Living with Advanced Cancer
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Living with Advanced Cancer
Managing symptoms of advanced cancer
People may experience many different symptoms when they have advanced cancer. Common symptoms include:
- loss of appetite
- breathlessness and,
While it may not be possible to control all symptoms, the following suggestions can help make you as comfortable as possible. As the disease progresses, the intensity of symptoms and how often you experience them will vary, and this may affect what you are able to do.
The relief of symptoms is one of the aims of your palliative care team. Contact them to work out what help you need.
Many people with advanced cancer worry they will be in pain, but not everyone will have pain. Those who do have pain may not be in pain all the time – it may come and go. The pain may be caused by the cancer itself or by cancer treatment. For example, the tumour may be blocking an organ or pressing on organs, nerves or bone.
If you do experience pain, it can usually be controlled. Pain management is a specialised field, and palliative care doctors and nurses are specifically trained in pain management.
There are many ways to relieve pain, including:
- pain medicines
- pain-relieving procedures for nerve pain
- complementary therapies such as massage, meditation, relaxation, acupuncture or hypnotherapy
- chemotherapy, radiation therapy or surgery.
Everyone experiences pain differently, so it may take time to find the most effective pain relief or combination of treatments for you. Using tools, such as a pain scale or pain diary, can help you describe your pain and how it is affecting you. This will help your pain specialists work out the best way to control the pain.
How and where the pain is felt and how it affects your life can change. Regular reviews by pain management experts can help keep the pain under control. It’s better to take medicine regularly, rather than waiting for the pain to build up. This is called staying on top of the pain. Controlling the pain may allow you to continue with activities you enjoy for some time and offer a better quality of life.
Medicines that relieve pain are called analgesics (also known as pain relievers, painkillers and pain medicines). Depending on the type of pain and how intense it is, you may be offered:
- mild pain medicines, such as paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs)
- moderate pain medicine, such as codeine
- strong pain medicine, such as the opioids morphine, hydromorphone, oxycodone and fentanyl.
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 potential side effects. Any side effects, such as constipation or drowsiness, can usually be managed.
Other ways to control pain
You may also be given other types of medicine to take with the main pain medicine. These could include antidepressants and anticonvulsants for nerve pain; anti-anxiety drugs for muscle spasms; or local anaesthetics for nerve pain.
If the pain is hard to control, a pain specialist may consider a nerve block. The type of nerve block you are offered will vary depending on the type of cancer you have. Delivering the pain medicine directly into the nerves in the spine via a tube (epidural) usually provides short-term relief. If longer-term pain control is needed, the epidural can be connected to a pump.
Cancer treatments for pain relief
Chemotherapy, radiation therapy and surgery may also be used to control pain.
Chemotherapy – Uses drugs to shrink a tumour that is causing pain because of its size or location. It can also slow the growth of the cancer and help
control symptoms, including pain, loss of appetite and weight loss.
Radiation therapy – Uses radiation, such as x-rays, to shrink a tumour and reduce discomfort. For example, it may relieve headaches by shrinking
cancer that has spread to the brain from another part of the body. Often a single treatment can be used.
Surgery – An operation can remove a single tumour in the soft organs; treat a bowel obstruction that is causing pain; or improve outcomes from chemotherapy and radiation therapy by reducing the size of a tumour.
People with advanced cancer often have problems with feeling sick (nausea) or being sick (vomiting). These can be caused by treatment with chemotherapy or radiation therapy, cancer growth, blockage of the bowel or the location of the cancer. Nausea can usually be managed with medicines.
Many people talk about anticipatory nausea, the response your body learns when you know it is chemotherapy time again. Even if you are no longer having chemotherapy, you may still feel a surge of nausea if you’re going past the place where you were treated.
Blockage in the bowel – Sometimes cancer in the abdominal area can cause the bowel to become blocked. This is called bowel obstruction. Because waste matter (faeces or poo) cannot pass through the bowel easily, symptoms may include feeling sick or vomiting. To relieve these symptoms, you may have a small, hollow tube (stent) put in that helps keep the bowel open. The stent is inserted through the rectum using a flexible tube called an endoscope.
High levels of calcium in the blood – Feeling nauseous may be a symptom of high levels of calcium in your blood (hypercalcaemia). If the cancer spreads to the bones, the cancer cells make the bone break down and release calcium into the blood. This can cause you to feel tired, thirsty and confused. Hypercalcaemia is more common in some types of advanced cancer. Drinking more water can help but you may also be given drugs to lower your calcium levels. These are called bisphosphonates, which are usually given through a drip into a vein.
Ways to manage nausea and vomiting
- Eat small meals or snacks 5–6 times during the day. Going without food for long periods can make nausea worse.
- Choose cold foods or foods at room temperature, such as sandwiches, salads, stewed fruit or jelly.
- Have food or drink with ginger, e.g. ginger ale, ginger tea or ginger biscuits.
- Take anti-nausea medicines as prescribed. Let the doctor know if the medicines don’t seem to be working.
- Avoid fried, greasy or spicy foods or those that have strong smells.
- Use stress-reduction techniques, such as meditation.
People with advanced cancer often notice changes in their appetite. This may be because of the cancer itself, treatment, or other side effects such as tiredness, nausea or vomiting, taste changes, pain, lack of activity, or depression.
A loss of appetite often leads to weight loss and malnutrition. Eating is important to help you maintain your strength, function and quality of life. However, it’s not necessary to force yourself to eat; this may only make you feel uncomfortable and cause vomiting and stomach pain.
Food-type nutritional supplements can increase nutrient intake. These are used as snacks between meals. Many pharmacies and supermarkets sell these specially formulated nutritional supplements. You do not need a prescription from your doctor or dietitian to buy them.
People with advanced cancer may develop a muscle-wasting syndrome known as cachexia. This means the body isn’t using protein, carbohydrates and fats properly. Your doctor or dietitian will discuss ways to control cachexia, which may include nutritional supplements or medicines such as appetite stimulants.
Ways to manage loss of appetite
- Focus on eating foods you enjoy.
- Eat what you feel like, when you feel like it, e.g. have cereal for dinner or a main meal at lunch.
- Use a smaller plate – a big plate full of food may put you off eating.
- Relax dietary restrictions. During treatment, maintaining your weight is more important than avoiding full-fat foods.
- Add flavour to foods with lemon juice, herbs and spices.
- Add ice-cream or cream to fruit or a smoothie to increase kilojoules and nutrients.
- Sip on juice, cordials, soft drinks and sports drinks during the day to keep hydrated.
- Make meals as enjoyable as possible, e.g. play music, light candles or eat with friends.
- Gentle physical activity can stimulate appetite, e.g. take a short walk around the block.
- Soft food and clear liquids may be easier to digest.
Download our booklet ‘Nutrition for People Living with Cancer’
People with advanced cancer often experience shortness of breath (breathlessness). This is also called dyspnoea.
Breathlessness can occur for different reasons, including:
- fluid surrounding the lungs
- the cancer itself
- scarring from radiation therapy
- pressure from a swollen abdomen
- anaemia (low red blood cell levels)
- underlying chronic breathing disorders, such as asthma or emphysema
- heart problems caused by chemotherapy.
Symptoms of breathlessness include difficulty catching your breath, noisy breathing or very fast, shallow breaths. Although breathlessness can make you feel distressed and anxious, there are ways to prevent or reduce its impact on your quality of life.
Treatment will depend on the cause of the breathlessness. You may need fluid around the lungs drained or medicine prescribed to treat an infection or other lung problem. If breathlessness is caused by the lungs not supplying enough oxygen to your blood, your doctor can arrange a portable oxygen cylinder.
Ask your doctor or nurse about medicines, such as a low dose of morphine, to manage feelings of distress.
Ways to manage shortness of breath
- Use a handheld fan or open a window to increase airflow near your face.
- Sit up or lean forward on a table with an arm crossed over a pillow to allow your breathing muscles to relax.
- Wear loose-fitting clothing around your waist and chest.
- Drink plenty of fluids. Being dehydrated can increase breathlessness.
- Place chairs around the house so that you can sit down between activities or when moving from room to room.
- Try to relax or practise different breathing techniques.
- Use a walking frame or lean on the shopping trolley when at the supermarket, as the position or pace can ease your breathing.
- Spread out activities during the day or break them up into smaller tasks.
For many people, extreme or constant tiredness (fatigue) can be a major problem, particularly as the cancer advances. You may find feeling fatigued distressing and frustrating. Some people say the fatigue is worse than any pain or nausea they’ve experienced.
Fatigue can be caused by a range of things, such as:
- anxiety or depression
- poor sleep
- progression of the cancer
- anaemia (low red blood cell levels)
- cancer treatment such as chemotherapy or radiation therapy
- loss of weight and muscle tone
- drugs such as analgesics, antidepressants and sedatives.
Tell the doctor or nurse if you think you are becoming weaker or more fatigued. If anaemia is making the fatigue worse, it can be managed. You may be referred to an occupational therapist who can teach you ways to save your energy
Ways to manage fatigue
- Plan activities for the time of day when you feel less tired, and include rest times.
- Do regular gentle activities, such as walking to the letterbox, doing stretches or getting out of bed for meals.
- Avoid stress where possible – relaxation techniques or meditation can help. Listen to our relaxation and meditation recordings.
- Have several short naps rather than one long rest during the day.
- Limit visitors if you find they are tiring you.
- Limit the amount of alcohol you drink. Alcohol can cause tiredness and energy loss.
- Use Meals on Wheels or other home delivery meal companies that bring prepared food to you, or buy frozen meals from the supermarket.
Getting enough sleep is important for maintaining your energy levels, reducing fatigue and improving mood. Difficulty sleeping may be caused by pain, breathlessness, anxiety or depression. Some medicines, hormonal changes and nausea can also affect sleep. If you already had sleep problems before the cancer spread, these can become worse.
Talk to your doctor about what might be helpful for you. Your medicines may need adjusting or sleep medicines may be an option.
Ways to improve sleep
- Try to do some gentle physical activity every day. This will help you sleep better. Talk to a physiotherapist or exercise physiologist, who can tailor an exercise program, and an occupational therapist, who can suggest equipment to help you move safely.
- Limit or avoid smoking, drinking alcohol and caffeine, and eating spicy food.
- Avoid using technology, such as a television, computer or smartphone, before bed as the blue light tells your body it’s time to wake up.
- Follow a regular routine before bed and set up a calm sleeping environment.
- Keep the room dark, quiet and at a comfortable temperature.
- Use relaxation practices, such as listening to gentle music, a recording of rain sounds or Cancer Council’s relaxation recording, before bed.
- If you can’t sleep, get up and sit on the couch until you feel sleepy again.
Living with Advanced CancerDownload PDF
This information is reviewed by
This information was last reviewed December 2019 by the following 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.