What are the treatments for advanced cancer?

The main treatment for advanced cancer (also called secondary, metastatic, or progressive cancer) is chemotherapy. Other treatments include surgery, radiation treatment, hormone treatment, monoclonal antibodies, and bisphosphonates. Quality of life is also aided by palliative care, hospice care, complementary therapies and self-help strategies.

How is treatment chosen?

Treatment options will depend on the type of cancer, where it has spread to, and where it began. Your doctor will discuss treatment with you, taking into consideration your general health and how you feel about treatments.

You may be treated at a cancer centre by an oncology team, which may include specialist palliative care services. Palliative care provides care and support so people with advanced cancer can live as fully and as comfortably as possible.

Chemotherapy

Chemotherapy is the most widely-used treatment when cancer has spread. It is the use of particular drugs to kill cancer cells or slow their growth.

The chemotherapy you may be offered is dependent on the cancer you have and how it is affecting you. The length of treatment is in part determined by how successful it is in helping you feel better.

Chemotherapy may be given as tablets (oral) or through a vein (intravenous). Several drugs may be given at the same time (combination chemotherapy). Discuss with your doctor anything you do not understand about the treatment, its side effects, and benefits.

Side effects from chemotherapy

Chemotherapy drugs damage normal cells as well as cancer cells, leading to side effects which may include:

• feeling sick and vomiting, which can often be prevented with anti-nausea drugs
• hair loss – any hair lost as a result of chemotherapy will grow back within a few months after treatment finishes. It is possible your new hair may be a different texture or colour
• tiredness
• lack of appetite
• diarrhoea or constipation
• most chemotherapy drugs can affect the bone marrow which produces the blood cells
  - if the bone marrow function is damaged this can lead to, eg, lowered resistance or infection
  - bruising or bleeding even from minor cuts (an occasional side effect)
• sore or dry mouth.

You will have regular blood tests throughout chemotherapy treatment to check your blood count. If you have a low white blood cell level you are at risk of infection. If you develop an infection you will be given antibiotics and your next treatment may be delayed to allow your bone marrow to recover.

Blood transfusions can be given if your platelet levels or red blood cells are low, or your doctor may delay the next treatment to allow the marrow to recover.

If you develop a fever (if your temperature is 38 degrees or over) or you feel unwell, whatever it is, even with a normal temperature, do not wait to see what happens – take action quickly. Contact your cancer nurse or doctor and follow the advice given.

Also see Chemotherapy side effects

Surgery

It may seem logical to have an operation to remove your cancer. Often, though, this is not possible. It may be in a position where it cannot be safely removed. In some instances surgery is offered to relieve symptoms, and occasionally to prolong life.

Sometimes it may be possible to remove a small secondary cancer in the lung, liver, or brain. Surgery may be offered to strengthen a weakened bone or stabilise a broken bone.

Some people with secondary bone cancer may be offered a vertebroplasty. Vertebroplasty is a minimally invasive surgical procedure in which bone cement is injected directly into the collapsed vertebrae (the bone in the spinal column). The purpose of this is to stabilise a fracture and reduce pain.

Radiation treatment

Radiation for advanced cancer is usually used to relieve symptoms such as pain from cancer in bones. There are many other instances where radiation treatment may be offered and these will be discussed with you as necessary.

Radiation treatment uses high energy rays to kill or injure cancer cells. These rays can be precisely targeted onto cancer sites in your body. Treatment is carefully planned to do as little harm as possible to your normal body tissues.

Any side effects from radiation are dependent on where it is given and how much is given. Usually, effects are mild when given for advanced cancer.

Hormone therapy

Cancers that grow in response to hormones can often be slowed by taking drugs to suppress the body’s production of the hormone.

For women, certain hormonal drugs cause menopausal symptoms, whatever your age. For men, hormone treatments can produce hot flushes and mood swings.

Monoclonal antibodies

Monoclonal antibodies (called this because they come from a single cell) work by recognising the protein on the surface of the cancer cell and then locking onto it (like a key in a lock).

Monoclonal antibodies destroy the cancer by either:

• triggering the body’s immune system to attack the cancer cell and causing the cell to kill itself, or
• attaching a cancer drug or a radioactive substance to the antibody, which delivers them directly to the cancer cell because they target those specific cells (targeted therapy).

Examples of monoclonal antibodies are trastuzumab (Herceptin) and rituximab (Mabthera).

Bisphosphonates

Bisphosphonates are drugs which are mainly used in the management of cancer which has spread to the bone (secondary bone cancer).

People with cancer in the bone have abnormally high levels of osteoclasts (cells which break down bone). When osteoclasts break down and absorb old bone faster than new bone is formed, fractures (breaks), bone pain, osteoporosis (bone thinning), and hypercalcaemia (high levels of calcium in the blood) can occur.

Bisphosphonates reduce the activity of osteoclasts and help protect and strengthen bone. They can help reduce pain and are used as part of the treatment of hypercalcaemia.

The side effects of bisphosphonates may include headaches, nausea, and flu-like symptoms, which usually subside within 48 hours of the infusion. Jaw problems have been reported as a very rare side effect. It is important to tell your dentist that you are having this treatment.

Palliative care

Palliative care is an approach to caring for people with cancer and their family that focuses on improving their quality of life and not just about care at the end of life. This can be offered in a hospital, rest home, at home, or by hospice.

Palliative care may be used during:

• times when your illness is causing discomfort; for example, bothersome pain, shortness of breath, or nausea and vomiting
• periods when your thoughts and feelings are distressing
• occasions when your illness may be having a big impact elsewhere in your life – maybe with your partner, children, family/whanau, work, or perhaps financial affairs.

In general, palliative care services are free. There may be a charge for hire of some equipment for home care. Palliative care and hospice services are funded by both the government and voluntary donation.

You may also be faced with decisions and choices that are confusing or difficult to make during your illness. The palliative care team may be able to help explain things to you, and help you find answers.

Hospice care

Hospice care (depending on where you are in New Zealand) may be offered as home-based community care, in-patient care, or a combination of both.

Reasons for in-patient hospice care may be to:

• control your symptoms
• give the person looking after you a break
• spend your last days.

Many people go into hospice for a short time and then return to their home.

Complementary therapies

Complementary therapies can increase your sense of control over what is happening to you, decrease stress and anxiety, and improve your mood.

Examples of complentary therapies:

• Some people find that meditation and other relaxation techniques can be calming and sometimes helpful in easing pain.
• Yoga, T’ai Chi, and guided imagery may also relieve you of the stresses.
• Massage, too, can be a great release, but find out from medical staff if there are areas of your body that should not be massaged.
• Hypnotherapy is another technique that can help to relieve anxiety and deal with pain.
• Art therapy can be helpful in allowing you to express strong emotions, which may be difficult to talk about.

Complementary therapies can be part of your treatment plan. For example, palliative care treatment can be arranged to include complementary therapies.
 
Most complementary methods will cost money. You could enquire at your nearest palliative care service or Cancer Society to see what they offer free of charge or for a small fee per session. If you use a private practitioner and have private health insurance, check with your health plan to see if there is a rebate for the service.

Alternative therapy

Alternative therapy is a term used to describe any treatment or therapy that may be offered as an alternative to conventional treatments.

Alternative therapy includes things like:

• homoeopathy
• naturopathy
• Chinese herbs.

Be wary of advertised 'cancer cures'

Alternative therapies are sometimes promoted as cancer ‘cures’. However, they are unproven, as they may not have been scientifically tested or, if tested, they were found to be ineffective.

Be especially wary of websites or literature that advertise unorthodox cancer ‘cures’ or treatments that they say the medical establishment want to suppress.

Other drawbacks of alternative therapies:

• they can be expensive
• they are often unavailable in New Zealand
• they can be physically stressful
• they often require major changes in lifestyle.

Inform your doctor if using other therapies

It is important to let your doctor know if you are taking any complementary or alternative therapies because some treatments may be harmful if they are taken at the same time as conventional treatments.

You may find that seeking out different forms of treatment can give you a sense of control. You may not wish to ‘leave any stone unturned’.

Making decisions about treatment

Some people are happy to have whatever treatment their doctor recommends, but others like to know as much as possible before starting any course of treatment.

It is usually possible to take a bit of time to think about the treatment options, and discuss them with the people closest to you and the doctors and nurses looking after you. Your oncologist (cancer specialist) is the best source of accurate medical information.

Your doctor may suggest there is no further treatment that can be given to control your cancer. This does not mean that ‘nothing more can be done’, but that the aim of treatment is changing.

Rather than trying to shrink the cancer, the aim will now be to ease troublesome or distressing symptoms. This will make sure you are comfortable and will give you the best possible quality of life.

Stopping treatment

Sometimes you will ask yourself if the treatment is worth it.

• Before you stop treatment, give yourself time to think about it.
• Are you feeling bad from the side effects of the treatment, from advancing disease, or from emotional overload? Some or all of these can be treated.
• Talk with others, particularly your doctor and those close to you.
• If you feel uncertain, you can speak to someone less closely involved – a counsellor, social worker, or the Cancer Society information service (details below). These people may be able to help you to weigh up what is best for you.

Do not feel under pressure from your family and friends to accept or refuse treatment. The final decision must be your own.

Related topics

Also see Living with advanced cancer and Advanced cancer sites

Original material provided by the Cancer Society of New Zealand, 2008. Edited by everybody, July 2010.