A Review on the Management of Symptoms in Patients with Incurable Cancer

Abstract

Palliative care aims to alleviate suffering and prioritize the quality of life of patients facing serious and fatal diseases, such as cancer. Cancer patients, especially in advanced stages, often have many difficult-to-control symptoms, such as pain, fatigue, dyspnea, anxiety, and depression, requiring the attention of a multidisciplinary team highly trained in palliative care and end-of-life management. Pain, dyspnea, nausea, and vomiting are the focus of symptomatic assessment in palliative care, but patients experience other equally important symptoms that do not receive as much attention and are often overlooked, which negatively impacts the quality of life of these patients. One of the main aims of palliative care is to provide patients with the best possible quality of life through adequate symptom control, teamwork, and psychosocial support based on the principles, values, and wishes of the patient and family. In this review, the authors summarize the management of common symptoms in patients in oncology and palliative care, as well as present a brief reflection on quality of life in this context.

Keywords: dyspnea; nausea; pain; palliative care; palliative medicine; psychological distress; quality of life; symptom assessment; symptom burden; vomiting.

Figure 2

WHO analgesic ladder for cancer pain management (with suggested 4th step). Based on WHO Guidelines and Vargas-Schaffer et al. [37].

Figure 1

Total Pain dimensions according to Dame Cicely Saunders.

Figure 3

Drugs and pharmacological combinations used in palliative sedation. Based on the Palliative Sedation Protocol (Hospice and Palliative Care Federation of Massachusetts 2004 [106]), the Waterloo Wellington Palliative Sedation Therapy Protocol (Waterloo Wellington Interdisciplinary HPC Education Committee—PST Task Force 2022 [107]), Inter-professional Palliative Symptom Management Guidelines—Refractory symptoms and palliative sedation (BC Centre for Palliative Care 2017 [104]), and 2023 EAPC Guidelines [101].