Symptom management: An important part of cancer care

Abstract

Physicians can do a better job of palliating symptoms and improving the quality of life of cancer patients if they understand the principles of symptom management. We review the general principles of symptom management for fatigue, anorexia, constipation, dyspnea, nausea, and vomiting.

Symptom Management in Metastatic Breast Cancer

“…Both nausea (the sensation of needing to vomit) and vomiting (forceful expulsion of gastric contents) decrease cancer patients' quality of life and occur in 30% (vomiting) to 60% (nausea) of cancer patients [62]. Causes of nausea and vomiting include chemotherapy, radiation therapy, and other medications; infection; anxiety; constipation; bowel obstruction; organ failure; electrolyte disturbances; uremia; impaired gastric emptying; gastric/esophageal irritation; and brain metastases [62,82].…”

“…Causes of nausea and vomiting include chemotherapy, radiation therapy, and other medications; infection; anxiety; constipation; bowel obstruction; organ failure; electrolyte disturbances; uremia; impaired gastric emptying; gastric/esophageal irritation; and brain metastases [62,82]. Antiemetics may be administered orally, s.c., i.v., sublingually, or transdermally, and multiple agents may need to be used to achieve symptom control.…”

“…Along with nausea and vomiting, patients with advanced cancer frequently report constipation (at least 50%), especially if they are being treated with opioids [28,62,85]. Prophylaxis and prevention of constipation with the goal of a soft bowel movement every 1-2 days should be initiated with the start of opioids.…”

“…The serotonin 5-HT 3 receptor antagonists and the substance P/neurokinin receptor antagonists are usually used for nausea and vomiting associated with chemotherapy or radiation, but may also be used in advanced cancer [83]. Metoclopromide, a dopamine antagonist, may be used to treat nausea associated with a noncomplete bowel obstruction (with octreotide), and lorazepam may be used to treat anticipatory or anxiety-related nausea; lorazepam also dissolves under the tongue for at home use if nausea and vomiting are present [62]. For cancer-related nausea, evidence supports the use of metoclopromide at a dose of 10 mg orally before meals and at bedtime or 10 mg orally, s.c., or i.v.…”

“…Pulmonary carcinomatous lymphangitis is common in breast cancer patients [58,59], and pulmonary infiltrates causing dyspnea may be associated with treatments (treatment-induced pneumonitis) such as radiation [60] or chemotherapy (especially with taxanes) [61]. Opioids are effective for the management of dyspnea, but are underused by physicians because of concerns about respiratory depression [62]. The American College of Physicians (ACP) recommends treatment with short-acting opioids, because several randomized controlled trials have shown the beneficial effects of systemic opioids in the control of dyspnea [63,64].…”