NIH State-of-the-Science Statement on symptom management in cancer: pain, depression, and fatigue

Abstract

Objective: To provide health care providers, patients, and the general public with a responsible assessment of currently available data regarding management of cancer symptoms such as pain, depression, and fatigue.

Participants: A non-Federal, non-advocate, 13-member panel representing the fields of psychiatry, nursing, social work, medical oncology, pediatric oncology, epidemiology, pharmacology, radiation oncology, and the public. In addition, experts in these same fields presented data to the panel and to a conference audience of approximately 300.

Evidence: Presentations by experts; a systematic review of the medical literature provided by the Agency for Healthcare Research and Quality; and an extensive bibliography of cancer symptom management research papers, prepared by the National Library of Medicine. Scientific evidence was given precedence over clinical anecdotal experience.

Conference process: Answering predefined questions, the panel drafted a statement based on the scientific evidence presented in open forum and the scientific literature. The draft statement was read in its entirety on the final day of the conference and circulated to the audience for comment. The panel then met in executive session to consider the comments received and released a revised statement at the end of the conference. The statement was made available on the World Wide Web at http://consensus.nih.gov immediately after the conference. This statement is an independent report of the panel and is not a policy statement of the NIH or the Federal Government.

Conclusions: Too many cancer patients with pain, depression, and fatigue receive inadequate treatment for their symptoms. Clinicians should use brief assessment tools routinely to ask patients about pain, depression, and fatigue and to initiate evidence-based treatments. Current evidence to support the concept of cancer symptom clusters is insufficient, and additional theoretically driven research is warranted. Research is needed on the definition, occurrence, assessment, and treatment of pain, depression, and fatigue alone and together through adequately funded prospective studies. Fear of cancer and its consequences must be ameliorated. All patients with cancer should have optimal symptom control from diagnosis throughout the course of illness, irrespective of personal and cultural characteristics. The state of the science in cancer symptom management should be reassessed periodically.