by Dr. Alisha Kassam
When cancer has metastasized it means that it has spread from the place where it first started to another organ or tissue in the body. Although some types of metastatic cancer in young adults can be cured, for many, a diagnosis of metastatic cancer means that cure may no longer be possible. Nonetheless, cancer treatments are often available for all metastatic cancers to help slow the growth of the cancer and control symptoms. These treatments may also help prolong life and a number of patients with metastatic disease can enjoy good quality of life for months, or in some cases, years.
At some point during your cancer journey you may be introduced to the term palliative care, and the important role it can play in your overall treatment plan. It is important for you to know that active cancer treatment, and palliative support can occur simultaneously, which is often the case for young adults.
The general public often confuses palliative care with end-of-life care, which focuses on providing comfort during the last few weeks of life. Although palliative care can include end-of-life care it encompasses much more.
Palliative care is an approach that aims to enhance the quality of life of patients and their families facing a life-threatening illness such as advanced cancer. Enhanced quality of life is achieved through relieving pain and other distressing symptoms, helping patients and families make difficult decisions about treatment options and addressing social, emotional and spiritual distress.
It is common for patients with metastatic cancer to develop symptoms as cancer progresses. The type of symptom will depend on where in the body the cancer has spread to. For example, if cancer has spread to the lung then one may experience shortness of breath or if cancer has spread to the bone then it is likely to cause pain in that area. Other possible symptoms of advanced cancer include nausea, vomiting, headaches, fatigue, loss of appetite, constipation, anxiety or depression. Your health care team will ask you about these symptoms during regular follow-up visits and recommend treatment options to help alleviate these symptoms.
At some point you may be told that your cancer is no longer responding to treatment or you may have made a personal decision to stop anti-cancer treatments. When this occurs, cancer treatments and medical testing stop and many young adults feel abandoned. It’s important to remember that although cancer treatment stops, care continues, and the focus is on improving quality of life and keeping you comfortable for as long as possible. A patient’s hope during the cancer experience also changes over time. At diagnosis many patients hope for a cure or that their cancer responds to treatment. When cancer treatment is no longer possible, most young adults are eventually able to reframe their hope. They may hope for meaningful times with their family and friends, hope for symptom control or hope they can make it to an important event. Staying positive and using humour can also be a good outlet during this transitional time.
It is natural to hope for the best but it is also important to prepare for the worst. Research has shown that young adults who have discussed their wishes for end-of-life care feel less stress at the end of their life, and so do their families. Important things to discuss with your loved ones and health care professionals include where you want to spend your final days, who you would like to appoint to be your health care proxy (the person who you want to make health care decisions on your behalf when you are unable to do so) and your wishes about the type of care and treatments you would like at the end of life.
Your health care team can also provide you with detailed information on your prognosis and what to expect in the final days and hours. Hearing this information is often comforting to young adults as it enables them to feel prepared and have some control over the uncontrollable. In the final days or hours of life patients often lose the desire to eat or drink, feel tired and weak and spend more time sleeping and lying in bed. Most young adults prefer to receive all their care at home during this time so they can be in familiar surroundings and around their loved ones. A health care team, usually consisting of nurses and a palliative care physician, will care for you at home and ensure that any distressing symptoms are managed promptly. This team can also help ease any emotional, psychological or spiritual suffering that may occur during this difficult time. If home is not desired, then a palliative care unit in your local hospital or a free-standing hospice may be a good alternative if available in your community.
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