Evidence-Based Approaches to Other Symptoms in Advanced Cancer : The Cancer Journal

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Special Issue on the Role of the Oncologist in Palliative Care

Evidence-Based Approaches to Other Symptoms in Advanced Cancer

Dy, Sydney Morss MD, MSc*; Apostol, Colleen C. RN, OCN, CHPN

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The Cancer Journal 16(5):p 507-513, September 2010. | DOI: 10.1097/PPO.0b013e3181f45877


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.

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