Managing Symptoms in Advanced Cancer

Palliative care is care that makes patients feel better but does not treat the disease itself. It should begin when the cancer is diagnosed and continue through treatment and beyond.

All patients have a right to comfort and quality of life throughout their care. Research shows that palliative care improves the quality of life of patients and family members. It is especially important if you choose to stop treating your cancer.

Palliative care includes:

• treating or preventing the symptoms and side effects caused by cancer and its treatment
• getting emotional and spiritual support
• addressing the practical concerns of patients and families

Because the effects of cancer differ from person to person, palliative care can address a broad range of physical symptoms. Common ones that can be addressed include:

• pain
• fatigue
• loss of appetite
• nausea and vomiting
• shortness of breath
• insomnia (trouble sleeping)

Telling your team about these symptoms is the first step. When your team knows what you are feeling, they can build a plan to help.

Many of the same methods used to treat cancer, such as medicines and certain treatments, can also reduce pain or other symptoms and help you feel more comfortable. This is called palliative treatment.

For example, doctors may give chemotherapy or radiation therapy to slow the growth of a tumor that is causing pain. Or surgery may be performed to remove a mass that is pressing on certain nerves and causing pain. In advanced cancer, palliative treatment may be given to help you feel better even if it is not meant to cure the cancer.

Some people assume there will always be severe pain with advanced cancer. This does not have to be the case. Pain can be managed throughout the course of the disease.

People whose pain is managed are able to focus on enjoying life. They can sleep better, spend time with friends and family, and focus on the daily activities they enjoy. It is important to be honest and open about your pain, and to tell your doctors if and where you have pain.

Palliative care cares for the whole person, so it goes beyond physical symptoms. It can help with:

• Emotional and coping needs. Specialists can provide resources for feelings such as depression, anxiety, and fear.
• Spiritual concerns. An expert can help you explore your beliefs and values to find a sense of peace or acceptance that fits your situation.
• Caregiver needs. Family and friends have changing needs too, and specialists can help them cope and get support.
• Practical needs. They can help with financial and legal worries, insurance questions, employment concerns, and discussions about goals of care and advance directives.

To receive palliative care, members of your health care team may be able to help. Sometimes, though, a palliative care specialist is the best person to treat certain problems.

Ask your doctor or nurse if there is a specialist you can see. Getting the right help early can make a real difference in how you feel each day, whether or not you are still having treatment aimed at the cancer.

• Call 911 or go to an emergency department if heavy bleeding starts suddenly and does not stop, or breathing gets so hard that the person cannot finish a sentence. Do the same for confusion or drowsiness that comes on over hours, a seizure, or someone you cannot rouse.
• Call 911 or go to an emergency department if new weakness or numbness appears in the legs, walking suddenly becomes unsteady, or bladder or bowel control is lost. When cancer has spread to bone, these can mean pressure on the spinal cord, and treatment within hours protects movement.
• Phone the cancer team at once, at any hour, if a temperature of 100.4°F (38°C) or higher shows up in someone still on chemotherapy. CDC treats that fever as a medical emergency. Make the call the moment you see it. If no one answers, go to an emergency department and say they are on chemotherapy.
• Call your care team the same day if pain breaks through the medicines you already have at home. Do the same for new breathlessness or for vomiting that keeps medicines from staying down.
• Call your care team within a day or two if a symptom on your comfort plan is slowly slipping: appetite fading, fatigue deepening, or sleep getting worse night after night.

These signs draw on NCI's Last Days of Life (PDQ), which notes that sudden heavy bleeding can happen and that pain and breathlessness near the end of life can usually be controlled. The cord-compression signs come from MedlinePlus — Spinal tumor, and the fever advice from CDC — Fever and Cancer Treatment.