Managing symptoms

One of the main aims of having palliative treatment is the relief of symptoms. These symptoms can impact your quality of life and be distressing for your family. While it may not be possible to alleviate all symptoms, the suggestions below can help make you as comfortable as possible. It may take time to find the most effective treatment – let your palliative care team know if a treatment is not working, as they may be able to offer an alternative. For more information and support, call Cancer Council 13 11 20.

Learn more about managing:

• Pain
• Ways to manage your medicines
• Problems with eating and drinking
• Bowel changes
• Shortness of breath
• Fatigue
• Changes in mood
• Sexuality and palliative care
• Should I join a clinical trials?

Pain

Whether you have pain will depend on where the cancer is and its size. Pain is different for everyone, and even people with the same type of cancer can experience different levels of pain. Palliative care services are specifically trained in pain management. If you do have pain, they will help you control the distress it is causing as much as possible.

Many people need a combination of treatments to achieve good pain control. Ways to relieve pain include:

• pain medicines, such as non-steroidal anti-inflammatory drugs and paracetamol for mild pain, and opioids (such as morphine, oxycodone, hydromorphone and fentanyl) for strong pain
• other types of medicine for nerve pain, such as antidepressants, anticonvulsants and local anaesthetics
• anti-anxiety drugs for muscle spasms
• procedures such as implanted devices, nerve blocks and epidurals for pain that is difficult to manage
• other treatments, such as physiotherapy, complementary therapies (e.g. massage, acupuncture) and psychological interventions (e.g. relaxation, mindfulness, distraction techniques)
• surgery, drug therapies and radiation therapy

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. Taking high-strength opioids (such as morphine) as prescribed will not shorten life or interfere with your breathing – people may even live longer with better quality of life when their pain is treated.

Talk to a specialist palliative care service if the dose you have been prescribed does not relieve your pain. Ask your specialist palliative care team or your GP to regularly review your pain management plan, especially if you have side effects from the pain medicine.

For more on this, see Pain and cancer.

Problems with eating and drinking

Many people with advanced cancer do not feel like eating or drinking. This may be because of the cancer or a side effect of treatment. Loss of appetite may also be caused by anxiety, fatigue or depression. However, food and drinks help maintain your strength and bowel movements, which improves your quality of life.

Loss of appetite

You don’t need to force yourself to eat. This may make you feel uncomfortable, and cause vomiting and stomach pain. Try having small meals, eating your favourite foods more frequently, and relaxing your usual dietary restrictions. It is common to feel less hungry as the disease progresses – talk to your palliative care team if you are concerned. They may suggest you drink nutritional supplements.

Nausea

You may feel sick (nausea), have reflux or have trouble keeping food down, either because of the cancer or as a side effect of a medicine you’re taking. You will probably be given anti-nausea medicine that you can take regularly to relieve symptoms. Finding the right one can take time – if you still have nausea or vomiting after using the prescribed medicine, let your palliative care team know so the dose can be adjusted or another medicine can be tried. Constipation can also cause nausea and appetite issues.

Having an empty stomach can make your nausea worse – try to eat something soon after getting up in the morning and then eat small meals and snacks regularly throughout the day. 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.

Difficulty swallowing

If chewing and swallowing become difficult, you may need to change the consistency of your food by chopping, mincing or pureeing. A speech pathologist can check how you’re swallowing.

For more on this, see Nutrition and cancer.

Bowel changes

Many people have difficulty passing bowel motions (constipation), often as a side effect of opioids, cancer treatments or other medicines, or because of changes to what they’re eating or how much they’re moving.

The usual suggestions for managing constipation, such as drinking lots of water, eating a high-fibre diet and exercising, may not be possible if you feel unwell. Your treatment team will discuss other ways of managing constipation, such as laxatives and stool softeners.

Shortness of breath

Breathlessness (dyspnoea) is an uncomfortable feeling of being short of breath. It may be caused by the cancer itself, an infection, a side effect of treatment, anxiety or an underlying disorder such as asthma or emphysema.

Depending on the cause, breathlessness may be managed with taking medicine (such as low-dose morphine), draining fluid from around the lungs, or having oxygen therapy (if your oxygen levels are low).

Simple ways to improve breathlessness are to:

• sit near an open window
• use a handheld fan to direct a cool stream of air across your face
• sleep in a more upright position
• listen to a relaxation recording – listen to our Finding Calm During Cancer podcast now.

Fatigue

Fatigue is a feeling of extreme tiredness or weakness. It is different from normal tiredness, as it doesn’t always go away with rest or sleep. Fatigue can be caused by the cancer itself, cancer treatment, depression or anxiety, poor sleep, an infection, anaemia, weight loss or medicines.

Your palliative care team may be able to adjust your medicines or treat the cause of the fatigue. A physiotherapist, exercise physiologist or occupational therapist can explain how to modify your activities to help you conserve your energy.

You may find that the fatigue gets worse as the disease progresses – complementary therapies such as meditation and relaxation can reduce distress and help you and your family cope.

For more on this, see Fatigue and cancer.

Changes in mood

When you are referred to palliative care or while you are having palliative care, you will probably experience a range of emotions. Many people feel shocked, fearful, sad, anxious, guilty or angry. Others feel relief or a sense of inner peace.

It is quite common for people diagnosed with advanced cancer to have continued feelings of depression. Signs of depression include trouble thinking clearly, losing interest in things you used to enjoy, or changes to sleep patterns and appetite. If you think you may be depressed, it is important to talk to your doctor, because counselling or medicines – even for a short time – can help.

For information about coping with depression and anxiety, call Beyond Blue on 1300 22 4636. For 24-hour crisis support, call Lifeline 13 11 14.

You may find that while some friends and family members are supportive, others may avoid you or not know what to say. This can be difficult, and you could feel isolated or upset. Advanced cancer can mean changes to your lifestyle – at some point, you may need to leave work, stop driving or give up other activities that are important to you. These changes can cause further sadness or stress.

It will probably help to talk to someone. Your partner, family and close friends can offer support, or you might prefer to talk to:

• members of your palliative care or treatment team
• a counsellor, social worker or psychologist
• your religious leader or spiritual adviser
• a telephone support group or peer support program
• Cancer Council 13 11 20.

Sexuality and palliative care

People with advanced cancer usually experience major physical and psychological changes. While these can have an effect on how you feel sexually, it doesn’t mean that intimacy needs to end.

For many people, intimacy can provide comfort and maintain connection. Even if sexual intercourse is no longer possible or desired, you may enjoy physical closeness through cuddling, stroking or massage.

Talk with your partner about your feelings and concerns about the sexual changes in your relationship, and ways to maintain intimacy. If you have concerns about sexual intimacy, talk to your GP, nurse or psychologist.

For more on this, see Sexuality, intimacy and cancer.

Podcast: Managing Pain when Cancer is Advanced

Listen to more of our podcast for people affected by advanced cancer