Palliative care


Palliative treatment

Medical treatment is a key part of palliative care. It aims to manage the physical and emotional symptoms of cancer without trying to cure the disease. 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. Some examples of palliative medical treatment are:

  • radiation therapy to reduce pain (e.g. if cancer has spread to the bones or a tumour is pressing on nerves or organs)
  • 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.

The information below describes cancer treatments that can be used palliatively. If you are having these treatments, you may experience side effects, such as nausea or fatigue. Let your palliative care team know about any side effects so they can be managed.

Making treatment decisions

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.

See Living with Advanced Cancer.

Types of palliative cancer treatments

Surgery

Surgery can be used to:

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

Drug therapies

Drugs are delivered into the bloodstream so the treatment can travel throughout the body. This is called systemic treatment, and includes:

  • chemotherapy – the use of drugs to kill or slow the growth of cancer cells
  • hormone therapy – drugs that stop the body's natural hormones from helping some cancers to grow
  • immunotherapy – treatment that triggers the body's own immune system to fight cancer
  • targeted therapy – drugs that attack specific molecules within cells that help cancer grow.

Some drug therapies can shrink a 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. Other drug therapies can reduce inflammation and relieve symptoms such as bone pain.

Radiation therapy

The use of a controlled dose of radiation to kill or damage cancer cells so they cannot grow, multiply or spread. Radiation therapy can shrink tumours or stop them spreading further. It can also relieve some symptoms, such as pain from secondary cancer in the bones.

Managing symptoms

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.

This section outlines some symptoms common to people with advanced cancer and offers suggestions on how to cope with them. For more information and support, call Cancer Council 13 11 20.

Pain

Whether you have pain will depend on the location of the cancer and its size. People experience pain in different ways and even people with the same type of cancer can experience different levels of pain. Palliative care services are specifically trained in pain management. If you do have pain, they will help you control it as much as possible.

Many people need a combination of treatments to achieve good pain control. Ways to relieve pain include:

  • pain medicines, such as non-steroidal anti-inflammatory drugs and paracetamol for mild pain, and opioids including 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
  • interventions such as nerve blocks or spinal procedures such as epidurals for pain that is difficult to manage
  • other treatments, such as physiotherapy, complementary therapies (e.g. massage, acupuncture), and psychological interventions (e.g. relaxation, mindfulness, distraction techniques)
  • surgery, drug therapies or radiation therapy.

Some people worry about becoming addicted to pain medicine, but this is unlikely when it is used to relieve pain. Any side effects, such as constipation or drowsiness, can usually be managed. Correctly used opioid medicine, such as morphine, will not shorten life or interfere with your breathing – people may even live longer with better quality of life 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, and ask your specialist palliative care team or your GP to regularly review your pain management plan.

See Overcoming Cancer Pain.

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 medicines and what each one is for.
  • Use medicine packs made up by the pharmacist to help you take the correct dose of each drug at the right time.
  • Keep a medicines list to record each medicine, the dose, and when it should be taken. Order a printed NPS MedicineWise list at nps.org.au/order or download the MedicineWise app from the App Store or Google Play.

Problems with eating and drinking

Many people with advanced cancer do not feel like eating. This may be because of the cancer or a side effect of treatment. It may also be caused by anxiety, fatigue or depression. However, food and drinks can help improve your quality of life by maintaining your strength and bodily functions.

It is important not to 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 to feel less hungry as the disease progresses – talk to your palliative care team if you are concerned. They may suggest you drink nutritional supplements.

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. You will probably be given anti-nausea medicine that you can take regularly to relieve symptoms. Finding the right one can take time – if you still have nausea or vomiting after using the prescribed medicine, let your palliative care team know so the dose can be adjusted or another medicine can be tried. Constipation (see below) can also cause nausea and appetite issues.

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.

See Nutrition and Cancer.

Bowel changes

Many people having palliative care experience difficulty passing bowel motions (constipation), often as a side effect of opioids, cancer treatments or other medicines, or because of changes to their diet or physical activity levels. The usual suggestions for managing constipation, such as drinking lots of water, eating a high-fibre diet and exercising, are often not useful for people with advanced cancer who feel unwell. Your treatment team will advise the best way to manage this problem, and may prescribe laxatives and stool softeners.

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, anxiety 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), surgery or oxygen therapy (if your oxygen levels are low). Simple practical measures can also be helpful. These include sitting near an open window, having a fan in the room or using a small handheld fan, adjusting your position in bed, doing breathing exercises, and practising relaxation techniques.

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 find these at palliativecare.org.au.

Fatigue

Fatigue is different from tiredness, as it doesn't always go away with rest or sleep. It can be caused by the cancer itself, cancer treatment, depression or anxiety, poor sleep, an infection, anaemia, weight loss or medicines. Ongoing fatigue can be distressing.

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 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 and your family cope.

Sexuality and palliative care

People with advanced cancer usually experience major physical and psychological changes. These can have an enormous impact on how they feel sexually, but do not mean that intimacy needs to end.

We are all sexual beings, and intimacy can provide comfort and maintain connection. Even if sexual intercourse is no longer possible or desired, you may enjoy physical closeness through cuddling, stroking or massage.

Talk with your partner about your feelings and concerns about the sexual changes in your relationship, and ways to maintain intimacy. If you have concerns about sexual intimacy, talk to your GP, nurse or psychologist.

See Sexuality, Intimacy and Cancer.

Complementary and alternative therapies

You may wonder whether there are any other therapies you could try. It is important to understand the difference between complementary and alternative therapies.

Complementary therapies are designed to be used alongside conventional medical treatments. Therapies such as meditation, yoga, massage and acupuncture, may improve the side effects of treatment, decrease stress and anxiety, and enhance your quality of life. Let your doctors know about any complementary therapies you are using or thinking about trying, as some may not be safe or evidence-based.

Alternative therapies are therapies used instead of conventional medical treatments. While they may claim to cure cancer, they are not scientifically tested or proven to be effective. These therapies are often expensive and can be very harmful. Cancer Council does not recommend the use of alternative therapies for cancer.

See Understanding Complementary Therapies.

Taking part in a clinical trial

Your doctor or nurse may suggest 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.

See Understanding Clinical Trials and Research or visit australiancancertrials.gov.au.

Expert content reviewers:

Prof Katherine Clark, Clinical Director, Palliative Care, Northern Sydney Local Health District Cancer & Palliative Care Network, and Conjoint Professor, Northern Clinical School, University of Sydney, NSW; Richard Austin, Social Worker, Specialist Palliative Care Service, TAS; Sondra Davoren, Manager, Treatment and Supportive Care, McCabe Centre for Law and Cancer, VIC; A/Prof Brian Le, Director of Palliative Care, Victorian Comprehensive Cancer Centre – The Royal Melbourne Hospital and Peter MacCallum Cancer Centre, VIC; Cathy McDonnell, Clinical Nurse Consultant, Concord Centre for Palliative Care, Concord Hospital, NSW; Natalie Munro, Team Leader, PalAssist, QLD; Penelope Murphy, 13 11 20 Consultant, Cancer Council NSW; Kate Reed, Nurse Practitioner Clinical Advisor, Palliative Care Australia; Merrilyn Sim, Consumer.

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