Advanced Adrenocortical Carcinoma: From Symptoms Control to Palliative Care

Abstract

The prognosis of patients with advanced adrenocortical carcinoma (ACC) is often poor: in the case of metastatic disease, five-year survival is reduced. Advanced disease is not a non-curable disease and, in referral centers, the multidisciplinary approach is the standard of care: if a shared decision regarding several treatments is available, including the correct timing for the performance of each one, overall survival is increased. However, many patients with advanced ACC experience severe psychological and physical symptoms secondary to the disease and the cancer treatments. These symptoms, combined with existential issues, debase the quality of the remaining life. Recent strong evidence from cancer research supports the early integration of palliative care principles and skills into the advanced cancer patient’s trajectory, even when asymptomatic. A patient with ACC risks quickly suffering from symptoms/effects alongside the disease; therefore, early palliative care, in some cases concurrent with oncological treatment (simultaneous care), is suggested. The aims of this paper are to review current, advanced ACC approaches, highlight appropriate forms of ACC symptom management and suggest when and how palliative care can be incorporated into the ACC standard of care.

Prognostic predictors of adrenocortical carcinoma: A single-center thirty-year experience

“…Early introduction of palliative care along with standard treatment improved quality of life, survival and psychological burden of both patients and caregivers (29). Moreover, our study revealed a negative association between large-vessel invasion and OS, which is seldom discussed with regard to prognostic prediction in most studies.…”

Androgen serum levels in male patients with adrenocortical carcinoma given mitotane therapy: A single center retrospective longitudinal study

“…Such therapy could have an impact not only on the quality of life and perceived well-being but also on general symptoms, such as asthenia, muscle strength, bone health, and anemia ( 23 ). In addition, testosterone therapy might represent a support care against cancer-related fatigue, inappetence, cachexia, and depression ( 25 ).…”

Adrenocortical carcinoma: A tumor with poor answer to classic chemotherapy

“…As regards therapy, surgical resection remains the keystone of ACC treatment.The use of Mitotane, an adrenolytic drug, in an adjuvant setting/advanced disease might prolong the relapse-free survival (49-55% in patients treated with Mitotane vs. 70-90% in control groups) [1,11,13]. First-line systemic therapy consists of Carboplatin/Cisplatin, Doxorubicin, Etoposide, and Mitotane [11].…”