Managing symptoms

The relief of symptoms is one of the main aims of the palliative care team. While it may not be possible to completely eliminate all symptoms, there are many things that can be done to 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.

This section outlines some symptoms common to people with advanced cancer and offers suggestions on how to cope with them. 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
• Sexuality and palliative care

Listen to our podcasts on Managing Cancer Fatigue, Appetite Loss and Nausea, and Managing Cancer Pain

Pain

Whether you have pain will depend on the location of the cancer and its size. People experience pain in different ways 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 it 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 including 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
• interventions such as nerve blocks or spinal procedures such as 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 or radiation therapy.

Some people worry about becoming addicted to pain medicine, but this is unlikely when it is used to relieve pain. Any side effects, such as constipation or drowsiness, can usually be managed. Correctly used opioid medicine, such as morphine, 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 you are having trouble getting the correct dose for your level of pain, and ask your specialist palliative care team or your GP to regularly review your pain management plan.

For more on this, see Pain and cancer.

Problems with eating and drinking

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

It is important not to 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 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.

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. 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.

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.

For more on this, see Nutrition and cancer.

Bowel changes

Many people having palliative care experience difficulty passing bowel motions (constipation), often as a side effect of opioids, cancer treatments or other medicines, or because of changes to their diet or physical activity levels. The usual suggestions for managing constipation, such as drinking lots of water, eating a high-fibre diet and exercising, are often not useful for people with advanced cancer who feel unwell. Your treatment team will advise the best way to manage this problem, and may prescribe laxatives and stool softeners.

Shortness of breath

People with advanced cancer often experience breathlessness (dyspnoea). This may be because of the cancer itself, an infection, a side effect of treatment, anxiety 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), surgery or oxygen therapy (if your oxygen levels are low). Simple practical measures can also be helpful. These include sitting near an open window, having a fan in the room or using a small handheld fan, adjusting your position in bed, doing breathing exercises, and practising relaxation techniques.

Fatigue

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

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 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 and your family cope.

Sexuality and palliative care

People with advanced cancer usually experience major physical and psychological changes. These can have an enormous impact on how they feel sexually, but do not mean that intimacy needs to end.

We are all sexual beings, and 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.