Hematology/oncology clinics of North America
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Depression is a common complication of advanced cancer. Methods of accurate assessment and recognition are available. Risk factors for the development of depression have been identified. Pharmacologic and nonpharmacologic treatments for depression are often effective even in patients with advanced cancer.
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Evaluation and treatment of fatigue in cancer patients requires a multidisciplinary approach because it has many possible etiologies and several contributing factors. A comprehensive approach is required, especially for patients with moderate to severe fatigue, so that all possible contributing factors can be determined and an appropriate treatment plan can be created. ⋯ The short- and long-term effects of an exercise program on the fatigue levels and overall physical performance of cancer patients should be assessed in new studies. Clearly, much more research is needed not only to identify factors responsible for the fatigue but also to develop effective interventions for cancer-related fatigue.
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There is a growing awareness and a WHO directive that the palliative care paradigm should be incorporated into the care of all children with cancer, irrespective of geographic location. The barriers to pediatric palliative care identified by pediatric oncologists [3] are lack of formal courses in pediatric palliative care, a high reliance on trial-and-error learning, lack of strong role models, and lack of access to a pain and palliative care service. These barriers must be overcome.
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Declining physical, emotional, and social function as a result of anorexia and cachexia are considerable contributors to discomfort for cancer patients and their families, and they impair the patient's ability to express optimal physical and psychosocial potential as long as possible. This decline no longer has to be accepted as an indispensable sequel to advanced cancer, just as pain is no longer considered to be unavoidable. A routine screening for anorexia and cachexia and associated symptoms is necessary, as is a careful, comprehensive assessment, because the condition is not always obvious. ⋯ Specialist palliative care services can be helpful to provide, hand-in-hand with the disease specialists [172], assessment and management of psychophysical symptoms and sociospiritual needs of patients during the course of the illness and at the end of life [173]. Research efforts aim to better characterize subgroups of patients suffering from secondary causes of anorexia and cachexia and to elucidate the mechanisms involved in the primary anorexia and cachexia syndrome. Increasingly individualized treatments are expected with combination treatments that involve different mechanisms including nutrition.
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Hematol. Oncol. Clin. North Am. · Jun 2002
ReviewCancer patients in pain: considerations for assessing the whole person.
Pain is a subjective perception that is influenced by psychosocial and behavioral factors and physical pathology. In cancer, the source of the pain may be the disease itself, the treatment, or co-occurring pain syndromes. Often, cancer is a progressive disease, and pain may be marked by exacerbations, additional treatment, and remissions. ⋯ In some circumstances, such as when patients are unwilling or unable to report on their pain, it is useful to gather information from caretakers. At a minimum, the severity, location, and pattern of pain and patients' functional activity and mood should be assessed. Timely, appropriate, and thorough assessment and treatment of cancer patients experiencing pain should reduce their suffering and improve the quality of their lives.