Managing symptoms

Whether you have pain will depend on the location of the cancer and its size. Palliative care services are specifically trained in pain management. If you do experience pain, they will help you control it as much as possible.

Some people worry about becoming addicted to pain medicine, but this is unlikely when medicines are taken to relieve pain. Any side effects, such as constipation or drowsiness, can usually be managed. Correctly used doses of opioid medicine, such as morphine, will not shorten life or interfere with your breathing – people often survive for longer when their pain is treated. Talk to a specialist palliative care service if you are having trouble getting the correct dose for your level of pain.

Options for relieving pain

Some of the ways to relieve pain are:

• pain medicines – e.g. non-steroidal anti-inflammatory drugs and paracetamol for mild pain; codeine for moderate pain; or opioids such as morphine, oxycodone and fentanyl for strong pain
• other types of medicine for nerve pain, such as antidepressants, anticonvulsants, or local anaesthetics
• anti-anxiety drugs for muscle spasms
• a nerve block or an infusion of drugs into the spine (intrathecal infusion) for pain that is difficult to manage
• complementary therapies, such as massage or acupuncture
• chemotherapy, radiation therapy or surgery.

You may feel sick or have trouble keeping food down either because of the cancer or as a side effect of a medicine you’re taking. Anti-nausea medicines (sometimes called anti-emetics) can be taken as tablets or, if swallowing is difficult, as wafers that dissolve on the tongue, as injections under the skin or as suppositories, which are inserted into the bottom and absorbed through the lining of the rectum.

Finding the right anti-emetic can take time – if you still have nausea or vomiting after using the prescribed medicine, let your palliative care team know so that another type can be tried.

An empty stomach can make your nausea worse – eat small meals and snacks regularly, and eat something soon after getting up in the morning. Avoid fried, greasy, spicy and strong-smelling foods. Try to drink water or other fluids, and consider eating foods with ginger, which can ease nausea.

Many people with advanced cancer do not feel like eating. This may be because of the cancer, as a side effect of treatment, or because of anxiety or depression. Food and drinks can help improve your quality of life by maintaining your strength and bodily functions.

Don’t force yourself to eat – this may make you feel uncomfortable, and cause vomiting and stomach pain. Try having small meals or eating your favourite foods more frequently, and relax any dietary restrictions. It is common for your appetite to lessen as the disease progresses – talk to your palliative care team if you are concerned.

People with advanced cancer often experience breathlessness (dyspnoea). This may be because of the cancer itself, an infection, a side effect of treatment or an underlying disorder such as asthma or emphysema.

Symptoms of breathlessness include difficulty catching your breath, noisy breathing or very fast, shallow breaths.

Depending on the cause, breathlessness may be managed with medicine (such as low-dose morphine or other opioid medicine), surgery or oxygen therapy. You can also try simple practical measures, such as sitting near an open window, having a fan in the room, adjusting your position in bed or doing relaxation exercises.

Fatigue can be a major problem for people living with advanced cancer. This can be caused by the cancer itself, depression or anxiety, poor sleep, an infection, anaemia, cancer treatment, weight loss or medicines.

Fatigue can be difficult to treat, which can cause you a lot of distress. Your palliative care team may be able to adjust your medicines or treat the infection or anaemia that is causing the fatigue. Your team can also suggest some practical measures. These could include occupational therapy, some gentle aerobic exercise guided by a physiotherapist, or additional equipment to help you conserve your energy.

You may find that the fatigue increases as the disease progresses – counselling may help reduce your distress, and complementary therapies such as meditation and relaxation can also help you cope.

Many people having palliative treatment take many different medicines throughout the day. There are some ways to help ensure you don’t forget to take the correct dose of each medicine:

• Ask your palliative care team for a list of the medicines.
• Use medicine packs made up by the pharmacist to assist with taking the right drug at the right time safely.
• Keep a medicines list to record each medicine, the dose, and when it should be taken. You can download a medicines list as a form or smartphone app at nps.org.au.