The National Institutes of Health (...

The National Institutes of Health (NIH) has released a consensus statement forward the management of cancer symptoms, including pain, depression, and fatigue. The statement was prepared at a nonfederal, nonadvocate panel of person specially versed s in the field and is an independent panel report, not an official document of the NIH or the federal command The conference, State-of-the-Science Conference onward Symptom Management in Cancer: Pain, Depression, and Fatigue, was sponsored by way of the National Cancer Institute and the Office of Medical Applications of Research of the NIH in July 2002 The total text of the statement can be set at www.consensus.nih.gov.

Because patients with cancer are living longer there is a growing be of importance to about their health-related quality of life and the quality of care they receive. About 13 million patients will be diagnosed with cancer this year, and approximately 60 percent will survive at least five years after diagnosis. Because of cancer's association with death and diminished quality of life, it is important to address the validitys of the symptoms of cancer and to shorten the burden of cancer and its treatment. The mostly common symptoms of cancer and treatment include pain, depression, and fatigue. Evidence put in mind ofs that pain is frequently undertreated, and depression and persistent lack of [i]vis viva[/i] progress as therapy becomes more aggressive. Physicians ne to be able to identify who is at risk for these cancer-related symptoms, what treatments work best to address these point to be solved [i]or[/i] settleds and how best to deliver interventions across the continuum of care.

The consensus panel addressed the following questions: What is the event of pain, depression, and fatigue, alone and in combination, in patients with cancer? What are the manners used for clinical assessment of these symptoms everywhere the course of cancer, and what is the evidence for their reliability and validity? What are the treatments for cancer-related pain, depression, and fatigue, and what is the evidence for their effectiveness? What are the impediments to effective symptom management in patients with cancer, and what are optimal strategies for overcoming these impediments?

The panel also identified several areas for coming events research, including developing conceptual protoplasts to direct research, exploring whether these symptoms differ between populations, improving the descriptive epidemiology of these symptoms, comparing simple screening strategies with more complicated screening and diagnostic approaches, evaluating novel treatments, and developing pain-specific treatment models

oftenness of Symptoms

Estimates of the common occurrence of pain, depression, and fatigue in cancer patients are not precise enough to be reliable. The estimates for pain range from 14 to 100 percent For depression, the range is 1 to 42 percent and the range for fatigue is 4 to 91 percent The report lists several reasons for the lack of consistency and weaknesses in research methodology.

Symptom Assessment

Assessment of pain, depression, and fatigue should be an important stair in the treatment of patients with cancer. A number of tools have been bring outed to help recognize and diagnose each symptom, yet only a few questionnaires assess all three simultaneously. Characteristics, similar as age, ethnicity, geographic distance from health care professionals, and coexisting conditions, also should be considered because they may affect the presentation and treatment of these symptoms. Repeated assessments should continue through the whole extent of the course of the illness.

Treating the Symptoms

Pain, depression, and fatigue are related to the underlying disease or its therapy, and they may persist in long-term survivors. Effective treatment of common of the symptoms may arise in relief of other symptoms, moreover treatment of one symptom may exacerbate another. The three-step analgesic ladder perform the operations indicated ined by the World Health Organization provides adequate pain relief for the majority of patients. The first consists of nonsteroidal anti-inflammatory put drugs intos (NSAIDs). As symptoms increase, the other tier adds a weak opioid to the NSAID. If the pain persists or worsens, the third tier substitutes a robust opioid. Around-the-clock pain medication compared with as-needed dosing may improve patient adherence and issue Discontinuation of analgesics because of adverse purports is infrequent.

Adjuvants can be administered for relief of neuropathic pain and to treat side purports of opioids. External beam radiotherapy is beneficial for patients with localized pain, and bisphosphonates may be effective for treatment of pain from bone metastases.

Adequate doses and duration of antidepressant medications in patients with cancer exhibit benefit, and cognitive-behavior and psychosocial interventions have shown a unpretending benefit in treating depression related to cancer.

Fatigue is the in the greatest degree common symptom experienced by patients with cancer, further there is little convincing evidence for effective therapies.

Impediments to Symptom Management