Cancer and its treatment often cause problems called side effects. While treating the cancer is important, so is relieving side effects and symptoms. In fact, treatment of cancer and its side effects often happen at the same time. This is called palliative care or supportive care.
Palliative care works best when you start it as soon as you need it during the treatment process. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and are more satisfied with treatment. You may have palliative care at any age and for any type and stage of cancer.
Areas where palliative care can help
Palliative treatments vary widely and often include:
-
Medication
-
Nutritional changes
-
Relaxation techniques
-
Emotional and spiritual support
-
Support for children or family caregivers
This article explains the several different types of palliative care and how they can help.
Social
You might find it hard to talk with your loved ones or caregivers about how you feel or what you are going through. Or you might need a support group or a ride to and from treatment. A social worker can help with these situations. For example, they can:
-
Help you plan a family meeting
-
Suggest ways to organize people who want to help
-
Help you find medical information, rides, or services
A social worker can also provide palliative care for family members and caregivers. For example, if they feel overwhelmed, the social worker can help them figure out what kind of help they need and find it.
Emotional
Having cancer can make you feel many different emotions, such as sadness, anxiety, or anger. It can also make you very stressed. A support group, counselor, psychologist or other specialist can help you understand and cope with these emotions.
To find help, talk with your health care team about how you feel. You can also find ways to cope with emotions.
Spiritual
Having cancer can bring up many spiritual questions. You might struggle to understand why you got cancer. Or you might want a greater purpose after surviving cancer.
If you belong to a faith community such as a church, synagogue, or other group, your spiritual leader or community members might be able to help support you spiritually. A hospital chaplain can also provide spiritual support, whether you are religious or not. Chaplains work with people of all faiths and those who do not have a specific faith. Learn more about spiritual support.
Mental
Cancer symptoms, treatments, and medications can all affect how your mind works. For example, if you are not sleeping enough, you might feel stressed and have a hard time thinking clearly. Or you might be very anxious about whether your treatment is working.
Palliative care for mental health includes exercise, counseling, meditation, and possibly medication to help with anxiety, depression, or sleep problems. A counselor, support group leader, or psychologist might suggest that you do activities that help you reduce stress and anxiety, such as yoga, creating art, joining a group of other cancer survivors, or volunteering for a cause you find meaningful.
Financial
Cancer treatment can be expensive. This might be a cause of stress and anxiety for you and your family. In addition to treatment costs, you might find that you have other extra expenses, such as the cost of traveling to a cancer center for care.
Talk with your health care team about any financial concerns. A social worker or financial counselor can provide palliative care for these concerns. For example, they might:
-
Help you talk with your health care team about the cost of care
-
Explain billing and insurance, or find someone who can do this
-
Help you apply for medical leave or disability payments
-
Find programs that provide free or low-cost medicines
Learn more about managing financial considerations.
Physical
Physical side effects of cancer and its treatment depend on several factors. These include your type of cancer, its stage, the treatment, and your general health. Physical side effects can include:
-
Pain
-
Fatigue (being very tired)
-
Nausea, vomiting, and loss of appetite
-
Breathing problems, such as being short of breath
-
Sleep problems
Palliative care for physical side effects might include anti-nausea medicines, physical therapy, or help with nutrition. You might see a palliative care specialist, sleep specialist, pain specialist, or another professional for help with physical side effects.
Palliative care after cancer treatment
Sometimes, physical side effects can last after treatment ends. Doctors call these “late effects” if they happen or last for months or years after treatment.
Palliative care specialists can help treat late effects. This is an important part of survivorship care. Learn more about long-term side effects of cancer treatment. Ask your doctor if your treatment is likely to cause any late effects.
For children
As your child prepares to start cancer treatment, you might worry about treatment-related side effects. But palliative care is also available for children. It is an important part of your child’s treatment plan, regardless of his or her age or the stage of disease.
Talk with the health care team before your child starts cancer treatment. Ask about the possible side effects of treatment and palliative care options. Tell the health care team if your child has new side effects or changes in side effects so the team can treat them quickly.
For caregivers and children
Palliative care is not only for the person with cancer. It can also include support for caregivers and children of people with cancer.
Loved ones often provide important physical, practical, and emotional support to the person with cancer. Caregivers can also experience stress, anxiety, depression, and frustration. Palliative care can help caregivers balance providing care while also improving their quality of life.
If you are a parent with cancer, you may need extra support from others for your children. This might include after-school care or help with making their meals. Taking care of your own health helps you be a good caregiver.
Your health care team or a social worker can help you find palliative care for caregivers and other family members.
For older adults
Palliative care can be especially important if you are 65 or older. Older adults can have more physical side effects, especially from chemotherapy. And your body might not recover as quickly from surgery as in the past. You may also be concerned about the following:
-
Will treatment affect my ability to live on my own?
-
Will treatment affect my memory?
-
How will cancer treatment affect my overall quality of life?
Learn more about concerns for adults older than 65, including tips and possible side effects of treatments.
Related Resources
The 4 Corners of Palliative Care: The Role of Spiritual Support
Understanding the Costs Related to Cancer Care
More Information
National Cancer Institute: Palliative Care in Cancer
National Institute for Nursing Research: For Patients and Families
National Institutes of Health: What are Palliative Care and Hospice Care?
Palliative care is used to manage a disease or medical condition that is serious or life threatening by easing pain and other associated physical, emotional, or psychosocial symptoms.
Palliative care also eases other distressing symptoms, like depression, anxiety, fatigue, insomnia, and shortness of breath. Palliative care provides advanced care planning and a support system to help you live a life that is as active, fulfilling, and as pain-free as possible.
Palliative care may last for weeks, months, or years, and the relief of moderate to severe pain during that time can greatly improve quality of life. The biggest problem with palliative care is that many people are referred for care too late. By starting this type of care early, and by using the right type of pain management, nearly all pain problems can be relieved or reduced.
Principles of palliative care and pain medicine
The first step in managing pain is to do a total pain assessment. You may be asked to choose a number from 0 to 10 to rank your pain, with 0 being very mild pain and 10 being the worst possible pain you could have.
Keep in mind 3 important principles when deciding how to manage pain. First, pain should always be treated right away. A delay allows pain to get worse. Second, you should not be afraid of becoming addicted to pain medicine. If medicines are used in the right way under close supervision of a healthcare provider, this is rarely a problem. Of course, if you believe that you are losing control of how you are using pain medicines, you should discuss this with your healthcare provider right away. Third, most pain problems can be controlled by using the World Health Organization's step-care approach:
-
Step 1. Start with a nonsteroidal anti-inflammatory drug (NSAID). Examples of NSAIDs include over-the-counter drugs like ibuprofen and stronger NSAIDs that your healthcare provider may prescribe. An alternative to NSAIDs for step 1 pain is acetaminophen.
-
Step 2. If pain continues or gets worse, your healthcare provider may prescribe a weak opioid medicine, like hydrocodone. A weak opioid may be combined with a nonopioid pain reliever.
-
Step 3. If pain continues or gets worse, your healthcare provider may prescribe a stronger opiate. Examples of strong opioids include morphine and fentanyl.
Understanding opioid drugs
Opioid drugs are the most effective and commonly used drugs for moderate to severe pain. A wide range of opioid drugs is available, and they can be taken in a variety of ways. One drawback of these medicines is that, over time, you will almost certainly develop a tolerance to the one you're taking and need higher doses to get the same effect. One way your healthcare provider may get around this problem is by switching the type, dose, or the way the drug is given.
These are common ways in which opioid drugs can be given:
-
Oral medicines. These can be taken in pill or liquid form and can be short acting or long acting (sustained release).
-
Adhesive patch. This can be applied to the skin to release medicine over time. An example of this is a fentanyl patch.
-
Opioid drug injection. This shot may be given under the skin or into a muscle.
-
Opioid drug IV. An opiate may be given directly into the blood through an intravenous line.
-
Medicine pump. Opiate medicine can be given through a pump attached to an IV line that you control. This is called patient-controlled analgesia.
-
Spinal injection. For pain that's hard to control, a pain-control specialist may give an opioid drug directly into the spinal cord area.
Understanding helper drugs
These medicines, called adjuvant analgesics, can help control pain in certain situations. These are commonly used adjuvant drugs:
-
Steroids. These are strong anti-inflammatory medicines that may help relieve pain by decreasing inflammation. They may be used along with other pain relievers for nerve, bone, or other types of pain.
-
Antidepressants. Treating any existing depression or anxiety can make pain easier to control. These drugs may also be useful in pain caused by nerve damage.
-
Anticonvulsants. These medicines are usually used to control seizures, but they can also help control nerve-related pain.
-
Local anesthetics. These are medicines that can block pain signals in the body. A pain specialist may inject a local anesthetic to block pain.
-
Muscle relaxants. Antianxiety medicines and muscle relaxants may be used along with pain medicine if pain is aggravated by tension or muscle spasms.
-
Bisphosphonates. These medicines are sometimes used to prevent fractures in people whose cancer has spread to the bone. They can play a key role in relieving bone injury and pain.
Other pain control interventions
Surgery is often the last thing a patient or his or her healthcare provider would consider at end of life. But at times surgery can provide pain relief and increase function. Surgery's primary goal can be to relieve specific symptoms. For instance, a healthcare provider may recommend surgery to stabilize a hip fracture in someone with advanced cancer. The surgery is not going to treat the cancer or lengthen the patient's life, but it may be the best way to reduce hip pain and improve mobility. Radiation therapy can also be used to improve pain and control symptoms. Because surgery involves risk, the healthcare provider must clearly define treatment goals for both the patient and the patient's family.
If you or a loved one needs palliative care, many options are available. Work with your healthcare provider to find the right approach. You can also get help from a pain medicine specialist or a palliative care specialist. Remember: You have a right to be as free of pain as possible. There is no reason to let pain decrease your quality of life.
When living with a serious, chronic illness, palliative care provides the treatment and services to help you live more comfortably. Johns Hopkins Home Care Group palliative care services help relieve pain and symptoms — and improve your quality of life.