Deciding whether to have treatment for advanced cancer can be difficult. Some people choose treatment even if it offers a small benefit for a short period of time. Others decide to focus on treating symptoms to reduce discomfort and maintain quality of life.
When treatment seems too much
When a cure is unlikely, you may not want to have treatments that leave you feeling exhausted or sick, even if they may help you to live longer.
- Before you start or stop treatment, think about the benefits and drawbacks. Decisions rarely have to be made immediately.
- Ask yourself if you are feeling unwell from the side effects of the treatment, the advancing disease or the emotions of the diagnosis. Some or all of these may be treated.
- Check with your health care team whether treatment can be adjusted.
- Speak to professionals, such as a counsellor or social worker, who can help you decide what is important to you.
You have the right to consent to, stop or refuse any treatment offered. If you do, your medical team must be confident that you understand the treatment proposed and the consequences of not having it.
In all states and territories, you can complete an advance care directive, which your treating doctors must follow. You can also appoint a substitute decision-maker to make treatment decisions if you are no longer able to do so.
Learn more about planning ahead
Treatment for advanced cancer
The aim of treatment for advanced cancer is to control the cancer for as long as possible. This might mean shrinking the size of the cancer or slowing its growth, sometimes for months or years. If this can no longer happen, treatment focuses on relieving the physical and emotional symptoms of cancer.
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 what else you can try, including joining a clinical trial.
Treatment for advanced cancer depends on where the cancer started and how much it has spread. A range of health professionals who specialise in different aspects of your care will work as a multidisciplinary team (MDT) to treat you. The team may include a surgeon, dietician, pharmacist and occupational therapist, among others.
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 1–4 weeks. Most people have several cycles of treatment. Most chemotherapy drugs are given by injection or drip into a vein (intravenously), but some 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 tiredness, bowel changes, nausea and hair loss. Many of these 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 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, which can help slow down the spread of the cancer.
If you have breast cancer or cancer of the uterus, 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, weight gain and sweating. Hormone therapy can also affect your fertility. It may bring on menopause in women. 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.
This is a type of drug treatment that attacks specific features of cancer cells, known as molecular targets, to stop the cancer growing and spreading.
Targeted therapy drugs work in a different way from chemotherapy drugs. Chemotherapy drugs also circulate throughout the body, but they particularly affect cells that divide rapidly. Targeted therapy drugs are used to control cancer growth. They often cause the signs and symptoms of cancer to reduce or disappear, which can help people 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.
The Pharmaceutical Benefits Scheme (PBS) subsidises the cost of some targeted therapy drugs for certain cancers. Therapies 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.
Different types of immunotherapy work in different ways. Some work by permitting the immune system to bypass 'checkpoints' set up by the cancer that block the immune system. Checkpoint immunotherapy is currently available in Australia for some types of cancer. It has worked well for some people, but it does not help everyone.
Even if immunotherapy is recommended, it is difficult to predict whether it will work. New immunotherapy drugs are being rapidly developed – talk to your doctor about whether any are suitable for you.
Side effects – the side effects of immunotherapy drugs are different from those caused by chemotherapy. 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).
Surgery can be used to:
- remove tumours from affected areas, such as the bowel or lymph nodes
- relieve discomfort caused by tumours that stop organs working properly or 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 uses a controlled dose of radiation, such as x-rays, to kill cancer cells or injure them so they cannot grow, multiply or spread. Radiation therapy can be precisely targeted at cancer sites in your body. Treatment is carefully planned to have the greatest effect and to limit damage to the surrounding healthy body tissues.
Radiation therapy can also relieve some symptoms, such as pain from secondary cancer in the bones. Different types of external beam radiation therapy or internal radiation therapy (brachytherapy) are used depending on the location of the cancer.
Side effects – common side effects from radiation therapy include fatigue, skin problems and loss of appetite. These may be temporary or longer lasting.
How palliative care can help
Advanced cancer usually can’t be cured, but it can often be controlled. Palliative care is person-centred care that helps people with a progressive life-limiting illness to live as fully and comfortable as possible.
Many people are reluctant to use palliative care because they think it is just for people who are dying, but it is useful at all stages of advanced cancer. It also provides support to families and carers.
Depending on your needs, you may use palliative care services occasionally or continuously for a few weeks or months. For example:
- to relieve pain, breathlessness, nausea and other symptoms
- to help organising equipment for home (e.g. wheelchairs, special beds)
- for counselling, financial, grief and bereavement support
- for referrals to respite care services.
Learn more and get support
Sometimes cancer can limit your activities. Rehabilitation is a way of improving your quality of life between or after treatments. It may help restore physical functioning through physiotherapy, occupational therapy, speech therapy or artificial body parts (prostheses) and 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 to do something 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 or palliative care service can also organise rehabilitation for you.
Complementary therapies can be used together with conventional medicine, such as chemotherapy or radiation therapy. There are many reasons people with advanced cancer consider using complementary therapies.
Research has shown that some complementary therapies can help people manage the various emotional and physical effects of cancer and its treatment. For example:
- anxiety – try meditation, relaxation, mindfulness, counselling, support groups, art therapy, music therapy, massage and hypnotherapy
- fatigue – try meditation, relaxation and exercise
- pain – try hypnotherapy, acupuncture, visualisation and massage
- stress – try meditation, relaxation, counselling, support groups and spiritual practices
- nausea and vomiting – try acupuncture and hypnotherapy.
Living with Advanced Cancer
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Expert content reviewers:
Prof Nicholas Glasgow, Head, Calvary Palliative and End of Life Care Research Institute, ACT; Kathryn Bennett, Nurse Practitioner, Eastern Palliative Care Association Inc., VIC; Dr Maria Ftanou, Head, Clinical Psychology, Peter MacCallum Cancer Centre, and Research Fellow, Melbourne School of Population and Global Health, The University of Melbourne, VIC; Erin Ireland, Legal Counsel, Cancer Council NSW; Nikki Johnston, Palliative Care Nurse Practitioner, Clare Holland House, Calvary Public Hospital Bruce, ACT; Judy Margolis, Consumer; Linda Nolte, Program Director, Advance Care Planning Australia; Kate ReedCox, Nurse Practitioner, National Clinical Advisor, Palliative Care Australia; Helena Rodi, Project Manager, Advance Care Planning Australia; Kaitlyn Thorne, Coordinator Cancer Support, 13 11 20, Cancer Council Queensland.
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The information on this webpage was adapted from Living with Advanced Cancer - A guide for people with cancer, their families and friends (2019 edition). This webpage was last updated in September 2021.