Korean J Hosp Palliat Care.  2013 Dec;16(4):205-215. 10.14475/kjhpc.2013.16.4.205.

Management of Non-pain Symptoms in Terminally Ill Cancer Patients: Based on National Comprehensive Cancer Network Guidelines

• Lee HR

• KMID: 2305294
• DOI: http://doi.org/10.14475/kjhpc.2013.16.4.205

Abstract

Most terminally ill cancer patients experience various physical and psychological symptoms during their illness. In addition to pain, they commonly suffer from fatigue, anorexia-cachexia syndrome, nausea, vomiting and dyspnea. In this paper, I reviewed some of the common non-pain symptoms in terminally ill cancer patients, based on the National Comprehensive Cancer Network (NCCN) guidelines to better understand and treat cancer patients. Cancer-related fatigue (CRF) is a common symptom in terminally ill cancer patients. There are reversible causes of fatigue, which include anemia, sleep disturbance, malnutrition, pain, depression and anxiety, medical comorbidities, hyperthyroidism and hypogonadism. Energy conservation and education are recommended as central management for CRF. Corticosteroid and psychostimulants can be used as well. The anorexia and cachexia syndrome has reversible causes and should be managed. It includes stomatitis, constipation and uncontrolled severe symptoms such as pain or dyspnea, delirium, nausea/vomiting, depression and gastroparesis. To manage the syndrome, it is important to provide emotional support and inform the patient and family of the natural history of the disease. Megesteol acetate, dronabinol and corticosteroid can be helpful. Nausea and vomiting will occur by potentially reversible causes including drug consumption, uremia, infection, anxiety, constipation, gastric irritation and proximal gastrointestinal obstruction. Metoclopramide, haloperidol, olanzapine and ondansetron can be used to manage nausea and vomiting. Dyspnea is common even in terminally ill cancer patients without lung disease. Opioids are effective for symptomatic management of dyspnea. To improve the quality of life for terminally ill cancer patients, we should try to ameliorate these symptoms by paying more attention to patients and understanding of management principles.

Keyword

Fatigue; Anorexia; Cachexia; Nausea; Vomiting; Dyspnea; Terminal care; Palliative care

MeSH Terms

Analgesics, Opioid
Anemia
Anorexia
Anxiety
Benzodiazepines
Cachexia
Comorbidity
Constipation
Delirium
Depression
Dyspnea
Education
Fatigue
Gastroparesis
Haloperidol
Humans
Hyperthyroidism
Hypogonadism
Lung Diseases
Malnutrition
Metoclopramide
Natural History
Nausea
Ondansetron
Palliative Care
Quality of Life
Stomatitis
Terminal Care
Terminally Ill*
Tetrahydrocannabinol
Uremia
Vomiting
Analgesics, Opioid
Benzodiazepines
Haloperidol
Metoclopramide
Ondansetron
Tetrahydrocannabinol