Treatment for advanced cancer

Chemotherapy is the most commonly used treatment when cancer has spread. The drugs kill cancer cells or slow their growth. There are many types of chemotherapy drugs, which 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.

Most chemotherapy drugs are given by injection or drip into a vein (intravenously), but some can also be taken as tablets or capsules (orally). Ask your doctor which combination of drugs is best for you, and how long your treatment will last.

Side effects – Some chemotherapy drugs cause tiredness, bowel changes, nausea and hair loss. Many of these 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.

Download our booklet ‘Understanding Chemotherapy’

Some cancers grow in response to particular hormones. These cancers are known as hormone-dependent cancers. Hormone 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, weight gain and sweating. Hormone therapy can also affect your fertility. It may bring on menopause in women. If you have been through menopause, hormone drugs called aromatase inhibitors may be used and these may cause thinning of the bones (osteoporosis) and vaginal dryness.

This is a type of drug treatment that attacks specific features of cancer cells, known as molecular targets, to stop the cancer growing and spreading. Targeted therapy drugs work in a different way from chemotherapy drugs. Chemotherapy drugs also circulate throughout the body, but they particularly affect cells that divide rapidly.

Targeted therapy drugs are used to control cancer growth. They 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.

The Pharmaceutical Benefits Scheme (PBS) subsidises the cost of some targeted therapy drugs for certain cancers. Therapies 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.

Download our fact sheet ‘Understanding Targeted Therapy’

This is a type of drug treatment that uses the body’s own immune system to fight cancer. Different types of immunotherapy work in different ways. Some of these new drugs work by permitting the immune system to bypass “checkpoints” set up by the cancer that block the immune system.

Checkpoint immunotherapy is currently available in Australia for some types of cancer. It has worked well for some people, but it does not help everyone. Even if immunotherapy is recommended, it is difficult to predict whether it will work. New immunotherapy drugs are being rapidly developed – talk to your doctor about whether any are suitable for you.

Side effects – The side effects of immunotherapy drugs are different from those caused by chemotherapy. 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).

Download our fact sheet ‘Understanding Immunotherapy’

Surgery can be used to:

• remove tumours from affected areas, such as the bowel or lymph nodes
• relieve discomfort caused by tumours that stop organs working properly or 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.

Download our booklet ‘Understanding Surgery’

Also known as radiotherapy, radiation therapy uses a controlled dose of radiation, such as x-rays, to kill cancer cells or injure them so they cannot grow, multiply or spread. Radiation therapy can be precisely targeted at cancer sites in your body. Treatment is carefully planned to have the greatest effect on the cancer cells and to limit damage to the surrounding healthy body tissues.

Radiation therapy can shrink tumours or stop them from spreading further. It can also relieve some symptoms, such as pain from secondary cancer in the bones. Different types of external beam radiation therapy or internal radiation therapy (brachytherapy) are used depending on the location of the cancer.

Side effects – Common side effects from radiation therapy include fatigue, skin problems and loss of appetite. These may be temporary or longer lasting.

Download our booklet ‘Understanding Radiation Therapy’

Palliative care is person-centred care that helps people with a progressive life-limiting illness to live as fully and comfortable as possible. The main goal is to help you maintain your quality of life by identifying and meeting your physical, emotional, cultural, social and spiritual needs. It also provides support to families and carers.

Many people are reluctant to use palliative care because they think it is just for people who are dying, but it is useful at all stages of advanced cancer. Starting palliative care from the time of diagnosis can help improve quality of life.

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.

Palliative care involves a range of services that will be tailored to your individual needs. Services may include:

• 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.

Your palliative care may be led by your GP or community nurse, or by the specialist palliative care team in your area. 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).

For more information about what palliative care is and how it helps, visit Palliative Care Australia.

How palliative treatment can help

Medical treatment is a key part of palliative care. Some examples of palliative medical treatment include:

• 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
• use of a feeding tube to help you get enough nutrition
• medicines to control symptoms and relieve discomfort.

Download our booklet ‘Understanding Palliative Care’

Sometimes cancer can limit your activities. Rehabilitation is a way of improving your quality of life between or after treatments. It may help restore physical functioning 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, you may need something to do that helps you feel involved in life and connected with people. For most people, rehabilitation is organised through their treatment centre. If you have been treated in a private hospital, ask your doctor about the availability of 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.

You may wonder whether there are any complementary therapies you could try. There are many reasons people with advanced cancer consider using complementary therapies. You may want help managing the symptoms and side effects of conventional cancer treatment, such as fatigue, nausea or pain. Some people use complementary therapies to help them feel better and to feel they’ve got some control over their treatment.

Complementary therapies

Complementary therapies can be used together with conventional medicine, such as chemotherapy or radiation 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
• stress – meditation, relaxation, counselling, support groups, spiritual practices
• nausea and vomiting – acupuncture, hypnotherapy.

While some cancer treatment centres and palliative care services offer complementary therapies (e.g. art therapy, massage, meditation), you may have to see a private practitioner. You’ll have to pay for most complementary therapies. If you have private health insurance, check if your health fund provides a rebate for visits to a private practitioner. Some community centres offer group therapies, such as tai chi or yoga, for free or for a small charge.

Alternative therapies

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 be effective.

When cancer has spread and treatment options are limited, some people consider alternative therapies. Friends and family may also tell you about 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 also be expensive and could affect management of your symptoms.

Be suspicious if any treatment:

• claims to cure all cancers
• requires you to travel overseas
• claims the medical/pharmaceutical industry wants to stop its use
• claims to have 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 spot and avoid scams. To find out more, visit Scamwatch.

Let your doctor 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.

Download our booklet ‘Understanding Complementary Therapies’