How Palliative Care Can Boost Your Quality of Life if You Have Metastatic Bladder Cancer

There’s a lot to juggle and process after receiving a metastatic bladder cancer diagnosis — follow-up tests, medical appointments, treatment regimens. All of it can feel overwhelming at times, adding to the general sense of anxiety you may be feeling.

“In some cases, patients may even live longer, because they are better supported to stay on their treatment path,” says Marcin Chwistek, MD, director of the supportive oncology and palliative care program at Fox Chase Cancer Center in Philadelphia.

Palliative care is not hospice. It’s an extra layer of support alongside active cancer treatment. “The word ‘palliative’ comes from a Latin word meaning ‘to cloak’ or ‘to protect,’” says Dr. Chwistek. “That’s what we do: protect patients from unnecessary suffering while they pursue whatever treatment path is right for them.” Here are a few ways palliative care can do just that.

Not everyone with metastatic bladder cancer experiences pain similarly, so your care team will use an individualized combination of medications and treatments to keep you as comfortable as possible.

Pelvic and Visceral Pain

This kind of pain, which can stem from pelvic tumors, often feels deep and achy. To manage it, your team may use a combination of over-the-counter pain relievers, such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAID) like ibuprofen, along with corticosteroids or opioids. If your pain has a nerve-related component, medications such as gabapentin or pregabalin may help.

Side Pain

Pain in your side or back is often a sign that a tumor is pressing on the ureter (the tube connecting the kidney to the bladder). The most effective relief often comes from removing the obstruction through urologic intervention (such as placing a stent or nephrostomy tube), but medication can also be given in the meantime, says Chwistek.

Bone Metastases

If the cancer has spread to the bones, your palliative care team may use bone-targeted agents such as bisphosphonates and denosumab, corticosteroids, NSAIDs (if your kidneys are functioning well enough), opioids, and sometimes nerve-targeting medications, such as gabapentin.

Palliative radiation is also very effective for painful bone metastases. “A short course — sometimes even a single treatment — can provide significant pain relief for [most people], often within one to two weeks,” says Chwistek. If you have pain in multiple areas, your care team may recommend broader-field radiation or radiopharmaceuticals.

Interventional options such as intrathecal pain pumps, nerve blocks, and vertebral augmentation may also be part of your palliative care plan, he adds.

• Causes of Fatigue A medical evaluation can help determine the cause of the fatigue, including anemia (from blood loss or treatment), electrolyte issues, sleep disorders, and thyroid or other hormonal imbalances. Depending on what’s found, treatment may include medications, transfusions, or other targeted interventions.
• Physical Support While it may seem counterintuitive, physical activity is among the most effective ways to combat fatigue, says Chwistek. For people living with cancer, exercise has been found to reduce fatigue, decrease the severity of treatment side effects, and improve mental health.

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   “The key is moderate and tailored exercise,” he says. “We’re not asking patients to run marathons, but gentle walking, resistance exercises, or chair-based movements can meaningfully reduce fatigue and improve function.”
• Nutritional Support If you have lost your appetite, experience changes in taste, or feel full very quickly, you may want to recruit a dietitian to your team. Dietitians focus on boosting protein intake, correcting nutrient deficiencies, and managing eating-related symptoms. They may advise you to try small, frequent meals, for example, or take certain supplements.
• Emotional and Cognitive Support Fatigue is not only physically exhausting but can also tax your emotional and mental health. If that’s true for you, consider talking to a therapist. “Cognitive behavioral approaches can help patients develop coping strategies, improve sleep hygiene, and conserve energy for activities that matter most to them,” says Chwistek.

Palliative care can also help you manage the urinary, kidney, and bowel symptoms of advanced bladder cancer.

Urinary Issues

Bladder spasms and frequent urination can be among the most distressing symptoms of the disease. Chwistek says they can “disrupt sleep, limit activity, and profoundly affect dignity and quality of life.”

Your care team can offer you several treatment options, including:

• Medications to Calm Spasms Drugs such as oxybutynin are often used to relax the bladder, especially in older adults.
• Direct Bladder Treatments In some cases, medications placed directly into the bladder (called intravesical treatments) can help soothe irritation and ease discomfort.
• Frequent-Urination Management Timed bathroom trips, strategic fluid timing, and medication can help manage urinary problems caused by less room in the bladder. If the symptoms are caused by the tumor itself, palliative radiation to the bladder can sometimes reduce irritation, says Chwistek.
• Relief for Pain or Burning Burning or pain with urination may improve with urinary analgesics, such as phenazopyridine, anti-inflammatory medications, or (in select cases) low-dose tricyclic antidepressants that help quiet pain signals.
• Supportive Urologic Procedures Palliative care teams work closely with urologists when procedures are needed, such as suprapubic catheter placement or other interventions to manage bleeding or obstruction.

Kidney Health

Tumors can block urine flow, causing kidney swelling (hydronephrosis) and pain. To relieve pressure, urologists may opt for ureteral stents or nephrostomy tubes.

Palliative teams ensure these procedures align with your goals. “When kidney function declines significantly, we have honest conversations with patients about how it affects treatment options and overall prognosis, always in a supportive context focused on what we can do to maintain quality of life,” says Chwistek.

Bowel Health

Bowel changes are common due to treatments and pain medications. “For opioid-induced constipation specifically, we have newer medications called PAMORAs (peripherally acting micro-opioid receptor antagonists), such as methylnaltrexone and naloxegol, that block opioid effects in the gut without affecting pain control,” says Chwistek, who also recommends drinking plenty of fluids, staying active, and taking laxatives.

If diarrhea is frequent, tell your doctor right away. Immunotherapy can cause colitis, which sometimes requires steroid treatment, says Chwistek. In the meantime, try to stay hydrated; steer clear of caffeine, high-fat foods, and raw vegetables; and eat small, frequent meals.

Palliative care focuses on working with a team of providers alongside your oncologist to help you ease symptoms and improve your quality of life, as well as support you through tough decisions.

“We’re not replacing oncologic care,” says Chwistek. “We’re partnering with the oncology team to ensure patients feel as well as possible throughout their journey.”

• Talk to your oncology team about starting palliative care early on. It can help you manage pain, fatigue, and other significant symptoms of metastatic bladder cancer.
• To treat cancer-related pain, your care team will likely use a combination of medications and other treatments.
• A palliative care team can offer you ongoing physical and emotional support, which can help you manage cancer-related fatigue.