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Treatment for advanced cancer

Treatment for advanced cancer

Deciding whether to have treatment for advanced cancer can be difficult. Some people choose treatment even if it offers only a small benefit for a short period of time. Others decide not to have active treatment for cancer, but to treat symptoms to reduce discomfort and maintain quality of life.

You may want to consider what quality of life means to you. Perhaps you would choose chemotherapy if it meant you could have two good weeks each month. Or you might value being able to spend as much time as possible with family and friends, without the disruption of tests, treatment, or hospital visits.

When treatment seems too much

It can seem worthwhile dealing with treatment side effects for primary cancer. But when a cure is unlikely, you may not want to have treatments that leave you feeling exhausted or sick, even if they may help you to live longer.

  • Before you start or stop treatment, think about the benefits and drawbacks. Decisions rarely have to be made immediately.
  • Ask yourself if you are feeling unwell from the side effects of the treatment, from the advancing disease or from the emotions of the diagnosis. Some or all of these may be able to be treated.
  • Check with your health care team whether treatment can be adjusted.
  • Speak to professionals, such as a counsellor or social worker, who can help you decide what is important to you.

You have the right to consent to, stop or refuse any treatment offered. If you stop or refuse treatment, your medical team must be confident that you understand the treatment proposed and the consequences of not having it. You can stop or refuse each treatment separately – you do not have to accept treatment on an all-or-nothing basis.

In all states and territories, you can complete an advance care directive, which your treating doctors must follow. You can appoint a substitute decision-maker to make treatment decisions if you are no longer able to do so.

Treatment for advanced cancer

The aim of treatment for advanced cancer is to control cancer for as long as possible. This might mean shrinking the size of cancer or slowing its growth for a while. In some cases, this may be months or years.

If treatment is no longer controlling cancer, the aim of treatment is to relieve the physical and emotional symptoms of cancer. New drugs are constantly becoming available, so if your current treatment stops working or you are finding it hard to cope with the side effects, ask your doctor about what else you can try and join a clinical trial.

Treatment choices for advanced cancer will depend on where cancer started and how much it has spread. Usually, cancer that has spread needs systemic treatment, which includes chemotherapy and immunotherapy. This means treatment is taken by mouth or injected into the bloodstream to reach cancer cells throughout the body.

Treatment that affects only a certain part of the body might also be used to relieve some symptoms, such as surgery and radiation therapy. These treatments can also be used palliatively, which means they aim to manage the physical and emotional symptoms of cancer.

A range of health professionals who specialize in different aspects of care will work as a multidisciplinary team (MDT) to treat you. The team may include a surgeon, dietician, pharmacist, occupational therapist, and counselor, among others.

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.

Hormone therapy 

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 number of hormones the tumor receives. This can help slow down the spread of 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.  

Targeted therapy

This is a type of drug treatment that attacks specific features of cancer cells, known as molecular targets, to stop the cancer from 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 cancer.

The Pharmaceutical Benefits Scheme (PBS) subsidizes the cost of some targeted therapy drugs for certain cancers. Therapies not on 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, diarrhea, bleeding and bruising, and blood pressure changes. 

Immunotherapy

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 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).

Surgery

Surgery can be used to:

  • remove tumors from affected areas, such as the bowel or lymph nodes
  • relieve discomfort caused by tumors that stop organs working properly or pressing on nerves
  • improve outcomes from chemotherapy and radiation therapy by reducing tumor size
  • insert a thin, hollow tube (stent) into a blocked organ to create a passage for substances to pass through.

Radiation therapy 

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 tumors 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 cancer.

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

Complementary therapies 

Complementary therapies can be used together with conventional medicine, such as chemotherapy or radiation therapy.  

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. 

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 and hypnotherapy
  • fatigue – meditation, relaxation and exercise
  • pain – hypnotherapy, acupuncture, visualisation and massage
  • stress – meditation, relaxation, counselling, support groups and spiritual practices
  • nausea and vomiting – acupuncture and hypnotherapy.

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