People experience many different symptoms when they have advanced cancer. Common symptoms include pain, nausea, a lack of appetite, breathlessness and tiredness. As the disease progresses, these symptoms can vary in intensity and frequency, placing different limitations on your body.
Many people with advanced cancer worry they will be in pain. Not everyone will experience pain as the cancer progresses, and those who do may find their pain comes and goes. Pain depends on the location of the cancer and its size. If you do experience pain, it can usually be controlled. Pain management is recognised as a specialised field for doctors and nurses. Palliative care services specialise in pain management.
There are many ways to relieve pain, including:
- pain medications such as paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), codeine and opioids
- a pain-relieving nerve block procedure
- relaxation techniques such as massage, meditation, yoga or hypnotherapy
- treating the cause of the pain with chemotherapy, radiotherapy or surgery.
There may be times when you need immediate advice about your symptoms. Find out which doctor or nurse you can contact at any hour of the day or night for urgent advice.
You may need to use more than one of these pain-relieving methods. And it may take time to find the right pain-control measure for you. If something doesn’t work, there may be other things you can try – ask your doctor to discuss these options.
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 medication regularly, rather than waiting for the pain to build up.
Pain relieving medication
Medications that relieve pain are called analgesics. They may be mild, like aspirin, paracetamol or non-steroidal anti-inflammatory drugs (NSAIDS) or relatively strong, like opioids.
Pain medications may be taken as tablets, other oral mixtures, suppositories, patches and injections, or self-regulating pumps. The pain specialists will assess your needs to work out the right drug, its dose, and how it will be delivered (for example, if you have a tablet or injection). They also help you control any side effects caused by the pain medication, such as constipation.
Make sure you understand how much medication you should take and how often (the dosage). A diary/instruction sheet can often help, and examples can be found in the Overcoming Cancer Pain booklet. Call Cancer Council 13 11 20 for a free copy.
Morphine is one of the most common opioid drugs used to control moderate to severe cancer pain. It is very effective and comes in quick-acting and long-acting forms. It can be taken for a long time, in increasing doses if needed. It doesn’t have to be only for when the pain is really bad.
Many people are concerned about taking opioids. However, addiction is not a major concern when morphine is taken to relieve pain. Morphine is most effective when taken regularly. It is better to treat the pain early than wait to treat the pain when it builds up. People usually experience side effects when they take morphine, most of which settle down after a few days.
Managing morphine side effects
- Drowsiness – This decreases after a couple of days so you can carry on normal activities and be pain free.
- Nausea – If you have difficulty tolerating morphine because of the nausea it causes, you may have to change medication.
- Constipation – This can be prevented by taking laxatives regularly.
Chemotherapy, radiotherapy and surgery
Even though they may not be able to cure the cancer, chemotherapy, radiotherapy and surgery are used to reduce pain from advanced cancer.
- Chemotherapy – can shrink cancer 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.
- Radiotherapy – can relieve some types of pain, for example headaches caused by increased pressure in the brain due to cancer that has spread from another part of the body (brain metastases).
- Surgery – can remove an single tumour in the soft organs; treat a serious condition like a bowel obstruction that is causing pain; or improve outcomes from chemotherapy and radiotherapy by reducing the size of a tumour.
You may have a nerve block if cancer is affecting the nerves and causing pain. A block is when the nerves are directly targeted with pain-relieving medication.
A pain specialist or an anaesthetist usually performs the nerve block procedure. The affected nerve is injected with a drug, such as a local anaesthetic. This makes the nerve unable to send pain signals to the brain. The pain relief is usually temporary; how long it lasts will depend on the type of drugs used. The medication chosen to block the nerve depends on the nerve involved and its role in the body. A nerve block may be used if other pain control methods are unsuccessful. It is usually used in combination with other medications, such as analgesics or antispasmodics.
Feeling sick in the stomach (nausea) is an unpleasant symptom that can be caused by treatment with chemotherapy or radiotherapy or the location of the cancer.
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. You don’t have to put up with nausea. Tell your doctor or nurse so they can identify the cause and give you the right treatment. They may prescribe anti-nausea medication or suggest dietary changes.
Feeling nauseous may also be a symptom of high levels of calcium in the bloodstream (hypercalcaemia). This is more common in certain types of advanced cancer and there are many other symptoms. You may need a drug that lowers calcium levels in the blood.
- Eat small meals or snacks as often as you can.
- Eat cold foods such as sandwiches, salads, stewed fruit or jelly.
- Have food or drink with ginger, e.g. ginger ale, ginger tea or ginger cake.
- Take anti-nausea medication regularly, before both eating and pain medication.
- Avoid strong odours and cooking smells.
- Use stress reduction techniques, such as meditation.
Lack of appetite
People with advanced cancer often experience a lack of appetite. This can result from the illness, treatment, tiredness, an altered sense of taste, pain, lack of activity, depression, nausea or vomiting.
You may go through periods of not wanting to eat. This may last a few days or weeks or it could be ongoing, you may just be unable to eat the way you used to.
- Prepare snacks and meals for times when you don’t feel like cooking.
- Eat with friends and family to help you eat more.
- Use small dishes so food isn’t lost on the plate, such as soup in a cup or dessert in a glass.
- Eat foods you enjoy. Treat yourself to your favourite foods or what you feel like, no matter what time of the day.
- Add ice-cream or fruit to a smoothie to increase calories and nutrients.
- Choose full-fat foods as much as possible.Use lemon juice, salt, herbs and spices to flavour bland food.
- Sip on juice, cordials, soft drinks and sports drinks during the day to keep hydrated.
- Add protein foods to fruit and vegetables, e.g. fruit and yoghurt, dip with roasted vegetables and olive oil.
Some people with advanced cancer experience trouble breathing or breathlessness. You may find the feeling of being breathless quite frightening. Feeling anxious can make breathlessness worse. Let your doctor or nurse know if you feel like this as there may be treatment that helps. Shortness of breath can be caused by:
- fluid surrounding the lungs
- having an infection
- the cancer itself
- scarring from radiotherapy
- pressure from a swollen abdomen
- chronic breathing disorders such as asthma or emphysema.
Treatment will depend on the cause of the breathlessness. You may need your lungs drained or medication prescribed to treat an infection or other lung problem. Opioids can ease the distress of shortness of breath, just as they ease the distress of pain. Side effects may include constipation and drowsiness. If breathlessness is ongoing, you may be offered portable oxygen.
- Sit up to ease your breathing or lean forward and rest on a table; avoid bending down.
- Wear loose clothing around your waist and chest.
- Use a fan or open a window to increase airflow near your face.
- Stay as active as you can to help maintain your strength.
- Try not to do too much at once. Pace activities during the day or break them up into smaller tasks.
- 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.
- Get all your clothes ready and have them in one place before you shower or bathe.
- Try to relax or practise breathing techniques.
For many people, extreme or constant tiredness (fatigue) can be a major problem. It can be very distressing for the person experiencing it and for those around them. Some people say their tiredness is worse than any pain or nausea they experience. Tiredness 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 radiotherapy
- inadequate nutrition causing 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. The cause may be something treatable, like anaemia or a mineral imbalance. You may be referred to an occupational therapist who can show you techniques for conserving your energy.
- Set small, manageable goals.
- When you plan your day, include rest times and plan to do things at the time of day when you feel less tired.
- Try gentle activities, such as walking to the letterbox, doing stretches or getting out of bed for meals.
- Avoid stress where possible – relaxation techniques can help.
- Keep a record of how you feel during the day.
- Have several short naps rather than one long rest period.
- Limit the number of visitors you have if they are tiring you.
- Eat well and drink plenty of fluids. A dietitian can help you change your eating habits.
- Limit the amount of alcohol you drink. Alcohol can cause tiredness and energy loss.