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  • Patients with cancer experience multiple symptoms that are often under-reported and not alleviated. Symptoms are often interrelated and can be both physical and/or psychological.

  • Pain expression can be modified by cognitive and psychological factors associated with advanced disease or the dying process.

  • A thorough psychosocial history, assessment of mental status, and screening with risk assessment tools for nonmedical opioid use is critical before prescribing opioid analgesics.

  • Fatigue is the most common symptom in patients with advanced cancer and its treatment is challenging in later stages of disease. Patients and families benefit from education about the burdens of both physical and emotional fatigue. It can be helpful to modify daily activities and rest to accommodate for symptoms of fatigue as well as optimizing nutrition and hydration.

  • Dyspnea is often an indicator of poor prognosis in advanced cancer. Initial management includes treating underlying causes medically when able. Palliative measures to reduce the sensation of air hunger include low flow supplemental oxygen for those with hypoxemia, opioids, or corticosteroids.

  • Anorexia and weight loss are a result of systemic inflammation and inadequate caloric intake because of cancer and are often difficult to reverse. Psychosocial support for cachectic patients and their family caregivers can help diminish patient-family distress.

  • Advanced care planning can decrease anxiety and suffering of patients and families as well as ensure autonomy for patients, especially if they become unable to express informed consent. However, it is an ongoing process that is best started early, revisited periodically, and incorporates room for change owing to unforeseen changes in the patient's clinical condition.


Cancer is frequently associated with a multitude of distressing physical and psychosocial symptoms that can occur throughout the disease trajectory.1 Access to a multidisciplinary supportive care team is imperative for patients with cancer experiencing multidimensional symptoms including pain, lack of energy, fatigue or drowsiness, dry mouth, dyspnea, anorexia and weight loss, insomnia, changes in mood, constipation, and delirium.2 Without optimal symptom control in patients, administration of anticancer therapies may be delayed or discontinued, quality of life will be diminished, and unnecessary suffering will increase (Fig. 68–1).


Multidimensional Symptoms Impacting Quality of Life.


Forty-two percent of patients seen in the outpatient cancer center1 and 50% of hospitalized patients with cancer have been reported to have uncontrolled pain.3 In patients with cancer, pain may be the only symptom present before diagnosis and can indicate the recurrence and/or spread of disease.

As many as 30% to 50% of patients receiving active anticancer therapy experience pain.1 Pain resulting from the tumor burden occurs in approximately 65% to 85% of patients with advanced cancer.4 In addition, cancer treatment with chemotherapy, radiation, or surgery accounts for the remaining etiology of pain in approximately 15% to 25 % of ...

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