Symptoms that may occur with advanced cancer

Some symptoms are a side effect of treatment while others are caused by the cancer itself.

Tiredness

For many people, extreme and constant tiredness (fatigue) can be a significant problem. It can be very distressing for the person experiencing it and for those around them. Some people say tiredness is worse than pain or nausea.

Tiredness can be caused by a range of things:

  • progression of the cancer
  • treatments
  • poor nutrition causing loss of weight and muscle tone
  • anxiety
  • inadequate sleep
  • drugs, such as analgesics, anti-depressants, and sedatives
  • anaemia
  • infection.

Unfortunately, treating tiredness successfully is not straightforward.

“It was a strange tiredness. It was a feeling of being totally drained of energy: as if someone had pulled out the plug connecting me to my power source.”

Lydia

Good things to do when you experience tiredness are:

  • Talk about the tiredness to your friends, relatives, and supporters: it helps them to understand how you feel.
  • Plan to do things at the time of day when tiredness is least severe. Morning is best for many people.
  • Plan your activities so that you conserve your energy for the things you really want or need to do.
  • Take short naps during the day. Naps allow you to feel better, yet still sleep at night.
  • Take gentle exercise, like walking to the letterbox or sitting out of bed for meals. This preserves muscle tone and a sense of normality.
  • Have high-calorie, high-protein drinks. This may slow weight loss and help maintain muscle strength.

Tell your doctor or nurse if you become weaker or more fatigued. The cause may be something treatable, like anaemia.

Nausea (feeling sick)

There is a range of anti-sickness drugs that work in different ways. Let your doctor know if you feel sick, or if the drug is not working. Most anti-nausea drugs take about 20 to 30 minutes to work.

The following suggestions may be helpful:

  • Eat small meals at frequent intervals.
  • Avoid fatty or fried foods.
  • Rest before and after eating.
  • Don’t lie flat during or after eating.
  • Drink plenty of fluids.
  • See a dietitian or nurse for dietary advice.
  • Try relaxation exercises.
  • Do something enjoyable as a distraction from feeling sick.

Pain

Not everyone with advanced cancer has pain. If you have pain, in most cases it can be controlled. Pain may come and go. It may be worse on some occasions or it may be always there.

People with advanced cancer do not necessarily have more severe pain as the cancer progresses.

Pain depends on the location of the cancer and its size. It may take a little time to find the most effective pain control for you.

Pain management is now recognised as a specialised field for doctors and nurses. Palliative care services specialise in pain management.

There are many ways to manage pain, including:

  • pain-relieving drugs like paracetamol, codeine, and morphine
  • pain-relieving procedures, such as ‘nerve block’ and ‘vertebroplasty’ (see the information about surgery in the section ‘Treatment for advanced cancer’)
  • treating the cause of the pain with chemotherapy, surgery, and radiation treatment, alone or together.

A combination of these methods may achieve the best results. How and where the pain is felt, and how it affects your life, can change. Regular reviews by pain management experts will ensure the best results are achieved.

Pain-relieving drugs

There is a range of pain-relieving drugs (analgesics). Some may be mild, like paracetamol; moderate, like codeine; or strong, like morphine. Pain-relieving drugs may be taken in tablet form (orally), as suppositories, syrups, infusions, patches (like skin patches), and injections.

Other drugs may also be prescribed, such as non-steroidal anti-inflammatory drugs (NSAIDs), and bisphosphonates (see information on bisphosphonates) for bone pain. For nerve pain (neuropathic pain) other treatments include anti-depressants and anti-convulsants, or a nerve block, used singly or in combination. Steroids may be used to relieve pain due to cancer pressing on a nerve, cancer in the brain, or cancer in the liver.

“For me there came a time when the pain killers I was taking were no longer sufficient and I found the decision to start morphine difficult to make. Having made it I have been taking the slow release morphine tablets for 18 months with no appreciable side effects. Without the morphine the pain would now be too debilitating for me to continue doing all the things I do now.” Peter

Morphine

Morphine is one of the best drugs we have to help people with severe pain. People often worry about morphine because of stories they have been told about it. They wonder whether they will become addicted, have their life shortened, or be offered it because they are dying. It comes in quick-acting and long-acting tablets, or as syrup. It also may be administered into the skin via a syringe driver.

  • If morphine is taken in controlled doses to relieve pain it is not addictive.
  • Morphine is a very effective pain reliever. It can be taken for a long time in increasing doses. It doesn’t have to be kept for ‘when the pain gets really bad’.
  • The ‘drowsiness’ effect of morphine decreases after a couple of days and people can continue to carry on normal activities and be pain free.
  • Morphine causes constipation. Regular laxatives can relieve or prevent this.
  • Morphine is most effective when taken regularly, even if the pain is not present. It is better to stay pain free rather than wait to treat the pain when it returns.
  • Occasionally people cannot tolerate morphine. Other drugs can be as effective.
  • Some people are nauseated when first taking morphine. The nausea usually passes, and can be treated.

“I finally came to terms with the concept of being morphine dependent when the oncologist pointed out that nobody thinks that diabetics are drug addicts because they need insulin.” Lucy

For some people morphine is not helpful and in this case there are many other ways of controlling the pain.

Breathlessness

Some people with advanced cancer experience breathlessness. Your breathing rate goes up or you feel you can’t catch your breath.

Treatment will depend on the reason for your breathlessness; for example, you can be short of breath if there is fluid around your lungs (this is called pleural effusion, (see the information on ascites in the section "Sites of secondary cancer"). This may need to be drained, or medication may be prescribed if you have an infection. Or it could be caused by the cancer itself, scarring from radiation treatment, or pressure from a swollen abdomen.

Asthma or emphysema might be present. Whatever the cause, anxiety can increase breathlessness.

Relaxation can help:

  • You may want to practise breathing techniques, alone or with someone else.
  • To slow down your breathing, try breathing with someone else. You might like to practise this when you are not breathless.
  • Sit up to ease your breathing or lean forward resting on a table.
  • Listening to a relaxation tape or CD can be helpful.
  • Have a fan in the room or open a window and get a draught of air moving near your face.
  • Your doctor may prescribe a small dose of morphine which can be taken for the relief of breathlessness. Ring 0800 CANCER (226 237) for a copy of the booklet and CD “Living with Cancer-related Breathlessness”.

It is important to discuss any concerns you have about your breathing with your doctor.

Lack of appetite

Many people who have advanced cancer lose their appetite and lose weight. This can be the most obvious sign that you have advanced cancer.

Tensions may arise because you don’t feel like eating what others have prepared. You may feel guilty because you can’t eat it.

Letting others know how you feel and what foods and snacks appeal may be helpful.

Some ideas that may be useful to improve your appetite are:

  • Eat small meals and snacks frequently.
  • Use a small plate and serve dessert in a wineglass.
  • Eat moist food, such as scrambled eggs.
  • Add ice cream or fruit to a drink to increase calories and nutrients.
  • Drink from a smaller glass.
  • Try food supplements such as Complan, which is available from a supermarket.
  • Lemon juice and salt may give flavour to food when it tastes bland.
  • You may prefer to sip clear liquids and then follow these with biscuits or something light.
  • Avoid fatty foods or heavy, sugary food.
  • Cold foods are easier to tolerate than hot.
  • Eat more of your favourite foods.
  • If you are not eating properly because you have a sore mouth, tell your doctor or nurse.

Speak to a dietitian with a special interest in cancer. For Cancer Society booklets, Eating Well/Kia Pai te Kai and Dealing with Dry Mouth/Te Whaihanga Waha Maroke, call 0800 CANCER (226 237), or call your local Cancer Society, or download them from our website.

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