Treating advanced cancer

The aim of treatment for advanced cancer is to control the cancer for as long as possible. This might mean shrinking the size of the cancer or slowing its growth for a while. In some cases, this may be for months or years. If treatment is no longer controlling the cancer, the aim may be to help relieve the physical and emotional symptoms of cancer. Your doctor will discuss your options and involve you in decisions about the best treatment for your situation. This is called shared decision-making.

New treatments may become available, so if your current treatment stops working or it’s hard to cope with side effects, ask your doctor what else you can try or if you’re eligible for a clinical trial.

Treatment choices for advanced cancer will depend on where the cancer started and how much it has spread. Usually cancer that has spread needs systemic treatment. This means treatment is taken by mouth (orally) or injected into the bloodstream to reach cancer cells throughout the body. Examples include chemotherapy, targeted therapy, immunotherapy and hormone therapy. Treatment that affects only a certain part of the body may also be used to control the cancer or to relieve symptoms. Examples include surgery and radiation therapy.

Often these treatments will be discussed with a range of health professionals at what is known as a multidisciplinary team (MDT) meeting. You are likely to see a number of health professionals who specialise in different aspects of your care. 

Your healthcare team

• general practitioner (GP) – assists you with treatment decisions and works in partnership with your other specialists in providing ongoing care
• medical oncologist – treats cancer with drug therapies such as chemotherapy, targeted therapy, immunotherapy and hormone therapy (systemic treatment)
• radiation oncologist – treats cancer by prescribing and overseeing a course of radiation therapy
• radiation therapist – plans and delivers radiation therapy
• surgeon – surgically removes tumours and performs some biopsies; specialist cancer surgeons are called surgical oncologists
• haematologist – diagnoses and treats diseases of the bone marrow, blood and lymphatic system; prescribes chemotherapy and other drug therapies
• nurse – administers drugs and provides care, information and support throughout treatment; may be a community nurse (see below), specialist palliative care nurse or a palliative care nurse practitioner
• community nurse – visits you at home to supervise medical care, assesses your needs for supportive care, and liaises with your GP and MDT as required
• pain medicine specialist – treats all types of pain, particularly severe or difficult pain
• pharmacist – dispenses medicines and gives advice about dosage and side effects
• cancer care coordinator – coordinates your care, liaises with other members of the MDT and supports you and your family throughout treatment; care may also be coordinated by a clinical nurse consultant (CNC) or clinical nurse specialist (CNS)
• palliative care specialists and nurses – work closely with your GP and cancer team to help control symptoms and maintain quality of life
• dietitian – helps with nutrition concerns and recommends changes to diet during treatment and recovery
• physiotherapist and exercise physiologist – help restore movement and mobility, and improve fitness and wellbeing
• occupational therapist – assists in adapting your living and working environment to help you resume usual activities during and after treatment
• counsellor, psychiatrist, psychologist – help you manage your emotional response to diagnosis and treatment
• spiritual care practitioner (pastoral carer or chaplain) – discusses any spiritual matters and helps you reflect on your life and search for meaning, if appropriate; may arrange prayer services and other religious rituals
• Aboriginal and Torres Strait Islander health practitioners – provide cultural and other support for Aboriginal and Torres Strait Islander peoples with cancer and their families
• speech pathologist – helps with communication and swallowing during and after treatment
• social worker – links you to support services and helps you with emotional, practical and financial issues

Rehabilitation

Sometimes cancer can limit your activities. Rehabilitation, or rehab, is a way of improving your quality of life between or after treatments. It helps restore your movement and other functions through physiotherapy, occupational therapy, speech therapy or artificial body parts (prostheses). It can also include emotional support, such as counselling.

Returning to work is another form of rehabilitation. You may find you need to start back at work with reduced hours. If you can no longer work, or choose not to, it may be helpful to find another activity that helps you feel involved in life and connected with people.

For many people, rehabilitation is organised through their treatment centre. If you have been treated in a private hospital, ask your doctor about these services. Your GP or palliative care service can also organise rehabilitation for you.

For more information on the availability of rehabilitation services in your area, contact Cancer Connect on 13 11 20.

I had to accept that I was dealing with fatigue and celebrate small improvements. I had to be careful not to overdo it and whatever help people offered, I took. That was very challenging for me but it helped.

Susan