Managing side-effects and symptoms of advanced cancer
In this section:
- How can my side-effects and symptoms be treated?
- Nausea and vomiting
- Breathing problems
- Difficulty in sleeping
- High calcium levels in blood
- Bone pain and weakened bones?
- Swollen tummy caused by a build-up of fluid (Ascites)
How can my side-effects and symptoms be treated?
Some symptoms of advanced cancer can be linked to the cancer itself. You may also have side-effects from your treatment. It is very unlikely that you will have all of these symptoms or even most of them. The symptoms you have will depend on how the cancer has affected you. Every individual has a unique response to treatment and every treatment has different side-effects.
Medication or other treatments like radiotherapy and chemotherapy can be very effective at controlling symptoms.
If you have any symptoms that are troubling you, let your doctor or nurse know straight away.
It is really important to tell your doctor if you have any symptoms or side-effects.
Most symptoms and side-effects can be controlled.
Pain is a big fear for many people with advanced cancer. In fact, many people do not have pain. Pain can also be due to other medical conditions that have nothing to do with your cancer. Even if you have pain there are many different types of pain relief that work very well.
Tell your doctor or nurse immediately if you do get pain. Your doctor will try to find out what is causing it.
Be honest about the level of pain you are in. This will help your doctor or nurse to give you the most appropriate medication to help with your pain levels.
- Describe the pain as clearly as you can.
- Is it a dull or sharp?
- Is the pain sudden, always there or does it come over you in waves?
- Is it mild or severe?
- Do you wake up in pain during the night?
- It may help to write down the times you get pain and what makes it better or worse.
It may help to write down the times you get pain and what makes it better or worse.
Pain can be helped by cancer treatments like radiotherapy or one of the many painkillers available. Sometimes different treatments such as nerve blocks, transcutaneous electrical nerve stimulation (TENS), acupuncture, hypnotherapy and relaxation techniques can relieve pain. You may be referred to a specialist in pain relief.
If you are prescribed painkillers and you only have pain from time to time, take the painkillers whenever you need them. But if the pain is there most or all of the time, take your painkillers regularly.
It is better to take medication regularly, rather than waiting for pain to strike. Discuss with your doctor or nurse if the pain is worse at night and wakes you up. You can get extra medication to help with ‘breakthrough pain’, which is when sudden sharp pain happens.
If you are constipated from the painkillers, talk to your doctor or nurse. They may suggest you take a laxative every day. Drink plenty of fluids such as water and fruit juice to keep your bowel habits regular. Your doctor or nurse will give you something stronger if your bowels have not opened for 2 or 3 days.
If you are feeling sick, your doctor may give you anti-sickness tablets. Take them 30 minutes before your painkillers. The nausea often improves as you get used to your medication. Do not drive or work machinery if you feel drowsy.
Nausea and vomiting
With advanced cancer, you might be sick (vomit) or feel sick (nausea) at some point during your illness. This can make everyday life very difficult to cope with. If you are having problems with feeling sick or being sick, do tell your doctor or nurse. There are ways to control sickness, depending on what is causing it.
Nausea can be due to the cancer itself, side-effects of drugs such as painkillers, constipation, or too much calcium in your blood.
There are many anti-sickness drugs available to treat nausea and they work in different ways. If the drug you are taking is not working, let you doctor know and a different treatment can be prescribed. You may need a combination of drugs to help prevent nausea and vomiting
Tips on eating and digestion:
- Eat small amounts of food regularly.
- Avoid fatty foods.
- Avoid foods that make you feel sick.
- Avoid taking a lot of fluid just before you eat.
- Take ginger or peppermint to ease the nausea.
- Take plenty of fluids in small amounts throughout the day.
- Try a complementary therapy, like acupuncture. It may help nausea.
Our booklet Diet and Cancer has some more useful on tips on helping to take a nutritious diet when your appetite is poor.
Shortness of breath can be very uncomfortable and distressing for anyone who has this symptom. Shortness of breath may be caused by a number of things such as:
- Tumour in your lung or in the lining outside it
- Fluid collecting in the lung itself
- Fluid collecting in the abdomen
- A clot in the lung
- Panic or anxiety
There are ways to relieve the problem, depending on what is causing your shortness of breath. If you feel breathless it is important to tell your doctor so they can find out the cause of your breathlessness and help to treat it for you.
For further information see our factsheet on Breathlessness and cancer or call the Cancer Nurseline Freephone 1800 200 700 or drop into a Daffodil Centre.
Fatigue is a common symptom of cancer and usually described as an overwhelming tiredness. Often it is not relieved by rest. You may find it hard to concentrate or to make decisions. The reason for the fatigue can sometimes be hard to identify. It can also be due to anxiety over a cancer diagnosis or the added stress caused by treatment. Whatever the reason, there may be ways to ease it.
For many patients, treatment may help by relieving symptoms such as pain and nausea, allowing you to get back to your normal routine.
You may feel tired because you are not sleeping well. See the section Difficulty sleeping below for more.
Exercise has been proven to be helpful in relieving fatigue. If your illness allows you to do physical exercise, get some on a regular basis. For example, a 30-minute walk 3 days a week might be a realistic goal and will boost your morale when you achieve it.
You can download a helpful booklet called Coping with Fatigue. Visit a Daffodil Centre or call our Cancer Nurseline on 1800 200 700 for a free copy.
Hints and tips on coping with fatigue:
- Build rest periods into your day. If you are going somewhere special, have a rest before you go out
- Stop before you feel overtired
- Eat a well-balanced diet
- Ask others for help
- Do some gentle exercise each day. Ask your doctor or nurse for advice
- Plan your day and only do what is important to you
During your illness, there may be times when you find it difficult to sleep. Often this is because you are anxious or worried about the future. Not being able to fall asleep when you have a lot on your mind may be the hardest part.
If you find it difficult to sleep at night, tell your doctor or nurse. If you are feeling depressed, you may find that you wake early and then cannot get back to sleep. Try talking to your family or close friends about your concerns. If you find this difficult, ask to see a counsellor. He or she will help you to find ways to cope.
Hints and tips - sleep problems:
- Have a regular routine at bedtime
- Go to bed each night at the same time.
- Take a warm milky drink before bed, but not coffee or tea.
- Have a warm bath with a few drops of lavender oil in it or sprinkle a few drops on your pillow.
- Listen to music or the radio if you cannot sleep. Or get up and watch TV or read a book. Wait until you feel tired again and then go back to sleep.
- Play relaxation tapes, or audiotapes with stories, to help you get back to sleep.
High calcium levels in blood
If you have cancer in the bone, more calcium is absorbed into your bloodstream from your bone. A high level of calcium in your blood is called hypercalcaemia. It can cause excessive thirst, vomiting, drowsiness and confusion.
To be treated, you will need to spend a day or two in hospital to get your calcium levels down. This is done by giving you drugs called bisphosphonates to stop further damage to your bone. Drinking plenty of fluids will help too. With treatment, you should feel much better after a few days.
Bone pain and weakened bones
Secondary cancer in the bone can cause bone pain. It can also make your bones weaker and more likely to break (fracture). Medications known as bisphosphonates can help to relieve bone pain as well as help strengthen them and reduce the risk of fractures. For more information on bisphosphonates see our Bone Health factsheet. You can get a free copy by calling our Cancer Nurseline on 1800 200 700 or from a Daffodil Centre.
Radiotherapy is very good for treating bone pain due to advanced cancer. The treatment kills off the cancer cells and can be given as a single dose or divided over a few days. It can take 2‒3 weeks to work.
If a bone is very weak, you may need surgery to strength it. This is done in hospital under a general anaesthetic. Your surgeon will put a pin into the centre of the weakened bone and might fix a metal plate to hold the bone firm as well. You will need to stay in hospital for a week or so to recover after this surgery.
Constipation can be a common problem if you have advanced cancer, especially if you are taking painkillers. Bowel problems can be distressing, especially when they affect your daily life.
If you are suffering from bowel problems, do talk to your doctor as soon as possible. He or she will want to assess you and find the cause before advising you on the best treatment.
Constipation might also be linked to a low-fibre diet, not drinking enough fluids, not eating enough, or being less active. The dietitian at the hospital can help you plan a diet high in fibre with plenty of fluid.
Gentle exercises can help to keep your bowel movements regular, so talk to your doctor or nurse for advice on what exercises you can do. If drug treatments don't work, your cancer care team may need to look for other more serious possible causes of constipation, such as pressure on the spinal cord and bowel blockage (obstruction).
Ascites is a build-up of fluid in the tummy area. This fluid causes the abdomen to become swollen and bloated. This can cause pain and discomfort, which can be very distressing. It can also push on the lungs and make it hard to breathe.
The doctor can remove the fluid with a long, hollow needle. This will relieve the problem but may have to be repeated. If the fluid keeps coming back a catheter (a flexible tube) can be left in place to drain off the excess fluid.