When palliative care is mentioned, pain is often the first — and sometimes the only — symptom that comes to mind.
Pain matters. But it is not the whole story.
Multiple studies have shown that patients with advanced cancer frequently experience a cluster of non-pain symptoms that are equally, if not more, distressing than pain itself. Dyspnea, fatigue, dysphagia, bleeding, and pressure symptoms often dominate daily life, yet remain under-recognized and undertreated (Ferrell et al., 2017; Hui et al., 2015).
Symptoms Patients Struggle to Name
In clinical practice, patients may initially ask for help with “pain,” but describe something different when encouraged to elaborate.
They speak about:
- shortness of breath
- pressure or heaviness
- bleeding that causes fear and embarrassment
- difficulty swallowing or speaking
- profound fatigue that limits even basic activities
These symptoms are harder to quantify than pain and are therefore more likely to be minimized — by patients and clinicians alike.
Why These Symptoms Carry a Different Psychological Weight
Unlike pain, which patients expect medicine to address, other symptoms often generate fear, panic, and loss of control.
Dyspnea is strongly associated with anxiety and existential distress (Booth et al., 2016). Tumor-related bleeding creates constant vigilance and social withdrawal. Obstructive symptoms serve as a continuous reminder of disease progression. These experiences erode not only physical comfort, but dignity, independence, and identity — domains increasingly recognized as core components of quality of life (QoL) in oncology.
The Role of Palliative Radiotherapy Beyond Pain Relief
Palliative radiotherapy is frequently discussed in the context of pain control, and rightly so — randomized data support its effectiveness for bone metastases (Chow et al., 2007).
However, its role extends far beyond analgesia.
Evidence supports palliative radiotherapy for:
- relief of airway or esophageal obstruction
- control of tumor-related bleeding
- reduction of mass effect on nerves or organs
- symptom palliation in spinal cord compression and mediastinal disease
These interventions often result in rapid symptom relief, sometimes within days, with relatively low treatment burden (Lutz et al., 2014).
Read Our Special Article About Palliative Radiotherapy
When Relief Means Regaining Function
For patients, benefit is not abstract or radiographic.
Relief means:
- being able to lie flat
- eating without fear
- breathing without panic
- leaving the house without planning around symptoms
Functional restoration — even if temporary — has been consistently associated with improved patient-reported outcomes and reduced emergency department visits (Hui &
Bruera, 2016).
Why Non-Pain Symptoms Are Often Treated Late
Non-pain symptoms are frequently addressed only when they become crises.
This delay may occur because:
- patients normalize or underreport symptoms
- clinicians focus on disease-directed endpoints
- systemic therapy remains the primary attention
Yet early, symptom-directed interventions have been shown to prevent acute deterioration and reduce unplanned hospitalizations (Temel et al., 2010).
Aligning Treatment With What Bothers the Patient Most
High-quality palliative care begins with a simple but powerful question:
“What is limiting your life right now?”
The answer is not always pain. When treatment is aligned with the symptom that burdens the patient most, clinical outcomes may not change — but the lived experience does.
Measuring Success Differently
In palliative care, success is not defined by tumor shrinkage.
It is defined by:
- reduced distress
- improved daily function
- fewer emergency interventions
- restored comfort and autonomy
These outcomes may be time-limited, but they are never insignificant.
Final Thought
Pain is important — but it is not the only symptom that deserves attention. Palliative care addresses whatever disrupts daily life, threatens dignity, or creates fear. When care responds to the patient’s real experience rather than solely to imaging or staging, relief becomes personal — and treatment becomes truly supportive.
Written By Eftychia Tataridou, MD