When your cancer treatment stops working

Talk with your health care provider about what advanced cancer means for you. No two people are alike. Find out what your treatment options are, what you can expect from treatment, and what the outcome may be. You may want to talk this over with your family, or have a family meeting with your provider, so you can plan ahead together.

You can still receive treatment when you have advanced cancer. But the goals will be different. Instead of curing cancer, treatment may help relieve symptoms and control cancer. This can help you be as comfortable as possible for as long as possible. It may also help you live longer.

Your treatment choices may include:

• Chemotherapy (chemo)
• Immunotherapy
• Targeted therapy
• Hormone therapy

Talk with your provider about your options and weigh the risks and benefits. Most cancer treatments have side effects that can affect the quality of your life. Some people decide that the side effects are not worth the small benefit from treatment. Other people choose to continue treatment for as long as possible. This is a personal decision you'll need to make together with your provider.

When standard treatments no longer work for your cancer, you still have some choices about what type of care you'd like to get. Some options include:

• Clinical trials. These are research studies that look for new ways to treat cancer. There are benefits and risks to being in a clinical trial, and each one has rules about who can participate. If you're interested, ask your provider about clinical trials for your type of cancer.
• Palliative care. This is treatment that helps prevent and treat symptoms and negative effects from cancer. It can also help you with emotional and spiritual struggles while facing cancer. Palliative care can help improve your quality of life. You may receive this type of care at every stage of cancer treatment.
• Hospice care. You may decide to choose hospice care if you are no longer seeking active treatment for your cancer. Hospice care aims to improve your symptoms and help you feel comfortable in the last months of life.
• Home care. This is treatment in your home instead of a hospital. You may be able to manage your care and get the medical equipment you need right at home. You may have to pay for some services yourself. Check with your health plan to see what they cover.

You may think that symptoms will get worse as cancer progresses. This isn't always the case. You may have a few symptoms or none at all. Common symptoms include:

• Pain
• Nausea and vomiting
• Fatigue
• Anxiety
• Loss of appetite
• Sleeping problems
• Constipation
• Confusion

If you have any of these symptoms, it's important to tell your provider. Don't downplay symptoms. There are many treatments that can help you feel better. You should not have to be uncomfortable. Relieving symptoms can help you enjoy your life more fully.

As a person with cancer, you may have felt anger, denial, sadness, anxiety, grief, fear, or regret. These feelings may be even more intense now. It's normal to feel a range of emotions. How you deal with your feelings is up to you. Here are things that may help.

• Get support. Sharing your feelings with others can help make your emotions feel less intense or troubling. You can join a support group for people with cancer or meet with a counselor or clergy member.
• Keep doing things you enjoy. Plan your day as you normally would and try to do things you enjoy. You could even take a class in something new.
• Let yourself feel hopeful. Think of things every day to look forward to. By feeling hopeful, you can find acceptance, a sense of peace, and comfort.
• Remember to laugh. Laughter can ease stress, help you relax, and connect you with others. Look for ways to bring humor into your life. Watch funny movies, read comic strips or humorous books, and try to see humor in the things around you.

This is a hard topic for many people to think about. But you may feel better knowing you have taken steps to prepare for the end of your life, whatever that means to you. Here are some ways you may want to plan ahead:

• Createadvance directives. These are legal papers that outline the type of care you want or do not want to have. You can also choose someone to make medical decisions for you if you can't make them yourself. This is called a health care proxy. Having your wishes known ahead of time can help you and your loved ones worry less about the future.
• Get your affairs in order. It's a good idea to go through your papers and make sure important documents are all together. This includes your will, trusts, insurance records, and bank statements. Keep them in a safe deposit box or with your lawyer. Make sure the people who will manage your affairs know where these documents are.
• Spend time with loved ones. Reach out to your spouse, siblings, children, grandchildren, or other loved ones and try to make lasting memories. You may want to give meaningful items to those you love.
• Leave a legacy. Some people choose to create special ways to celebrate their lives. Consider making a scrapbook, making jewelry or art, writing poetry, planting a garden, making a video, or writing down memories from your past.

It's not easy to face the end of your life. Yet living day-to-day and working to appreciate your life and the people around you can bring a sense of fulfillment and satisfaction. This can help you make the most of the time you have.

American Cancer Society website. Understanding advanced and metastatic cancer. www.cancer.org/cancer/managing-cancer/advanced-cancer/what-is.html. Updated September 10, 2020. Accessed May 17, 2023.

American Cancer Society website. Bone metastases. www.cancer.org/cancer/managing-cancer/advanced-cancer/bone-metastases.html. Updated March 10, 2023. Accessed May 9, 2023.

Corn BW, Hahn E, Cherny NI. Palliative radiation medicine. In: Tepper JE, Foote RL, Michalski JM, eds. Gunderson and Tepper's Clinical Radiation Oncology. 5th ed. Philadelphia, PA: Elsevier; 2020:chap 17.

Nabati L, Abrahm JL. Caring for patients at the end of life. In: Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, eds. Abeloff's Clinical Oncology. 6th ed. Philadelphia, PA: Elsevier; 2020:chap 51.

National Cancer Institute website. Coping with advanced cancer. www.cancer.gov/publications/patient-education/advancedcancer.pdf. Updated June 2020. Accessed October 31, 2022.

Updated by: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists & Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.