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As Cancer Progresses

When cancer becomes metastatic (spreads to other parts of your body) and incurable, it has “progressed”. This is also called “advanced cancer”.

Patient handout: As Cancer Progresses

When cancer becomes metastatic (spreads to other parts of your body) and incurable, it has “progressed”. This is also called “advanced cancer”.

This is a hard time for you and your loved ones. You realize that you could die from this illness. You and your loved ones might have many questions.

You may notice some changes, such as a new lump or new symptoms. You should talk to your oncologist (cancer doctor) if this happens.


A blood test or imaging (such as an MRI or CT scan) will show your oncologist if your cancer has progressed. Your oncologist will talk to you about these results and what they mean.
Some people live with metastatic cancer for many months or years. Other people may not live as long. 

Your oncologist will talk with you about your prognosis (how long they expect you to live). 

How long you may live depends on: 
  • Whether or not you have more cancer treatments.
  • Where the cancer has spread to.
  • Health problems not related to cancer.
When we cannot cure the cancer, the goals of treatment are to: 
  • Control or slow down cancer growth (“palliative treatment”)
  • Relieve symptoms from cancer (“palliative care”)
Bowtie Model of Palliative CareClick here to see enlarged image


Above is the Bowtie Model of Palliative Care developed by Dr. Pippa Hawley of BC Cancer. This shows how palliative care and treatment can be involved early in a person’s illness. It also shows how palliative care and treatment can support a patient during their cancer treatment, either towards a cure or through cancer progression.


Getting palliative care or palliative treatment does not mean you will die very soon. It means the palliative care team of doctors and nurses will give you extra support during your illness. If you get palliative care early in your illness, you will have an opportunity to avoid symptoms altogether or to deal with them quickly when they start.

As your cancer progresses, you may get chemotherapy, immunotherapy or radiation therapy.  These treatments may help control the cancer or your symptoms. Your oncologist will answer questions about your treatment options.

These treatments can be very hard on your body.  You will want to think carefully about your treatments.  If treatment is making you weaker, you might wish to stop the treatment. Your oncologist will help you make decisions.

Your oncologist may refer you to palliative care services at BC Cancer or at home.  They can also refer you to support services such as social workers, counsellors, dietitians, homecare nurses and others.

‎Patients and families often ask questions about symptoms they notice. Here are some symptoms you may have.


Pain

You should not have to suffer very bad pain. Talk to your health care team if you are having pain.  

Your oncologist may give you pain medication. You may get an opioid, like morphine. Your oncologist might also refer you to a specialist at the BC Cancer Pain & Symptom Management/Palliative Care Clinic. This is a team of specialists who can help you manage your pain and other symptoms.

When your health care team manages your pain as soon as it becomes a problem, you will feel better. You will also be more able to cope with cancer treatments and other challenges you may face. 

Fatigue (extreme tiredness) and Weakness 

Most people with advanced cancer will have fatigue at some point. As your cancer progresses, you may become more fatigued.  You may not be able to do all of your normal activities. 

It is ok to do less activity and to rest more often.  Eventually, you might need to rest most of the time with very little activity.  
Fatigue is also a common side effect of cancer treatment.  You may feel weak from your treatments, your cancer or weight loss. 

If you are feeling weak and are worried about it, talk to your health care team.

Loss of appetite

Cancer treatments can make you lose your appetite (desire to eat). Once the treatments finish, your appetite will usually get better.
Certain cancers can also make you lose your appetite.

If you have a poor appetite, eat:
  • Small meals or snacks.
  • Often during the day.
  • Foods that you like.
There is no good evidence that sugar makes cancer grow. Do not worry about eating sugar, especially if you are not eating very much of anything else.

Try to drink 6-8 cups (1.5-2 litres) of fluid every day. Take small sips often. Fluids include: 
  • Water
  • Juice
  • Herbal tea
  • Sports drinks
  • Broth or soups
  • Liquid nutritional drinks such as Ensure®.
If you have nausea (feeling queasy) or are vomiting (throwing up), tell your health care team. They can help you control these symptoms.  

For more information about eating when you do not have an appetite, visit the BC Cancer Nutrition website: www.bccancer.bc.ca/health-info/coping-with-cancer/nutrition-support

Weight Loss

You might lose weight because of your cancer or cancer treatments. This can be very stressful. Talk to your health care team if you are worried.

In some cases, patients lose a lot of weight. They lose fat and muscle. This is called “cachexia” (ka-kek-sia). There are some treatments for cachexia but it is very difficult to reverse this type of weight loss.

Cognitive Problems 

Very rarely, patients may have cognitive problems, like confusion or trouble concentrating. This may be due to your cancer or the amount of certain chemicals in your blood. Talk to your health care team if you have any cognitive problems.

If you become sick, you may need to stay in hospital. You may have a condition that doctors can treat or you may be sick because your cancer is getting worse. 


Your oncologist may suggest you stay in the Palliative Care unit. This is a hospital unit where patients with incurable illnesses go for a short time to help them get better. The Palliative Care Unit will help you manage your symptoms. Palliative care units do not usually give cancer treatments. 

When you are talking about staying in the hospital, your oncologist may explain cardiopulmonary resuscitation (CPR).  

We only do CPR on people who have stopped breathing and whose hearts are not pumping blood, when the reason for this happening is something that is treatable. 

Palliative Care Units do not do CPR. You may need to sign a form to show you understand this. The Palliative Care Unit will still help you manage your symptoms and take very good care of you.  

Your oncologist will talk with you if they think you are nearing the end of your life. They will help you make decisions about your care. 

If you get very sick, you will stop your cancer treatments. You will need to decide where you want to be cared for. If you wish to stay at home, you will need information about what kind of support is available. 

Your oncologist will connect you with homecare nurses. They can help manage your symptoms and your care at home. If it gets too hard for you to stay at home, you may need to go to hospice for end-of-life care. 

While you are still well, it is a good idea to start making some plans for the end of your life. 


This includes: 
  • Writing a will.
  • Writing a care plan (your wishes, hopes, values and goals for your care).
  • Naming a person who can be your medical decision maker if you are not able to speak for yourself. This person is a called a Substitute Decision Maker. They should be a trusted family member or friend.

You should talk with your substitute decision maker about your wishes for medical care. Make sure they understand what you want. 


If you do this now, your loved ones will not have to make difficult medical decisions on your behalf. If you are unwell or cannot speak for yourself, your loved ones will know what you would have wanted to do.


Once you pick a substitute decision maker, you may need to fill out a form called a Representation Agreement (Section 9), if the chosen person is not your legal default person.


If you have questions about Advance Care Planning, talk to your health care team.

Revised February 2020

SOURCE: As Cancer Progresses ( )
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