoint inhibitors are currently available in Australia for some types of cancer. They have worked well for some people, but they don’t help everyone and it can be difficult to predict whether they will work in certain situations.

New immunotherapy drugs are being developed – talk to your doctor about whether any are suitable for you.

Side effects – Immunotherapy can cause inflammation in different parts of the body, for example, in the lungs (causing shortness of breath), bowel (causing diarrhoea) or thyroid gland (leading to abnormal thyroid hormone levels). Skin inflammation or rashes are more common. Side effects of immunotherapy need to be reported to your doctor as they may be serious. Some side effects that might be okay after chemotherapy may not be okay after immunotherapy.

Surgerymay not be able to remove all cancer cells, but may be used to:

• remove tumours from affected areas, such as the bowel or lymph nodes
• relieve pain and discomfort caused by tumours that stop organs working properly or are pressing on nerves
• improve outcomes from chemotherapy and radiation therapy by reducing tumour size
• insert a thin, hollow tube (stent) into a blocked organ to create a passage for substances to pass through.

Radiation therapy Also known as radiotherapy, radiation therapy uses a controlled dose of radiation, such as x-rays, to kill cancer cells or damage them so they cannot grow, multiply or spread. It can be precisely targeted at cancer sites in your body.

Treatment is carefully planned to have the greatest effect on the cancer cells and limit damage to healthy body tissues. Radiation therapy can often shrink tumours or stop them from spreading further.

It can also relieve some symptoms, such as bleeding from the tumour or pain from secondary cancer in the bones. Different types of external beam radiation therapy and sometimes internal radiation therapy (brachytherapy) are used depending on the location of the cancer.

Side effects – Common side effects include fatigue, skin problems and loss of appetite. These may be temporary or longer lasting. Side effects from radiation depend on the area being treated, for example, skin reactions over the area or tummy upset after radiation to the abdomen. For most people, there is some level of fatigue when having radiation treatment and this may be something to consider.

Complementary therapies are treatments used alongside conventional cancer treatments, such as chemotherapy or radiation therapy, to improve general health and wellbeing.

Check with your doctor if you are unsure about a particular complementary therapy.

Research has shown that some complementary therapies may help people manage the various emotional and physical effects of cancer and its treatment. Examples include:

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

Cancer treatment centres and palliative care services may offer free therapies (e.g. art therapy, massage, meditation). Some community centres offer group therapies, such as tai chi or yoga, for free or for a small charge.

Often you will see a private practitioner and pay for most complementary therapies. If you have private health insurance, check if it provides a rebate for visits to a private practitioner.

Alternative therapies are commonly defined as treatments used instead of conventional medicine. Many alternative therapies have not been scientifically tested, so there is no proof they stop cancer growing or spreading.

Others have been tested and shown not to work. When cancer has spread and treatment options are limited, some people consider alternative therapies. Friends and family may also suggest that you try alternative treatments.

While side effects of alternative therapies are not always known, some 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 alternative therapies may be expensive, and they could affect management of your symptoms. Be suspicious if any treatment:

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

Cancer Council does not recommend the use of alternative therapies as a treatment for cancer.

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