The Palliative Care of Patients With Incurable Cancer

Abstract

Background: The purpose of palliative medicine is to optimize the quality of life of patients with incurable, progressive diseases. The care delivered in actual clinical practice is not uniform and often takes insufficient account of the currently available scientific evidence.

Methods: In accordance with the methodological directives on systematic literature reviews and consensus-finding that have been issued by the German Oncology Guideline Program (Leitlinienprogramm Onkologie), a nationwide, representative group of experts updated the previously published seven chapters of the S3 (evidence-based and consensus-based) guideline and formulated new recommen- dations on a further eight topics in palliative care.

Results: Non-drug options for the treatment of fatigue include aerobic exercise and psycho-educative methods, particularly cognitive behavioral therapy. Sleep distur- bances can be treated with improved sleep hygiene and relaxation techniques, as well as with drugs: Z substances for short-term and sedating antidepressants for intermediate-term treatment. For nausea and vomiting, the first line of treatment consists of antidopaminergic drugs, such as haloperidol, or drugs with an antido- paminergic effect combined with a further receptor affinity, such as metoclopramide. For patients suffering from malignant intestinal obstruction (MIO), an important con- sideration for further treatment is whether the obstruction is complete or incomplete. Psychotherapeutic interventions are indicated for the treatment of anxiety.

Conclusion: Multiple studies have confirmed the benefit of the early integration of palliative care for achieving the goals of better symptom control and maintenance of derate quality of evidence supporting the management of certain symptoms in patients with incurable cancers.

Figure 1

Decision tree for determining on and carrying out a medical intervention. *¹ If there is reason to suspect that the patient may lack capacity, the patient’s personal representative or healthcare proxy should be involved in the decision. The role of the representative is to support the patient through the decision-making process, and to represent the patient as necessary. *² If medically desirable or if desired by the patient

Figure 2

Treatment algorithm for nausea and vomiting *http://leitlinienprogramm-onkologie.de/Supportive-Therapie.95.0.html; CNS, central nervous system; ICP, intracranial pressure

Figure 3

Forms of desire to die, according to various authors

eFigure 1

PRISMA flow diagram: This example is for the topic “efficacy of drug therapies for symptomatic treatment of malignant bowel obstruction” PRISMA, preferred reporting items for systematic reviews and meta-analyses; SysRev, systematic review

eFigure 2

Treatment options in patients with primary and secondary fatigue

eFigure 3

Staged interventions for odor control