Medical treatment is an important part of palliative care. It aims to manage the physical and emotional symptoms of cancer without trying to cure the disease. Some examples of palliative medical treatment are:
- radiotherapy to reduce pain if cancer has spread to the bones
- chemotherapy or targeted therapy to stop the cancer growing into other organs
- surgery to reduce tumours causing pain or other symptoms
- medicines to control symptoms and relieve discomfort.
You have the right to say no to any treatment offered, but your medical team need to be confident that you understand the nature of the treatment proposed and the possible consequences of not having it. You do not have to accept treatments on an all-or-nothing basis – you can refuse some and accept others. Treatments for advanced cancer can cause significant side effects, and some people choose not to have active treatment for the cancer but to focus on controlling their symptoms to reduce pain and discomfort.
There is no single program of palliative treatment. The treatment you are offered will be tailored to your individual needs and will depend on the type of cancer you have, how far it has spread, your symptoms, and the amount of support you have.
For some people, treatment will cause significant side effects, such as nausea or fatigue. It's important to discuss any side effects with your palliative care team so they can be managed appropriately.
Common treatments for cancer
Surgery can remove tumours from affected areas, such as the bowel or lymph nodes; relieve discomfort caused by tumours that obstruct organs or cause bleeding; and improve outcomes from chemotherapy and radiotherapy by reducing the size of a tumour.
Chemotherapy uses drugs known as cytotoxics to kill or slow the growth of cancer cells. It can shrink cancer that is causing pain because of its size or location; slow the growth of the cancer; and help control symptoms, including pain and loss of appetite.
Also known as radiation therapy, radiotherapy uses radiation, such as x-rays, to kill or injure cancer cells. Radiotherapy can shrink tumours or stop them spreading further. It can also relieve some symptoms, such as pain from secondary cancer in the bones.
Cancer that grows in response to hormones can often be slowed by taking drugs to suppress the body's production of the hormone.
Immunotherapy uses drugs to alter the immune system's response to the cancer. Some types work by permitting the immune system to bypass "checkpoints" set up by the cancer to block it. These drugs are approved to treat only some types of cancer.
Targeted therapy attacks specific particles (molecules) within cells that allow cancers to grow and spread, while minimising harm to healthy cells. Not all cancers respond to targeted therapy and it is sometimes available only on clinical trials.
The relief of symptoms is one of the main aims of the palliative care team. While it may not be possible to completely eliminate all symptoms, there are many things that can be done to help make you as comfortable as possible. It may take time to find the most effective treatment – let your palliative care team know if a treatment is not working as they may be able to offer an alternative.
Whether you have pain will depend on the location of the cancer and its size. Palliative care services are specifically trained in pain management. If you do experience pain, they will help you control it as much as possible.
Some people worry about becoming addicted to pain medicine, but this is unlikely when medicines are taken to relieve pain. Any side effects, such as constipation or drowsiness, can usually be managed. Correctly used doses of opioid medicine, such as morphine, will not shorten life or interfere with your breathing – people often survive for longer when their pain is treated. Talk to a specialist palliative care service if you are having trouble getting the correct dose for your level of pain.
For more information on medical treatment for advanced cancer and managing pain, see Living with Advanced Cancer and Overcoming Cancer Pain or call Cancer Council 13 11 20.
Options for relieving pain
Some of the ways to relieve pain are:
- pain medicines – e.g. non-steroidal anti-inflammatory drugs and
- paracetamol for mild pain; codeine for moderate pain; or opioids such as morphine, oxycodone and fentanyl for strong pain
- other types of medicine for nerve pain, such as antidepressants, anticonvulsants, or local anaesthetics
- anti-anxiety drugs for muscle spasms
- a nerve block or an infusion of drugs into the spine (intrathecal infusion) for pain that is difficult to manage
- complementary therapies, such as massage or acupuncture
- chemotherapy, radiotherapy or surgery.
Nausea and vomiting
You may feel sick or have trouble keeping food down either because of the cancer or as a side effect of a medicine you're taking. Antinausea medicines (sometimes called anti-emetics) can be taken as tablets or, if swallowing is difficult, as wafers that dissolve on the tongue, as injections under the skin or as suppositories, which are inserted into the bottom and absorbed through the lining of the rectum. Finding the right anti-emetic can take time – if you still have nausea or vomiting after using the prescribed medicine, let your palliative care team know so that another type can be tried.
An empty stomach can make your nausea worse – eat small meals and snacks regularly, and eat something soon after getting up in the morning. Avoid fried, greasy, spicy and strong-smelling foods. Try to drink water or other fluids, and consider eating foods with ginger, which can ease nausea.
Loss of appetite
Many people with advanced cancer do not feel like eating. This may be because of the cancer, as a side effect of treatment, or because of anxiety or depression. Food and drinks can help improve your quality of life by maintaining your strength and bodily functions. Don't force yourself to eat – this may make you feel uncomfortable, and cause vomiting and stomach pain. Try having small meals or eating your favourite foods more frequently, and relax any dietary restrictions. It is common for your appetite to lessen as the disease progresses – talk to your palliative care team if you are concerned.
Shortness of breath
People with advanced cancer often experience breathlessness (dyspnoea). This may be because of the cancer itself, an infection, a side effect of treatment or an underlying disorder such as asthma or emphysema. Symptoms of breathlessness include difficulty catching your breath, noisy breathing or very fast, shallow breaths. Depending on the cause, breathlessness may be managed with medicine (such as low-dose morphine or other opioid medicine), surgery or oxygen therapy. You can also try simple practical measures, such as sitting near an open window, having a fan in the room, adjusting your position in bed or doing relaxation exercises.
Palliative Care Australia provides resources on topics such as what questions to ask your palliative care team; facts about medicines used in palliative care; pain and pain management; and advance care planning. You can access these at palliativecare.org.au.
Fatigue can be a major problem for people living with advanced cancer. This can be caused by the cancer itself, depression or anxiety, poor sleep, an infection, anaemia, cancer treatment, weight loss or medicines.
Fatigue can be difficult to treat, which can cause you a lot of distress. Your palliative care team may be able to adjust your medicines or treat the infection or anaemia that is causing the fatigue. Your team can also suggest some practical measures. These could include occupational therapy, some gentle aerobic exercise guided by a physiotherapist, or additional equipment to help you conserve your energy. You may find that the fatigue increases as the disease progresses – counselling may help reduce your distress, and complementary therapies such as meditation and relaxation can also help you cope.
Ways to manage medicines
Many people having palliative treatment take many different medicines throughout the day. There are some ways to help ensure you don't forget to take the correct dose of each medicine:
- Ask your palliative care team for a list of the medicines.
- Use medicine packs made up by the pharmacist to assist with taking the right drug at the right time safely.
- Keep a medicines list to record each medicine, the dose, and when it should be taken. You can download a medicines list as a form or smartphone app at nps.org.au
You may wonder whether there are any other therapies you could try. Complementary therapies, including meditation, yoga, massage or acupuncture, may improve the side effects of treatment, decrease stress and anxiety, and enhance your quality of life. These therapies are used alongside conventional medical treatments.
Alternative therapies are used instead of conventional medical treatments. They are often promoted as cancer cures but they are not scientifically tested or proven to be effective. They can be harmful and very expensive. If you have questions about a particular alternative therapy, call Cancer Council on 13 11 20, talk to your doctor, or visit iheard.com.au.
Let your doctor know about any therapies you plan to use – they may interact badly with your medical treatment. To find out more, see Understanding Complementary Therapies or call Cancer Council on 13 11 20.
Taking part in a clinical trial
Your doctor or nurse may suggest you take part in a clinical trial. Doctors run clinical trials to test new or modified treatments to see if they are better than current methods. Clinical trials may help improve palliative care and the management of common symptoms of advanced cancer. If you decide to take part in a trial, you can withdraw at any time. For more information, see Understanding Clinical Trials and Research, call Cancer Council on 13 11 20 or visit australiancancertrials.gov.au.
Expert content reviewers:
Dr Jan Maree Davis, Area Director, Palliative Care Services, South Eastern Sydney Local Health District Southern Sector, and Conjoint Lecturer, University of New South Wales, NSW; Gabrielle Asprey, Facilitator, Telephone and Internet Support Groups, Cancer Council NSW; Julie Butterfield, Consumer; Dr Kathryn Dwan, Senior Policy Officer, Palliative Care Australia; Philippa Kirkpatrick, National Policy Manager, Palliative Care Australia; Amanda Maple, 13 11 20 Consultant, Cancer Council SA; Eileen McNally, Palliative Care Psychosocial Lead, Canberra Hospital, ACT; Patricia Pannell, Clinical Nurse, Central Adelaide Palliative Care Service, SA.