Medical treatment is a key part of palliative care. It aims to manage the symptoms of cancer without trying to cure the disease. The treatment you are offered will depend on:
- your individual needs
- what type of cancer you have
- how far it has spread
- your symptoms
- the support you have.
Prognosis means the expected outcome of a disease. Some people with advanced cancer want to know whether and when they are likely to die, while others don’t. It’s a very personal decision.
Your doctor can give a general indication of your life expectancy, based on an average patient. As everyone responds to treatment differently, the actual time could be shorter or longer.
Sometimes, families and carers want to know the prognosis even when you don’t. You can ask the palliative care team to talk to your family or carer when you’re not there. Dealing with death is difficult and confronting for most people and their families. Talking about any emotions you are experiencing may help you come to terms with your situation.
Types of palliative cancer treatment
Surgery can be used to:
- remove all or part of a tumour from affected areas, such as the bowel or lymph nodes
- relieve discomfort caused by tumours blocking organs or pressing on nerves
- reduce tumour size (debulking) to help improve outcomes from chemotherapy and radiation therapy
- insert a thin tube (stent) into a blocked organ to create a passage for substances to pass through.
Drugs can travel throughout the body. This is called systemic treatment. Drug therapies include chemotherapy, hormone therapy, immunotherapy and targeted therapy. Some drug therapies:
- can shrink a cancer that is causing pain because of its size or location
- slow the growth of the cancer
- help control symptoms, including pain and loss of appetite
- reduce inflammation and relieve symptoms such as bone pain.
Radiation therapy can shrink tumours or stop them spreading further. It can also relieve some symptoms, such as pain from secondary cancers in the bones. You can have radiation therapy in different ways and doses. It can be given in single or multiple visits.
Making treatment decisions
You have the right to say no to any treatment recommended, but your medical team need to be confident that you understand what you’ve been offered and how not having the treatment may affect your prognosis. You do not have to accept treatments on an all-or-nothing basis – you can refuse some and accept others.
Treatments 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. You may want to discuss your decision with the treatment team, GP, family and friends.
Contact a cancer nurse
One of the main aims of having palliative treatment is the relief of symptoms. These symptoms can impact your quality of life and be distressing for your family. While it may not be possible to alleviate all symptoms, there are ways you can manage symptoms and feel more comfortable.
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 where the cancer is and its size. Pain is different for everyone, 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 the distress it is causing as much as possible. Many people need a combination of treatments, such as pain medicines and complementary therapies, to achieve good pain control.
Some people worry about becoming addicted to pain medicine but this is unlikely when medicines are taken palliatively. Your health care team will monitor you to avoid and manage potential side effects.
Taking high-strength opioids (such as morphine) as prescribed 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 the dose you have been prescribed does not relieve your pain.
Problems with eating and drinking
Many people with advanced cancer do not feel like eating or drinking. This may be because of the cancer or a side effect of treatment. Loss of appetite may also be caused by anxiety, fatigue or depression. However, food and drinks help maintain your strength and bowel movements, which improves your quality of life.
Loss of appetite – you don’t need to force yourself to eat. This may make you feel uncomfortable, and cause vomiting and stomach pain. Try having small meals, eating your favourite foods more frequently, and relaxing your usual dietary restrictions. It is common to feel less hungry as the disease progresses – talk to your palliative care team if you are concerned.
Nausea – you may feel sick (nausea), have reflux 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 – let your palliative care team know if the dose needs to be adjusted or another medicine can be tried. Constipation can also cause nausea and appetite issues. Having an empty stomach can make your nausea worse – try to eat something soon after getting up in the morning and then eat small meals and snacks regularly throughout the day. Try to drink water or other fluids, and consider eating foods with ginger, which can ease nausea.
Difficulty swallowing – if chewing and swallowing become difficult, you may need to change the consistency of your food by chopping, mincing or pureeing. A speech pathologist can check how you’re swallowing.
Many people have difficulty passing bowel motions (constipation), often as a side effect of opioids, cancer treatments or other medicines, or because of changes to what they’re eating or how much they’re moving.
The usual suggestions for managing constipation, such as drinking lots of water, eating a high-fibre diet and exercising, may not be possible if you feel unwell. Your treatment team will discuss other ways of managing constipation, such as laxatives and stool softeners.
Shortness of breath
Breathlessness (dyspnoea) is an uncomfortable feeling of being short of breath. It may be caused by the cancer itself, an infection, a side effect of treatment, anxiety or an underlying disorder such as asthma or emphysema.
Depending on the cause, breathlessness may be managed with taking medicine (such as low-dose morphine), draining fluid from around the lungs, or having oxygen therapy (if your oxygen levels are low). Simple ways to improve breathlessness are to:
Fatigue is a feeling of extreme tiredness or weakness. It is different from normal tiredness, as it doesn’t always go away with rest or sleep. Fatigue can be caused by the cancer itself, cancer treatment, depression or anxiety, poor sleep, an infection, anaemia, weight loss or medicines.
Your palliative care team may be able to adjust your medicines or treat the cause of the fatigue. A physiotherapist, exercise physiologist or occupational therapist can explain how to modify your activities to help you conserve your energy.
You may find that the fatigue gets worse as the disease progresses – complementary therapies such as meditation and relaxation can reduce distress and help you and your family cope.
Changes in mood
When you are referred to palliative care or while you are having palliative care, you will probably experience a range of emotions. Many people feel shocked, fearful, sad, anxious, guilty or angry. Others feel relief or a sense of inner peace.
It is quite common for people diagnosed with advanced cancer to have continued feelings of depression. Signs of depression include trouble thinking clearly, losing interest in things you used to enjoy, or changes to sleep patterns and appetite. If you think you may be depressed, it is important to talk to your doctor, because counselling or medicines – even for a short time – can help. Visit Beyond Blue and Lifeline for more information.
You may find that while some friends and family members are supportive, others may avoid you or not know what to say. This can be difficult, and you could feel isolated or upset. Advanced cancer can mean changes to your lifestyle – at some point, you may need to leave work, stop driving or give up other activities that are important to you. These changes can cause further sadness or stress. It will probably help to talk to someone. Your partner, family and close friends can offer support, or you might prefer to talk to:
Sexuality and palliative care
People with advanced cancer usually experience major physical and psychological changes. While these can have an effect on how you feel sexually, it doesn’t mean that intimacy needs to end.
For many people, 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.
Complementary and alternative therapies
You may wonder whether you should try complementary and alternative therapies. It is important to understand how they are different.
Complementary therapies are designed to be used alongside conventional medical treatments. Therapies such as meditation, massage and acupuncture can increase your sense of control, decrease stress and anxiety, and improve your mood. Let your doctors know about any 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. These are unlikely to be scientifically tested and may prevent successful treatment of the cancer. Cancer Council does not recommend the use of alternative therapies as a cancer treatment.
Joining a clinical trial
Your doctor or nurse may suggest that 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. Over the years, clinical trials have improved palliative care and the management of common symptoms of advanced cancer, and led to better outcomes.
You may find it helpful to talk to your specialist, clinical trials nurse or GP, or to get a second opinion. If you decide to take part in a clinical trial, you can withdraw at any time.
Advanced care planning
When diagnosed with a life-limiting illness, some people think about what is important to them. Palliative care teams are experienced with helping patients and their families talk about their goals and preferences for care, and the amount of treatment they want for the cancer. This process is called advance care planning. It can involve:
- completing advance care documents
- appointing a substitute decision-maker.
While it may be difficult to think about, some people find planning ahead helps them. Advance care planning can be started at any stage, whether you feel well or ill. It allows you to share your preferences for your future health care if you become unable to make decisions for yourself.
Making your wishes clear can help give you peace of mind. Think about what matters to you most. Would you choose to have less time if it means feeling relatively well, or would you want as much time as possible, even if treatment would lead to unpleasant side effects? Where would you like to be cared for? Everyone has their own individual preferences, and these will often change as your circumstances change. You and your family may find it useful to start thinking about these issues before they are raised by a health professional.
Advance care planning doesn’t mean you have given up or will die soon. Your needs might change over time and it is a good idea to regularly review your plan. Palliative Care Australia has developed a discussion starter that can help you reflect on your preferences for care and talk about them with your family, carers and close friends.
Making an advance care directive
You can write down your goals and instructions for your future medical care in a document known as an advance care directive. Depending on where you live, the advance care directive may have a different name such as an advance health directive or advanced care plan. It provides a record of your values and treatment preferences.
Doctors, family, carers and substitute decision-makers can consider this record if you become unable to communicate or make decisions. You can update or cancel your advance care directive at any time. Ask your doctor or hospital to place your directive on your medical record. You can also save it online.
Each state and territory has different laws about advance care planning. Visit Advance Care Planning Australia for more information and to create your plan.
Appointing a substitute decision-maker
The ability to make a legally binding decision is called capacity. You can legally appoint someone to make medical decisions for you if in the future you lose capacity to make these decisions yourself. A substitute decision-maker should be someone you trust. They should understand your values and preferences for future care and be able to make decisions you would have wanted.
Depending on where you live, the documents for appointing this person may be known as an enduring power of attorney, enduring power of guardianship or appointment of medical treatment decision maker.
Understanding Palliative Care
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Expert content reviewers:
Dr Cynthia Parr, Specialist in Palliative Care, HammondCare and Macquarie University Hospital, NSW; Dr Lisa Cuddeford, Clinical Lead, WA Paediatric Palliative Care Service, WA; Dr Laura Kirsten, Principal Clinical Psychologist, Nepean Cancer Care Centre, NSW; Penny Neller, Project Coordinator, National Palliative Care Projects, Australian Centre for Health Law Research, Queensland University of Technology, QLD; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA; A/Prof Peter Poon, Director, Supportive and Palliative Care, Monash Health, and Adjunct Associate Professor, Monash University, VIC; Dr Kathy Pope, Radiation Oncologist, Peter MacCallum Cancer Centre, VIC; Kate Reed-Cox, Nurse Practitioner National Clinical Advisor, Palliative Care Australia; Juliane Samara, Nurse Practitioner, Clare Holland House – Specialist Palliative Aged Care, Calvary Public Hospital, ACT; Annabelle Solomon, Consumer; Silvia Stickel, Consumer; Kaitlyn Thorne, Manager, PalAssist, Cancer Council Queensland; Kim Vu, Consumer; Rosie Whitford, Social Worker – Grief, Bereavement and Community Palliative Care, Prince of Wales Hospital, NSW.
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The information on this webpage has been adapted from Understanding Palliative Care - A guide for people with cancer, their families and friends (2021 edition). This webpage was last updated in November 2021.