Living with Advanced Cancer
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Living with Advanced Cancer
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 for a while. In some cases, this may be for months or years. If treatment is no longer controlling the cancer, the aim of treatment may be to help relieve the physical and emotional symptoms of cancer.
New treatments 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 what else you can try. Also, ask if you are eligible to join any clinical trials.
Treatment choices for advanced cancer will depend on where the cancer started and how much it has spread. Usually cancer that has spread needs systemic treatment. This means treatment is taken by mouth (orally) or injected into the bloodstream to reach cancer cells throughout the body. Examples include chemotherapy, targeted therapy, immunotherapy and hormone therapy. Treatment that affects only a certain part of the body may also be used to control the cancer or to relieve symptoms. Examples include surgery and radiation therapy.
Often these treatments will be discussed with a range of health professionals at what is known as a multidisciplinary team (MDT) meeting. You are likely to see a number of health professionals who specialise in different aspects of your care.
Health professionals you may see
general practitioner (GP) – assists you with treatment decisions and works in partnership with your other specialists in providing ongoing care
medical oncologist – treats cancer with drug therapies such as chemotherapy, targeted therapy, immunotherapy and hormone therapy (systemic treatment)
radiation oncologist – treats cancer by prescribing and overseeing a course of radiation therapy
radiation therapist – plans and delivers radiation therapy
surgeon – surgically removes tumours and performs some biopsies; specialist cancer surgeons are called surgical oncologists
haematologist – diagnoses and treats diseases of the bone marrow, blood and lymphatic system; prescribes chemotherapy and other drug therapies
nurse – administers drugs and provides care, information and support throughout treatment; may be a community nurse, specialist palliative care nurse or a palliative care nurse practitioner
community nurse – visits you at home to supervise medical care, assesses your needs for supportive care, and liaises with your GP and MDT as required
Aboriginal and Torres Strait Islander health practitioners – provide cultural and other support for Aboriginal and Torres Strait Islander peoples with cancer and their families
pharmacist – dispenses medicines and gives advice about dosage and side effects
cancer care coordinator – coordinates your care, liaises with other members of the MDT and supports you and your family throughout treatment; care may also be coordinated by a clinical nurse consultant (CNC) or clinical nurse specialist (CNS)
palliative care specialists and nurses – work closely with your GP and cancer team to help control symptoms and maintain quality of life
dietitian – helps with nutrition concerns and recommends changes to diet during treatment and recovery
physiotherapist and exercise physiologist – help restore movement and mobility, and improve fitness and wellbeing
occupational therapist – assists in adapting your living and working environment to help you resume usual activities during and after treatment
social worker – links you to support services and helps you with emotional, practical and financial issues
speech pathologist – helps with communication and swallowing during and after treatment
counsellor, psychiatrist, psychologist – helps you manage your emotional response to diagnosis and treatment
spiritual care practitioner (pastoral carer or chaplain) – discusses any spiritual matters and helps you reflect on your life and search for meaning, if appropriate; may arrange prayer services and other religious rituals
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 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 already been through menopause, hormone drugs called aromatase inhibitors may be used.
Targeted therapy is a promising drug treatment that attacks specific features of cancer cells, known as molecular targets, to stop the cancer growing and spreading. The development of targeted therapy drugs has led to improved survival rates for several types of cancer, and some people have seen encouraging outcomes during targeted therapy treatment. These drugs are becoming an increasingly 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, lung, ovarian, stomach and thyroid, as well as melanoma and some forms of leukaemia, lymphoma and myeloma. Targeted therapy drugs have been effective in treating some people with these cancers, but they 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. However, new immunotherapy drugs are being developed all the time – 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. Unlike chemotherapy, side effects of immunotherapy need to be reported to your doctor as they may become serious.
Surgery may 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.
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.
Having palliative care
Many people fear hearing the words palliative care because they think it is just for people who are dying, but it’s not. Palliative care is useful at all stages of advanced cancer, and involves a range of services that can help with lots of things like pain management or getting around more easily.
What is palliative care?
Palliative care is person-centred care that helps people with a progressive life-limiting illness to live as fully and as comfortably as possible. Palliative care can link you with support. For example, you may need help to move around your home more safely. The main goal is to maintain your quality of life by identifying and meeting your physical, emotional, cultural, social and spiritual needs. Palliative care also provides support to families and carers.
Who is in a palliative care team?
Your palliative care may be led by your GP or community nurse, or by the specialist palliative care team in your area. The team may include doctors, nurses, social workers, physiotherapists, occupational therapists, and spiritual care practitioners. They may also link you to a counsellor, psychologist or other health professionals.
Where is palliative care usually given?
The palliative care team will help you work out the best place for your care. This may be at home supported by community palliative care services, in hospital, at a residential aged care facility or in a palliative care unit (hospice). Many services – including things like pain relief – are now available to you at home.
How can palliative care help?
Palliative care involves a range of services that will be tailored to your individual needs. There are various ways it can help, including:
- relief of pain, breathlessness, nausea and other symptoms
- help organising equipment for home (e.g. wheelchairs, special beds)
- links to other services such as home help and financial support
- counselling, grief and bereavement support
- referrals to respite care services
- volunteer services trained in palliative care.
When can I start?
Depending on your needs, you may use palliative care services occasionally or continuously, for a few weeks or months. The number of people receiving palliative care for several years is increasing. Contacting the palliative care team early means that you can find out what the different team members do and see which services might be useful now or in the future. This will vary according to how you feel, what problems you have, and how your carers are managing.
Where to find out more
For information about palliative care and how it may be able to help you, visit Palliative Care Australia. To find a palliative care service in your local area, search the online directory – or you could speak to your doctor or nurse.
Complementary and alternative therapies
It’s common to wonder whether there are any other therapies you could try. You may want help managing the symptoms and side effects of conventional cancer treatment, such as fatigue, nausea or pain. Some people use therapies to help feel some control over their treatment.
What are complementary therapies?
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 can 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. The Australian Competition and Consumer Commission tracks health and medical scams to help the public detect and avoid scams. To find out more, visit Scamwatch.
Let your doctor and pharmacist know if you plan to use any complementary or alternative therapies to make sure they do not result in harmful side effects or interfere with other medicines you are taking.
Sometimes cancer can limit your activities. Rehabilitation, or rehab, is a way of improving your quality of life between or after treatments. It helps restore your movement and other functions through physiotherapy, occupational therapy, speech therapy or artificial body parts (prostheses). It 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, it may be helpful to find another activity that helps you feel involved in life and connected with people.
For many people, rehabilitation is organised through their treatment centre. If you have been treated in a private hospital, ask your doctor about these services. Your GP or palliative care service can also organise rehabilitation for you.
For more information on the availability of rehabilitation services in your area, contact Cancer Council 13 11 20.
This information is reviewed by
This information was last reviewed December 2022 by the following expert content reviewers: Dr Lucy Gately, Medical Oncologist, Alfred Health and Walter and Eliza Institute for Medical Research, VIC; Dr Katherine Allsopp, Supportive and Palliative Care Specialist, Westmead Hospital, NSW; A/Prof Megan Best, The University of Notre Dame Australia and The University of Sydney, NSW; Dr Keiron Bradley, Palliative Care Consultant, Medical Director Palliative Care Program, Bethesda Health Care, WA; Craig Brewer, Consumer; Emeritus Professor Phyllis Butow, Psychologist, The University of Sydney and Chris O’Brien Lifehouse, NSW; Louise Durham, Palliative Care Nurse Practitioner Outpatients, Princess Alexandra Hospital, Metro South Palliative Care, QLD; Dr Roya Merie, Radiation Oncologist, ICON Cancer Centre, Concord, 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; Xanthe Sansome, Program Director, Advance Care Planning Australia, VIC; Sparke Helmore Lawyers; Peter Spolc, Consumer.