Managing symptoms

Medicines that relieve pain are called analgesics (also known as pain relievers, painkillers and pain medicines). Depending on the type of pain and how intense it is, you may be offered:

• mild pain medicines, such as paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs)
• moderate pain medicine, such as codeine
• strong pain medicine, such as the opioids morphine, hydromorphone, oxycodone and fentanyl.

Some people worry about becoming addicted to pain medicine, but this is unlikely when medicines are taken palliatively. Your health care team will monitor you to avoid potential side effects. Any side effects, such as constipation or drowsiness, can usually be managed. 

You may also be given other types of medicine to take with the main pain medicine. These could include antidepressants and anticonvulsants for nerve pain, anti-anxiety drugs for muscle spasms or local anaesthetics for nerve pain.

If the pain is hard to control, a pain specialist may consider a nerve block. The type of nerve block you are offered will vary depending on the type of cancer you have. Delivering the pain medicine directly into the nerves in the spine via a tube (epidural) usually provides short-term relief. If longer-term pain control is needed, the epidural can be connected to a pump.

Chemotherapy, radiation therapy and surgery may also be used to control pain.

• Chemotherapy – uses drugs to shrink a tumour that is causing pain because of its size or location. It can also slow the growth of the cancer and help control symptoms.
• Radiation therapy – uses radiation to shrink a tumour and reduce discomfort. For example, it may relieve headaches by shrinking cancer that has spread to the brain. Often a single treatment can be used.
• Surgery – an operation can remove a single tumour in the soft organs, treat a bowel obstruction that is causing pain or improve outcomes from chemotherapy and radiation therapy by reducing the size of a tumour.

Sometimes cancer in the abdominal area can cause the bowel to become blocked. This is called bowel obstruction.

Because waste matter (faeces or poo) cannot pass through the bowel easily, symptoms may include feeling sick or vomiting. To relieve these symptoms, you may have a small, hollow tube (stent) put in that helps keep the bowel open. The stent is inserted through the rectum using a flexible tube called an endoscope. 

Feeling nauseous may be a symptom of high levels of calcium in your blood (hypercalcaemia). If the cancer spreads to the bones, the cancer cells make the bone break down and release calcium into the blood. This can cause you to feel tired, thirsty and confused.

Hypercalcaemia is more common in some types of advanced cancer. Drinking more water can help but you may also be given drugs to lower your calcium levels. These are called bisphosphonates, which are usually given through a drip into a vein.

• Eat small meals or snacks 5–6 times during the day. Going without food for long periods can make nausea worse.
• Choose cold foods or foods at room temperature, such as sandwiches, salads, stewed fruit or jelly.
• Have food or drink with ginger, e.g. ginger ale, ginger tea or ginger biscuits.
• Take anti-nausea medicines as prescribed. Let the doctor know if the medicines don’t seem to be working.
• Avoid fried, greasy or spicy foods or those that have strong smells.
• Use stress-reduction techniques, such as meditation.

• Focus on eating foods you enjoy.
• Eat what you feel like, when you feel like it, e.g. have cereal for dinner or a main meal at lunch.
• Use a smaller plate – a big plate full of food may put you off eating.
• Relax dietary restrictions. During treatment, maintaining your weight is more important than avoiding full-fat foods.
• Add flavour to foods with lemon juice, herbs and spices.
• Add ice-cream or cream to fruit or a smoothie to increase kilojoules and nutrients.
• Sip on juice, cordials, soft drinks and sports drinks during the day to keep hydrated.
• Make meals as enjoyable as possible, e.g. play music, light candles or eat with friends.
• Gentle physical activity can stimulate appetite, e.g. take a short walk around the block.
• Soft food and clear liquids may be easier to digest.
• Speak to your doctor about trying some medicines that could help improve your appetite.
• See a dietitian for information about nutritional supplements, such as protein shakes, to ensure you don’t lose too much weight.  

Food-type nutritional supplements can increase nutrient intake. These are used as snacks between meals. Many pharmacies and supermarkets sell these specially formulated nutritional supplements. You do not need a prescription from your doctor or dietitian to buy them.

Breathlessness can occur for different reasons, including:

• fluid surrounding the lungs
• infection
• the cancer itself
• scarring from radiation therapy
• pressure from a swollen abdomen
• anaemia (low red blood cell levels)
• underlying chronic breathing disorders, such as asthma or emphysema
• heart problems caused by chemotherapy.

Symptoms of breathlessness include difficulty catching your breath, noisy breathing or very fast, shallow breaths. Although breathlessness can make you feel upset and anxious, there are ways to prevent or reduce its impact on your quality of life. 

Ask your doctor or nurse about medicines, such as a low dose of morphine, to manage feelings of distress.

• Use a handheld fan or open a window to increase airflow near your face.
• Sit up or lean forward on a table with an arm crossed over a pillow to allow your breathing muscles to relax. You can also use a walking frame when out or lean on the shopping trolley at the supermarket, as this position can ease your breathing. 
• Wear loose-fitting clothing around your waist and chest.
• Drink plenty of fluids. Being dehydrated can increase breathlessness.
• Place chairs around the house so that you can sit down between activities or when moving from room to room.
• Spread out activities during the day or break them up into smaller tasks.
• Try to relax or practise different breathing techniques. Some people also find acupuncture and meditation helpful.  

Fatigue can be caused by a range of things, such as:

• anxiety or depression
• poor sleep
• infection
• progression of the cancer
• anaemia (low red blood cell levels)
• cancer treatment such as chemotherapy or radiation therapy
• loss of weight and muscle tone
• drugs such as analgesics, antidepressants and sedatives.

• Plan activities for the time of day when you feel less tired, and include rest times.
• Do regular gentle activities, such as walking to the letterbox, doing stretches or getting out of bed for meals.
• Avoid stress where possible – relaxation techniques or meditation can help.
• Have several short naps rather than one long rest during the day.
• Limit visitors if you find they are tiring you.
• Limit the amount of alcohol you drink. Alcohol can cause tiredness and energy loss.
• Use home delivery meal companies that bring prepared food to you, or buy frozen meals from the supermarket.
• Delegate some tasks or speak to an occupational therapist about equipment to assist with activities (e.g., a shower chair, a commode).  
• Apply for a disability parking sticker to reduce how far you need to walk when going to the hospital or shops.  
• Prioritise important activities or those that you feel enrich your wellbeing.  

• Try to do some gentle physical activity every day. This will help you sleep better. Talk to a physiotherapist or exercise physiologist, who can create a tailored exercise program, and an occupational therapist, who can suggest equipment to help you move safely.
• Talk to your doctor about what might be helpful for you. Your medicines may need adjusting or sleep medicines may be an option. 
• Limit or avoid smoking, drinking alcohol and caffeine, and eating spicy food.
• Avoid using technology before bed as the blue light tells your body it’s time to wake up.
• Follow a regular routine before bed and set up a calm sleeping environment. Keep the room dark, quiet and at a comfortable temperature.
• Use relaxation practices, such as listening to gentle music before bed.
• If you can’t sleep, get up and sit on the couch until you feel sleepy again.
• Listen to our 'Sleep and Cancer' podcast episode.