Skip to main content Accessibility help
  • Print publication year: 2016
  • Online publication date: September 2016

29 - Palliative care and symptom management

from Section X - Specialized interventional techniques in cancer care


Palliative care and communication with cancer patients

Overview of palliative care

The World Health Organization defines palliative care as an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial, and spiritual. Palliative care is focused on symptom relief and maximizing function, without necessarily impacting the natural history of the underlying illness. Bereavement support is integral to its mission as it views the patient and his or her loved ones as a unit of care. Palliative care is interdisciplinary, involving not only nurses and physicians, but chaplains, psychologists, social workers, and speech, physical, occupational, and other therapists. While palliative care has historic roots in the terminal care of cancer patients, its scope encompasses a wide variety of patients with non-malignant diseases. These include neurodegenerative disorders; advanced organ disease; and patients in critical care units. Ideally, palliative care is provided to patients with severe illnesses early in the course of their disease, alongside disease-modifying or curative therapy. As an illness progresses, and as disease-modifying or even life-prolonging interventions become less available, a patient's entire care may become palliative-focused. While much of the care of patients with life-threatening illness can be described as palliative, many patients will not require specialist palliative care, and basic competency in palliative care is important for clinicians across a variety of specialties and practice types.

Palliative medicine describes the physician's role in the aforementioned care model. Besides expert symptom assessment and treatment, palliative medicine physicians offer subspecialty expertise in determining prognosis and communication encounters with patients and families involving breaking bad news, establishing goals of medical care, and planning for the future in light of a life-threatening illness. The scope of practice of palliative medicine physicians varies by location and institution. Common settings include inpatient consultative palliative care services, acute inpatient palliative care wards, outpatient palliative care clinics, cancer pain and symptom management clinics, emergency departments, nursing home palliative care services, and hospice settings. Palliative care is increasing by number of programs and prevalence among adult and pediatric hospitals such that many cancer care providers will have access to palliative care specialists if needed.

1. World Health Organization. WHO definition of palliative care. Available at: Accessed April 1, 2006.
2. Mosenthal, AC, Murphy, PA. Trauma care and palliative care: time to integrate the two? J Am Coll Surg. 2003; 197:509–516.
3. Curtis, JR, Rubenfeld, GD. Improving palliative care for patients in the intensive care unit. J Palliat Med. 2005; 8:840–854.
4. von Gunten, CF. Secondary and tertiary palliative care in US hospitals. JAMA. 2002; 287:875–888.
5. Himelstein, BP, Hilden, JM, Boldt, AM, Weissman, DE. Pediatric palliative care. NEJM. 2004; 350:1752–1762.
6. Accessed 18 Sept 2014.
7. Temel, JS, Greer, JA, Muzikansky, A, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010; 363(8):733–742
8. Casarett, D, Pickard, A, Bailey, FA, et al. Do palliative consultations improve patient outcomes? J Am Geriatr Soc. 2008; 56(4):593–599.
9. Norton, SA, Hogan, LA, Holloway, RG, et al. Proactive palliative care in the medical intensive care unit: effects on length of stay for selected high-risk patients. Critical Care Medicine. 2007; 35:1530–1535
10. Bendaly, EA, Groves, J, Juliar, B, Gramelspacher, GP. Financial impact of palliative care consultation in a public hospital. J Palliat Med 2008; 11(10):1304–1408.
11. Morrison, RS, Penrod, JD, Cassel, JB, et al. Palliative Care Leadership Centers' Outcomes Group. Cost savings associated with US hospital palliative care consultation programs. Arch Intern Med. 2008; 168(16):1783–1790.
12. Ranganathan, A, Dougherty, M, Waite, D, Casarett, D. Can palliative home care reduce 30-day readmissions? results of a propensity score matched cohort study. J Palliat Med. 2013; 16(10):1290–1293
13. Brumley, R, Enguidanos, S, Jamison, P, et al. Increased satisfaction with care and lower costs: results of a randomized trial of in-home palliative care. J Am Geriatr Soc. 2007; 55: 993–1000.
14. Morrison, RS, Meier, D. Palliative care. NEJM. 2004; 350:2582–2590.
15. Weeks, JC, Catalano, PJ, Cronin, A, et al. Patients’ expectations about effects of chemotherapy for advanced cancer. N Engl J Med. 2012; 367(17):1616–1625.
16. Schag, CC, Heinrich, RL, Ganz, PA. Karnofsky performance status revisited: reliability, validity, and guidelines. J Clin Oncol. 1984; 2:187–193.
17. Vigano, A, Dorgan, M, Jeanette, B, Bruera, E, Suarez-Almazor, ME. Survival prediction interminal cancer patients: a systematic review of the medical literature. Palliat Med. 2000; 14: 363–374.
18. Daas, N den. Estimating length of survival in end-stage cancer: a review of the literature. J Pain Symptom Manage. 1995; 10:548–555.
19. Lamont, EB, Christakis, NA. Complexities in prognostication in advancer cancer. “To help them live their lives the way they want to.” JAMA. 2003; 290:98–104.
20. Maltoni, M, Pirovano, M, Scarpi, E, et al. Prediction of survival of patients terminally ill with cancer. Results of an Italian prospective multicentric study. Cancer. 1995; 75:2613–2622.
21. Reuben, DB, Mor, V, Hiris, J. Clinical symptoms and length of survival in patients with terminal cancer. Arch Int Med. 1988; 148:1586–1591.
22. Janisch, L, Mick, R, Schilsky, RL, et al. Prognostic factors for survival in patients treated in phase I clinical trials. Cancer. 1994; 74:1965–1973.
23. Maltoni, M, Caraceni, A, Brunelli, C, et al. Prognostic factors in advanced cancer patients: evidence-based clinical recommendations – a study for the steering committee of the European Association for Palliative Care. J Clin Oncol. 2005; 23:6240–6248.
24. Ralson, SH, Gallacher, SJ, Patel, U, Campbell, J, Boyle, IT. Cancer-associated hypercalcemia: morbidity and mortality. Clinical experience in 126 treated patients. Ann Intern Med. 1990; 112:499–504.
25. Iwase, M, Kurachi, Y, Kakuta, S, et al. Clin Oral Investig. 2001; 5:194–198.
26. Siddiqui, F, Weissman, DE. Fast facts and concepts #151; Hypercalcemia of malignancy. February 2006. End-of-Life Physician Education Resource Center.
27. Khuntia, D, Brown, P, Li, J, Mehta, MP. Whole-brian radiotherapy in the management of brain metastasis. J Clin Onc. 2006; 24:1295–1304.
28. McMillan, DC. The systemic inflammation-based glasgow prognostic score: a decade of experience in patients with cancer. Cancer Treat Rev. 2013; 39(5):534–540.
29. Gripp, S, Moeller, S, Bolke, E, et al. Survival prediction in terminally ill cancer patients by clinical estimates, laboratory tests, and self-rated anxiety and depression. J Clin Oncol. 2007; 25(22):3313–3320.
30. Christakis, NA, Lamont, EB. Extent and determinants of error in physicians’ prognoses in terminally ill patients: prospective cohort study. West J Med. 2000; 172(5):310–313.
31. Glare, P, Virik, K, Jones, M, et al. A systematic review of physicians’ survival predictions in terminally ill cancer patients. BMJ. 2003; 327:195–201.
32. Christakis, NA, Lamont, EB. Extent and determinants of error in doctors’ prognoses in terminally ill patients: prospective cohort study. BMJ. 2000; 320:469–473.
33. Lamont, EB, Christakis, NA. Prognostic disclosure to patients with cancer near the end of life. Ann Int Med. 2001; 134:1096–1105.
34. Hagerty, RG, Butow, PN, Ellis, PM, Dimitry, S, Tattersall, MH. Communicating prognosis in cancer care: a systematic review of the literature. Ann Oncol. 2005; 16:1005–1053.
35. Randall, TC, Wearn, AM. Receiving bad news: patients with haematological cancer reflect upon their experience. Palliat Med. 2005; 19:594–601.
36. Weissman, DE. Fast facts and concepts #13; Determining prognosis in advanced cancer. 2nd Edition, July 2005. End-of-Life Palliative Education Resource Center.
37. Ambuel, B, Weissman, DE. Fast facts and concepts #6; Delivering bad news: part 1. 2nd Edition, July 2005. End-of-Life Palliative Education Resource Center.
38. Ambuel, B, Weissman, DE. Fast facts and concepts #11; Delivering bad news; part 2. 2nd Edition, September 2005. End-of-Life Palliative Education Resource Center.
39. Weissman, DE. Decision making at a time of crisis near the end of life. JAMA. 2004; 292:1738–1743.
40. Lussier, D, Huskey, AF, Portenoy, RK. Adjuvant analgesics in cancer pain management. The Oncol. 2004; 9:571–591.
41. Mercadante, S, Portenoy, RK. Opioid poorly-responsive cancer pain. Part 1: clinical considerations. J Pain Symptom Manage. 2001; 21:144–150.
42. Thomas, JR, Gunten, CF von. Pain in terminally ill patients. Guidelines for pharmacological management. CNS Drugs. 2003; 17:621–631.
43. Cherny, NI. Cancer pain: principles of assessment and syndromes. In: Berger, AM, Portenoy, RK, Weissman, DE, eds. Principles and Practice of Palliative Care and Supportive Oncology, 2nd edition. New York, NY: Lippincott Williams and Wilkins; 2002:3–52.
44. Menefee, LA, Monti, DA. Nonpharmacologic and complementary approaches to cancer pain management. J Am Osteopath Assoc. 2005; 105:S15–20.
45. Hillard, RE. Music therapy in hospice and palliative care: a review of the empirical data. eCAM. 2005; 2:173–178.
46. Mercadante, S, Casuccio, A, Agnello, A, Pumo, S, et al. Analgesic effects of nonsteroidal anti-inflammatory drugs in cancer pain due to somatic or visceral mechanisms. J Pain Symptom Manage. 1999; 17:351–356.
47. Mercadante, S, Fulfaro, F, Casuccio, A. A randomized controlled study on the use of anti-inflammatory drugs in patients with cancer pain on morphine therapy: effects on dose-escalation and a pharmacoeconomic analysis. Eu J Cancer. 2002; 38:1358–1363.
48. Davis, MP, Walsh, D, Lagman, R, LeGrand, SB. Controversies in pharmacotherapy of pain management. Lancet Oncol. 2005; 6:696–704.
49. Leppert, W, Luczak, J. The role of tramadol in cancer pain treatment – a review. Supp Care Cancer. 2005; 13:5–17
50. Hanks, GW, Conno, F de, Cherny, N, et al. Morphine and alternative opioids in cancer pain: the EAPC recommendations. Br J Cancer. 2001; 84:587–593
51. Gutstein, HB, Akil, H. Opioid analgesics. In: Hardman, JG, Limbird, LE, eds. Goodman and Gilman's: the Pharmacological Basis of Therapeutics, 10th Ed. New York, NY: McGraw-Hill; 2001:569–619.
52. Weissman, DE. Fast facts and concepts #71: Meperidine for pain: What's all the fuss? June 2002. End-of-Life Physician Education Resource Center.
53. Aranoff, GM, Brennan, MJ, Douglas, PD, Ginsberg, B. Evidence-based oral transmucosal fentanyl citrate (OTFC) dosing guidelines. Pain Med. 2005; 6: 305–314.
54. Bruera, E, Sweeney, C. Methadone use in cancer patients with pain: a review. J Palliative Med. 2002; 5:127–138.
55. Gordon DB, Weissman DE. Fast facts and concepts #70: PRN range analgesic orders. June 2002. End-of-Life Physician Education Resource Center.
56. Quigley, C. The role of opioids in cancer pain. BMJ. 2005; 331:825–829.
57. Dean, M. Opioids in renal failure and dialysis patients. J Pain Symptom Manage. 2004; 28:497–504.
58. Paice, JA, Toy, C, Shott, S. Barriers to cancer pain relief: fear of tolerance and addiction. J Pain Symptom Manage. 1998; 16:1–9.
59. Sloan, P, Melzack, R. Long-term patterns of morphine dose and pain intensity among cancer patients. Hosp J. 1999; 14:35–47.
60. Collin, E, Poulain, P, Gauvain-Piquard, A, et al. Is disease progression the major factor in morphine ‘tolerance’ in cancer pain treatment? Pain. 1993; 55:319–326.
61. National Cancer Institute. Substance Abuse Issues In Cancer (PDQ). Available at: Accessed April 1, 2006.
62. Passik, SD, Kirsh, KL, Caspar, D. Addiction-related assessment tools and pain management: instruments for screening, treatment planning, and monitoring compliance. Pain Med 2008; 9:S145–166
63. Chou, R, Fanciullo, GJ, Fine, PG, Miaskowski, C, Passik, SD, Portenoy, RK. Opioids for chronic noncancer pain: prediction and identification of aberrant drug-related behaviors: a review of the evidence for an American Pain Society and American Academy of Pain Medicine Clinical Practice Guideline. J Pain. 2009; 10(2):131–146
64. Claxton, R, Arnold, R. Screening for opioid misuse and abuse. Fast Facts and Concepts. August 2011; 244.
65. [Anonymous]. Management of chronic pain syndromes: issues and interventions. Pain Med. 2005; 6: S1–S21.
66. Caraceni, A, Zecca, E, Bonezzi, C, et al. Gabapentin for neuropathic cancer pain: a randomized controlled trial from the gabapentin cancer pain study group. J Clin Oncol. 2004; 22:2909–2917.
67. McDonald, AA, Portenoy, RK. How to use antidepressants and anticonvulsants as adjuvant analgesics in the treatment of neuropathic cancer pain. J Supp Oncol. 2006; 4:43–52.
68. Smith, EM, Pang, H, Cirrincione, C, et al. Effect of duloxetine on pain, function, and quality of life among patients with chemotherapy-induced painful peripheral neuropathy: a randomized clinical trial. JAMA. 2013; 309(13):1359–1367.
69. Hanks, GW. The pharmacological treatment of bone pain. Cancer Surv. 1988; 7:87–101.
70. Hamouda, WE, Roshdy, W, Teema, M. Single versus conventional fractionated radiotherapy in the palliation of painful bone metastases. Gulf J Oncolog. 2007; 1(1):35–41.
71. Hayashi, S, Tanaka, H, Hoshi, H. External beam radiotherapy for painful bone metastases from hepatocellular carcinoma: multiple fractions compared with an 8-gy single fraction. Nagoya J Med Sci. 2014; 76(1–2):91–99.
72. Wu, JS, Wong, R, Johnston, M, Bezjak, A, Whelan, T, Cancer Care Ontario Practice Guidelines Initiative Supportive Care Group. Meta-analysis of dose-fractionation radiotherapy trials for the palliation of painful bone metastases. Int J Radiat Oncol Biol Phys. 2003; 55(3):594–605.
73. Callstrom, MR, Charboneau, JW. Percutaneous ablation: safe, effective treatment of bone tumors. Oncology (Williston Park). 2005; 19(11 Suppl 4):22–26.
74. Posteraro, AF, Dupuy, DE, Mayo-Smith, WW. Radiofrequency ablation of bony metastatic disease. Clin Radiol. 2004; 59(9):803–811.
75. Finlay, IG, Mason, MD, Shelley, M. Radioisotopes for the palliation of metastatic bone cancer: a systematic review. Lancet Oncol. 2005; 6:392–400.
76. Posteraro, AF, Dupuy, DE, Mayo-Smith, WW. Radiofrequency ablation of bony metastatic disease. Clin Radiol. 2004; 59:803–811.
77. Hacein-Bey, L, Baisden, JL, Lemke, DM, et al. Treating osteoporotic and neoplastic vertebral compression fractures with vertebroplasty and kyphoplasty. J Palliat Med. 2005; 8:931–938.
78. Elkersh, MA, Simopoulos, TT, Bajwa, ZH. Fundamentals of interventional pain medicine. The Neurol. 2005; 11:285–293.
79. Wong, GY, Schroeder, DR, Carns, PE. Effect of neurolytic celiac plexus block on pain relief, quality of life, and survival in patients with unresectable pancreatic cancer. A randomized controlled trial. JAMA. 2004; 291:1092–1099.
80. Davis, MP, Walsh, D. Treatment of nausea and vomiting in advanced cancer. Support Care Cancer. 2000; 8:444–452.
81. Boer-Dennert, M de, Wit, R de, Schmitz, PI, et al. Patient perceptions of the side-effects of chemotherapy: the influence of 5HT3 antagonists. Br J Cancer. 1997; 76:1055–61.
82. Aapro, M. 5-HT3-receptor antagonists in the management of nausea and vomiting in cancer and cancer treatment. Oncology. 2005; 69:97–109.
83. Olver, IN. Update on anti-emetics for chemotherapy-induced emesis. Intern Med J. 2005; 35:478–481.
84. Hesketh, PJ, Grunberg, SM, Gralla, RJ, et al. The oral neurokinin-1 antagonist aprepitant for the prevention of chemotherapy-induced nausea and vomiting: a multinational, randomized, double-blind, placebo-controlled trial in patients receiving high-dose cisplatin – the Aprepitant Protocol 052 Study Group. J Clin Oncol. 2003; 21:4077–4080.
85. Herrstedt, J, Muss, HB, Warr, DG, et al. Efficacy and tolerability of aprepitant for the prevention of chemotherapy-induced nausea and emesis over multiple cycles of moderately emetogenic chemotherapy. Cancer. 2005; 104:1548–1555.
86. Hocking, CM, Kichenadasse, G. Olanzapine for chemotherapy-induced nausea and vomiting: a systematic review. Support Care Cancer. 2014; 22(4):1143–1151
87. Chung, F, Lane, R, Spraggs, C, et al. Ondansetron is more effective than metoclopramide for the tratement of opioid-induced emesis in post-surgical adult patients. Ondansetron OIE Post-Surgical Study Group. Eur J Anaesthesiol. 1999; 16:669–677.
88. Glare, P, Pereira, G, Kristjanson, LJ, Stocker, M, Tattersall, M. Systematic review of the efficacy of antiemetics in the treatment of nausea in patients with far-advanced cancer. Supp Care Cancer. 2004; 12:432–440.
89. Bruera, E, Seifert, L, Watanabe, S, et al. Chronic nausea in advancer cancer patients: a retrospective assessment of a metoclopramide-based antiemetic regimen. J Pain Symptom Manage. 1996; 11:147–153.
90. Mystakidou, K, Befon, S, Liossi, C, Vlachos, L. Comparison of the efficacy and safety of tropisetron, metoclopramide, and chlorpromazine in the treatment of emesis associated with far advanced cancer. Cancer. 1998; 83:1214–1243.
91. Critchley, P, Plach, N, Grantham, M, et al. Efficacy of haloperidol in the treatment of nausea and vomiting in the palliative patient: a systematic review. J Pain Symptom Manage. 2001; 22:631–634.
92. Passik, SD, Lundbert, J, Kirsh, KL. A pilot exploration of the antiemetic activity of olanzapine for the relief of nausea in patients with advanced cancer and pain. J Pain Symptom Manage. 2002; 23:526–532.
93. Passik, SD, Kirsh, KL, Theobald, DE, et al. A retrospective chart review of the use of olanzapine for the prevention of delayed emesis in cancer patients. J Pain Symptom Manage. 2003; 25:485–488.
94. Navari, RM, Einhorn, LH, Passik, SD, et al. A phase II trial of olanzapine for the prevention of chemotherapy-induced nausea and vomiting: a Hoosier Oncology Group study. Supp Care Cancer. 2005; 13:529–534.
95. Mizukami, N, Yamauchi, M, Koike, K, et al. Olanzapine for the prevention of chemotherapy-induced nausea and vomiting in patients receiving highly or moderately emetogenic chemotherapy: a randomized, double-blind, placebo-controlled study. J Pain Symptom Manage. 2014; 47(3):542–550.
96. Basch, E, Prestrud, AA, Hesketh, PJ, et al. Antiemetics: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2011; 29(31):4189–4198.
97. Navari, RM, Nagy, CK, Gray, SE. The use of olanzapine versus metoclopramide for the treatment of breakthrough chemotherapy-induced nausea and vomiting in patients receiving highly emetogenic chemotherapy. Supp Care Cancer. 2013; 21(6):1655–1663.
98. Tramer, MR, Carroll, D, Campbell, FA, Reynolds, DJ, Moore, RA, McQuay, HJ. Cannabinoids for control of chemotherapy induced nausea and vomiting: quantitative systematic review. BMJ. 2001; 323:1–8.
99. Walsh, D, Nelson, KA, Mahmoud, FA. Established and potential therapeutic applications of cannabinoids in oncology. Supp Care Cancer. 2003; 11:137–143.
100. Accessed June 23, 2014.
101. Swift, W, Gates, P, Dillon, P. Survey of Australians using cannabis for medical purposes. Harm Reduct J. 2005; 2:18.
102. Walsh, Z, Callaway, R, Belle-Isle, L, et al. Cannabis for therapeutic purposes: patient characteristics, access, and reasons for use. Int J Drug Policy. 2013; 24(6):511–516.
103. Bowles, DW, O'Bryant, CL, Camidge, DR, Jimeno, A. The intersection between cannabis and cancer in the United States. Crit Rev Oncol Hematol. 2012; 83(1):1–10.
104. Malik, IA, Khan, WA, Qazilbash, M, Ata, E, Butt, A, Khan, MA. Clinical efficacy of lorazepam in prophylaxis of anticipatory, acute, and delayed nausea and vomiting induced by high doses of cisplatin. A prospective randomized trial. Am J Clin Oncol. 1995; 18:170–175.
105. Ezzo, J, Vickers, A, Richardson, MA, et al. Acupuncture-point stimulation for chemotherapy-induced nausea and vomiting. J Clin Onc. 2005; 23:7188–7198.
106. Roscoe, JA, Morrow, GR, Hickok, JT, et al. The efficacy of acupressure and acustimulation wrist bands for the relief of chemotherapy-induced nausea and vomiting. A University of Rochester Cancer Center Community Clinical Oncology Program multicenter study. J Pain Symptom Manage. 2003; 26:731–742.
107. , I, Bruera, E. Constipation in advanced cancer patients. Supp Care Cancer. 1998; 6:356–364.
108. Homsi, J, Walsh, D, Rivera, N, et al. Symptom evaluation in palliative medicine: patients report vs systematic assessment. Supp Care Cancer. 2006; 14:444–453.
109. Fallon, M, O'Neill, B. ABC of palliative care: constipation and diarrhoea. BMJ. 1997; 315:1293–1296.
110. Tamayo, AC, Diaz-Zuluaga, PA. Management of opioid-induced bowel dysfunction in cancer patients. Supp Care Cancer. 2004; 12:613–618.
111. Allan, L, Richarz, U, Simpson, K, Slappendel, R. Transdermal fentanyl versus sustained release oral morphine in strong-opioid naïve patients with chronic low back pain. Spine. 2005; 30:2484–2490.
112. Meissner, W, Schmidt, U, Hartmann, M, Kath, R, Reinhart, K. Oral naloxone reverses opioid-associated constipation. Pain. 2000; 84:105–109.
113. Sykes, NP. An investigation of the ability of oral naloxone to correct opioid-related constipation in patients with advanced cancer. Palliat Med. 1996; 10:135–44.
114. Clemens, KE, Faust, M, Jaspers, B, Mikus, G. Pharmacological treatment of constipation in palliative care. Curr Opin Support Palliat Care. 2013; 7(2):183–191.
115. Thomas, J, Karver, S, Cooney, GA, et al. Methylnaltrexone for opioid-induced constipation in advanced illness. N Engl J Med. 2008; 358(22):2332–2343.
116. Portenoy, RK, Thomas, J, Boatwright, ML Moehl, et al. Subcutaneous methylnaltrexone for the treatment of opioid-induced constipation in patients with advanced illness: a double-blind, randomized, parallel group, dose-ranging study. J Pain Symptom Manage. 2008; 35(5):458–468.
117. Yavuzsen, T, Davis, MP, Walsh, D, LeGrand, S, Lagman, R. Systematic review of the treatment of cancer–associated anorexia and weight loss. J Clin Oncol. 2005; 23:8500–8511.
118. Body, JJ. The syndrome of anorexia–cachexia. Curr Opin Oncol. 1999; 11:225–260.
119. MacDonald, N. Is there evidence for earlier intervention in cancer-associated weight loss? J Supp Oncol. 2003; 1:279–286.
120. Wilcock, A. Anorexia: a taste of things to come? Palliat Med. 2006; 20:43–45.
121. Simons, JP, Schols, AM, Hoefnagels, JM, Westerterp, KR, Velde, GP ten, Wouters, EF. Effects of medroxyprogesterone acetate on food intake, body composition, and resting energy expenditure in patients with advanced, nonhormone-sensitive cancer: a randomized, placebo-controlled trial. Cancer. 1998; 82:553–560.
122. Desport, JC, Gory-Delabaere, G, Blanc-Vincent, MP, et al. Standards, options, and recommendations for the use of appetite stimulants in oncology (2000). Br J Cancer. 2003; 89:S98–S100.
123. Sood, A, Moynihan, TJ. Cancer-related fatigue: an update. Curr Oncol Rep. 2005; 7:277–282.
124. Raison, CL, Miller, AH. Depression in cancer: new developments regarding diagnosis and treatment. Biol Psychiat. 2003; 54:283–294.
125. Hickok, JT, Roscoe, JA, Morrow, GR, Mustian, K, Okunieff, P, Bole, CW. Frequency, severity, clinical course, and correlates of fatigue in 372 patients during 5 weeks of radiotherapy for cancer. Cancer. 2005; 104:1772–1778.
126. Ahlberg, K, Ekman, T, Gaston-Johansson, F, Mock, V. Assessment and management of cancer-related fatigue in adults. Lancet. 2003; 362:640–650.
127. Adamsen, L. Midtgaard, J, Andersen, C, Quist, M, Moeller, T, Roerth, M. Transforming the nature of fatigue through exercise: qualitative findings from a multidimensional exercise programme in cancer patients undergoing chemotherapy. Eur J Cancer Care. 2004; 13:362–370.
128. Patrick, D, Gagnon, DD, Zagari, MJ, et al. Assessing the clinical significance of health-related quality of life (HRQoL) improvements in anaemic cancer patients receiving epoetin alfa. Eur J Cancer 2003; 39:335–345.
129. Mock, V. Evidence-based treatment for cancer-related fatigue. J Natl Cancer Inst Monograph. 2004; 32:112–118.
130. Smith, RE. Erythropoietic agents in the management of cancer patients. Part 1: Anemia, quality of life, and possible effects on survival. J Supp Oncol. 2003; 1:249–258.
131. Munch, TN, Zhang, T, Wiley, J, Palmer, JL, Bruera, E. The association between anemia and fatigue in patients with advanced cancer receiving palliative care. J Palliat Med. 2005; 8:1144–1149.
132. Monti, M, Castellani, L, Berlusconi, A, Cunietti, E. Use of red blood cell transfusions in terminally ill cancer patients admitted to a palliative care unit. J Pain Symptom Manage. 1996; 12:18–22.
133. Bruera, E, Driver, L, Barnes, EA. Patient-controlled methylphenidate for the management of fatigue in patients with advancer cancer: a preliminary report. J Clin Oncol. 2003; 21:4439–4443.
134. Schwartz, AL, Mori, M, Gao, R, Nail, LM, King, ME. Exercise reduces daily fatigue in women with breast cancer receiving chemotherapy. Med Sci Sports Exerc. 2001; 33:718–723.
135. Dimeo, FC, Stieglitz, RD, Novelli-Fischer, U, Fetscher, S, Keul, J. Effects of physicial activity on the fatigue and psychologic status of cancer patients during chemotherapy. Cancer. 1999; 85:2273–2277.
136. Iop, A, Manfredi, AM, Bonura, S. Fatigue in cancer patients receiving chemotherapy: an analysis of published studies. Ann Oncol. 2004; 15:712–720.
137. Covey, AM. Management of malignant pleural effusions and ascites. J Supp Oncol. 2005; 3:169–176.
138. Garrison, RN, Kaelin, LD, Galloway, RH, Heuser, LS. Malignant ascites. Clinical and experimental observations. Ann Surg. 1986; 203:644–651.
139. Runyon, BA, Hoefs, JC, Morgan, TR. Ascitic fluid analysis in malignancy-related ascites. Hepatol. 1988; 8:1104–1109.
140. Lee, CW, Bociek, G, Faught, W. A survey of practice in management of malignant ascites. J Pain Symptom Manage. 1998; 16:96–101.
141. Marrero, J, Martinez, FJ, Hyzy, R. Advances in critical care hepatology. Am J Respir Crit Care Med. 2003; 168:1421–1426.
142. Aass, N, Fossa, SD, Dahl, AA, Moe, TJ. Prevalence of anxiety and depression in cancer patients seen at the Norwegian Radium Hospital. Eur J Cancer. 1997; 33:1597–604.
143. Pirl, WF. Evidence report on the occurrence, assessment, and treatment of depression in cancer patients. J Natl Cancer Inst Monograph. 2004; 32:32–39.
144. Stiefel, F, Trill, MD, Berney, A, Olarte, JM, Razavi, D. Depression in palliative care: a pragmatic report from the Expert Working Group of the European Association for Palliative Care. Supp Care Cancer. 2001; 9:477–488.
145. Ebmeier, KP, Donaghey, C, Steel, JD. Recent developments and current controversies in depression. Lancet. 2006; 367:153–167.
146. Goodwin, JS, Zhang, DD, Ostir, GV. Effect of depression on diagnosis, treatment, and survival of older women with breast cancer. J Am Geri Soc. 2004; 52:106–111.
147. Hjerl, K, Andersen, EW, Keiding, N, Mouridsen, HT, Mortensen, PB, Jorgensen, T. Depression as a prognostic factor for breast cancer mortality. Psychosomat. 2003; 44:24–30.
148. Passik, SD, Dugan, W, McDonald, MV, Rosenfeld, B, Theobald, DE, Edgerton, S. Oncologists’ recognition of depression in their patients with cancer. J Clin Oncol. 1998; 16:1594–1600.
149. Periyakoil, VJ. Fast facts and concepts #43: Is it grief or depression? August 2005. 2nd edition. End-of-Life Physician Education Resource Center.
150. Chochinov, HM, Wilson, KG, Enns, M, Lander, S. “Are you depressed?” Screening for depression in the terminally ill. Am J Psychiat. 1997; 154:674–676.
151. Arnold, RA. Fast fact and concept #146: Screening for depression in palliative care. December 2005. End-of-Life Physician Education Resource Center.
152. Holland, JC, Morrow, GR, Schmale, A, et al. A randomized clinical trial of alprazolam versus progressive muscle relaxation in cancer patients with anxiety and depressive symptoms. J Clin Oncol. 1991; 9:1004–1011.
153. Sheard, T, Maguire, P. The effect of psychological interventions on anxiety and depression in cancer patients: results of two meta-analyses. Br J Cancer. 1999; 80:1770–1780.
154. Thase, ME, Greenhouse, JB, Frank, E, et al. Treatment of major depression with psychotherapy or psychotherapy–pharmacotherapy combinations. Arch Gen Psychiatry. 1997; 54:1009–15.
155. Temel, JS, Greer, JA, Muzikansky, A, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010; 363(8):733–742.
156. Clark, DB, Andrus, MR, Byrd, DC. Drug interactions between linezolid and selective serotonin reuptake inhibitors: case report involving sertraline and review of the literature. Pharmacother. 2006; 25:269–276.
157. Weinrieb, RM, Auriacombe, M, Lynch, KG, Lewis, JD. Selective serotonin re-uptake inhibitors and the risk of bleeding. Expert Opin Drug Safety. 2005; 4:337–344.
158. Kroenke, K, Messina, N, Benattia, I, Graepel, J, Musgnung, J. Vanlafaxine extended release in the short-term treatment of depressed and anxious primary care patients with multisomatoform disorder. J Clin Psychiat. 2006; 67:72–80.
159. Raskin, J, Pritchett, YL, Wang, F, et al. A double-blind, randomized multicenter trial comparing duloxetine with placebo in the management of diabetic peripheral neuropathic pain. Pain Med. 2005; 6:346–356.
160. Theobald, DE, Kirsh, KL, Holtsclaw, E, Donaghy, K, Passik, SD. An open-label, crossover trial of mirtazapine (15 and 30 mg) in cancer patients with pain and other distressing symptoms. J Pain Symptom Manage. 2002; 23:442–447.
161. Pereira, J, Bruera, E. Depression with psychomotor retardation: diagnostic challenges and the use of psychostimulants. J Palliat Med. 2001; 4:15–21.
162. Burgess, C, Cornelius, V, Love, S, Graham, J, Richards, M, Ramierez, A. Depression and anxiety in women with early breast cancer: five year observational cohort study. BMJ. 2005; 330:702.
163. Hipkins, J, Whitworth, M, Tarrier, N, Jayson, G. Social support, anxiety and depression after chemotherapy for ovarian cancer: a prospective study. Br J Health Psychol. 2004; 9:569–581.
164. Fowler, JM, Carpenter, KM, Gupta, P, Golden-Kreutz, DM, Andersen, BL. The gynecologic oncology consult: symptom presentation and concurrent symptoms of depression and anxiety. Obstet Gynecol. 2004; 103:1211–1217.
165. Fellowes, D, Barnes, K, Wilkinson, S. Aromatherapy and massage for symptom relief in patients with cancer. Cochrane Database of Systematic Reviews. (2): CD002287, 2004.
166. Sloman, R. Relaxation and imagery for anxiety and depression control in community patients with advanced cancer. Cancer Nurs. 2002; 25:432–435.
167. Bottomley, A. Anxiety and the adult cancer patient. Eur J Cancer Care. 1998; 7:217–224.
168. Goodman, WK. Selecting pharmacotherapy for generalized anxiety disorder. J Clin Psychiat. 2004; 65:S8–S13.