Special Issue on the Role of the Oncologist in Palliative CareEvidence-Based Approaches to Other Symptoms in Advanced CancerDy, Sydney Morss MD, MSc*; Apostol, Colleen C. RN, OCN, CHPN†Author Information From the *Health Policy and Management, Oncology, and Medicine, JohnsHopkins University; and †Harry J. Duffey Family Pain and Palliative Care Program,Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, MD. Reprints: Sydney Morss Dy, MD, MSc, Room 624, 609 N Broadway, Baltimore, MD 21205. E-mail: [email protected]. This article was updated and adapted in part from the Johns Hopkins Internet Learning Center Program (www.hopkinsilc.org) modules, supported by a fee from participating residency programs. Literature reviews were adapted and updated from the Cancer Quality-ASSIST project, which was supported by a grant from Amgen Inc to the RAND Corporation. The Cancer Journal: September 2010 - Volume 16 - Issue 5 - p 507-513 doi: 10.1097/PPO.0b013e3181f45877 Buy Metrics Abstract Dyspnea, nausea and vomiting, anorexia, fatigue, and sleep disturbances are common and distressing in advanced cancer. We updated previous systematic reviews of how these symptoms can be alleviated with targeted literature searches. The approach to these symptoms requires comprehensive symptom assessment; treating underlying causes when benefits exceed risks; prioritizing treatment, as patients usually have many symptoms; and addressing psychosocial and spiritual distress. For dyspnea, evidence supports systemic opioids and nonpharmacological treatments such as a fan. The strongest evidence supports metoclopramide for cancer-related nausea and octreotide for bowel obstruction. For anorexia, enteral or parenteral nutrition is indicated with obstruction and expected prognosis of at least 6 weeks. Evidence supports several drugs for appetite affecting quality of life. For fatigue, evidence supports psychosocial interventions and methylphenidate. For insomnia, evidence supports cognitive-behavioral therapy in cancer; no sleep agents have superior effectiveness. © 2010 Lippincott Williams & Wilkins, Inc.