Symptoms In Advanced Cancer Patients Research Articles

COGNITIVE BEHAVIORAL THERAPY MAY ALLEVIATE ANXIETY AND DEPRESSIVE SYMPTOMS IN ADVANCED CANCER PATIENTS

COGNITIVE BEHAVIORAL THERAPY MAY ALLEVIATE ANXIETY AND DEPRESSIVE SYMPTOMS IN ADVANCED CANCER PATIENTS

Dimensions of spiritual well-being in relation to physical and psychological symptoms: a cross-sectional study of advanced cancer patients admitted to a palliative care unit

ObjectivesAdvanced cancer patients face various symptoms, which can cause physical and psychological distress. As a multidimensional construct, spiritual well-being (SWB) may be an inner resource for dealing with these problems. Our study explored the impact of different dimensions of SWB on physical and psychological symptoms in advanced cancer patients admitted to a palliative care unit.MethodsThis cross-sectional study was conducted among 108 advanced cancer patients in the Hospice Ward, Shengjing Hospital of China Medical University. Patients completed questionnaires on SWB and cancer-related symptoms (insomnia, fatigue, pain, depression and anxiety) at the time of admission. Linear regression analysis was applied to determine the relationship between SWB (meaning, peace and faith) and symptom distress.ResultsSWB accounted for an additional variance of cancer-related symptoms (17.8% to 44.4%). Meaning was negatively associated with insomnia (β = -0.516, p < 0.001) and fatigue (β = -0.563, p < 0.001). Peace and faith were related to lower psychological symptoms, while meaning represented a positive effect on anxiety (β = 0.275, p = 0.036). Higher peace was associated with lower cancer pain (β = -0.422, p < 0.001).ConclusionsOur findings suggested that achieving peace and faith appeared to function consistently as a positive resource for advanced cancer patients on depression, anxiety and pain, while meaning may serve to facilitate or hinder positive adjustment. Future studies should focus on the potential clinical implications by identifying the distinct dimension of SWB as symptom management targets in the palliative care practice.

Symptom frequency in patients with advanced cancer admitted to a palliative care unit in the Islamic Republic of Iran

Background: Symptoms and their severity are among the main causes of suffering in patients with advanced cancer. Although knowledge of symptom prevalence is important for clinical practice, little is known about the frequency of symptoms in advanced cancer patients. Aims: To identify the most frequent cancer-related symptoms in a palliative care unit in the Islamic Republic of Iran. Methods: A cross-sectional study was conducted on patients with advanced cancer admitted to the Palliative Care Unit at Imam Khomeini Hospital, Tehran, between March 2019 and March 2020. We collected data from 387 patients’ records, including age, sex, cancer type, reported symptoms, and pain intensity. Pain intensity was measured using a numeric rating scale of no pain (0), mild (1 or 2), moderate (3–6), and severe (7–10). Results: Gastric (16.02%), breast (13.95%), colon (11.60%), ovarian (8.79%), and lung (5.94%) were the most frequent cancers. Patients reported 2582 symptoms. The most frequent symptoms were pain (91.2%), anorexia (86.7%), oral thrush (69.3%), nausea (55.6%), constipation (53.7%), fatigue (45.5%), and vomiting (40.1%). Based on pain intensity measurement, 72.2% of patients reported severe, 17.0% moderate, and 10.8% mild pain. Pain intensity and symptom frequency did not differ significantly by age, sex, and type of cancer. Conclusion: Cancer patients reported multiple symptoms. In the Islamic Republic of Iran, with limited palliative care services, these findings can guide palliative care centre doctors and nurses in symptom management

Nurse AMIE: Addressing symptoms in rural patients with advanced cancer.

TPS12148 Background: Prior research has shown that monitoring symptoms in advanced cancer patients may provide a survival benefit. Monitoring is a labor-intensive process that requires nursing staff response and visiting a medical office. This may be more challenging in rural areas, given staffing challenges and distances traveled for care. Lower density of supportive care services has been documented in rural as compared to urban settings in Pennsylvania and West Virginia. We have developed a computer tablet-based supportive care program, called Nurse AMIE, and are investigating its use in symptom management among cancer survivors. Our hypothesis is that a tablet-based supportive care program can improve overall survival of advanced cancer patients in rural Pennsylvania and West Virginia. Methods: This randomized controlled trial will recruit 344 patients residing in a rural county or zip code (RUCC 4-9 or RUCA 4-10) in Pennsylvania or West Virginia, who receive treatment for stage III-IV cancer, are 18 years or older, ECOG 0-3, are fluent in written and spoken English, have sufficient vision/hearing to interact with a computer tablet and staff, and have a clinician-defined life expectancy of 6 months or more. Exclusion criteria: patients on active treatment or behavioral or supportive care trials, or with medical or psychiatric conditions that would impair ability to test study hypotheses. Patients will be randomized on a 1:1 basis to receive either Nurse AMIE or a binder with written supportive care materials. Intervention participants will be asked to log into Nurse AMIE daily, where they will interact with a nurse avatar and answer symptom questions (focusing on sleep, fatigue, pain, and distress). They will receive an empathic response to symptoms and be offered evidence based, guideline concordant self-care interventions to address symptoms (including exercise, nutrition, guided meditation, cognitive behavioral therapy videos, and soothing music). Once weekly, patients will answer 21 questions from the Pro-CTCAE survey. All symptom data will be loaded into a dashboard reviewed daily by study staff. Pain or distress scores of 7+ (out of 10) will be communicated to the care team through the EMR. The trial is powered to detect a 19% difference in overall survival at 2 years follow-up (based on Denis et al JAMA 2019). Secondary outcomes include incidence of chemotherapy toxicities, patient reported outcomes, and cost effectiveness. Enrollment is anticipated to start in March 2022. A community advisory board of 12 cancer patients and stakeholders meet on a quarterly basis to provide feedback on study activities (e.g., usability testing, adaptations, overall implementation) and ensure the project responds to the needs and preferences of rural cancer patients in Pennsylvania and West Virginia. NIH R01-CA254659. Clinical trial information: NCT05221606.

The frequency and predictors of end-of-life symptom in patients with advanced cancer.

e24061 Background: Advanced cancer patients complain of highly distressing symptom at the end-of-life, and important reasons for palliative intervention to relive symptoms. Methods: We analyzed 1282 patients who died of advanced cancer from August 2011 to August 2019 retrospectively. We divided into patients who complain of symptom include fatigue, dyspnea, nausea and vomiting, and cancer pain, or didn’t for 3 days prior to death, and analyzed predictors by multiple logistics method. The primary endpoint of this study was to identify frequency and predictors of end-of-life symptoms in advanced cancer patients. Results: As a background, the median age is 73 years old, 690 males, 592 females, 227 gastroesophageal cancers, 250 biliary pancreatic cancers, 54 hepatocellular carcinomas, 189 colorectal cancer, 251 lung cancers, 71 breast cancers, 58 urological malignancies, 60 gynecological malignancies, 47 head and neck cancer, 31 hematological malignancies, and 22 sarcomas. Number of patients who complained of dyspnea, fatigue, nausea and vomiting, and cancer pain were 235 (18.3%), 318 (24.8%), 81 (6.3%), and 322 (25.1%) at the end-of-life. In a multivariate analysis, peritoneal metastasis (ORs 1.812), with mental (ORs 0.549), palliative referral (ORs 0.680), Eastern Cancer Organization Group Performance Status (ECOG-PS) (OR0.679) and consciousness level (ORs 0.610) was independent predictors in patients with fatigue at the end-of-life. Chest cancer (Odds Ratio 2.635), lung (ORs 2.159), brain (ORs 0.431) and peritoneal metastasis (ORs 0.602), with mental (ORs 0.429), respiratory (ORs 1.960) and metabolic disorder (ORs 0.520), palliative referral (ORs 0.645) and consciousness level (ORs 0.468) was independent predictors in patients with dyspnea. Lung metastasis (ORs 0.480, peritoneal metastasis (ORs 1.812), with anti-cancer therapy (OR 2.244) and consciousness level (ORs 0.610) was independent predictors in patients with nausea and vomiting. Brain metastasis (ORs 0.435, liver metastasis (ORs 1.374), and consciousness level (ORs 0.599) was independent predictors in patients with cancer pain. Conclusions: We reported frequency and independent predictors of end-of-life symptoms in advanced cancer patients. Information on these predictors be useful to explaining about their end-of-life in advance.

Prevalence and associated factors of orphan symptoms in advanced cancer patients: a multicenter observational study.

The aims of this study were to examine the prevalence of myoclonus, sweating, pruritus, hiccup, and vesical and rectal tenesmus, and to explore associated factors in patients with advanced cancer. This multicenter prospective cohort study was conducted in 23 inpatient hospices/palliative care units in Japan from January to December 2017. The prevalence and characteristics of each symptom were assessed on admission and in the 3 days before death. We selected factors that might influence the occurrence of each symptom and investigated the association. A total of 1896 patients were enrolled. The prevalence of orphan symptoms rose from admission to the 3 days before death: myoclonus 1.3 to 5.3% (95% CI 0.9-1.9%/4.3-6.5%), sweating 1.8 to 4.1% (95% CI 1.3-2.6%/3.1-5.1%), hiccup 1.1 to 1.8% (95% CI 0.7-1.7%/1.2-2.6%), and tenesmus 0.7 to 0.9% (0.4-1.2%/0.5-1.5%). Prevalence of pruritus fell from 3.5 to 2.5% (95% CI 2.7-4.4%/1.8-3.4%). Sweating, pruritus, and hiccups persisted throughout the day in nearly half of the patients. Myoclonus was significantly associated with brain tumors, sweating with opioids and antipsychotics, pruritus with liver and biliary tract cancer, cholestasis and severe diabetes, hiccup with male gender, digestive tract obstruction, severe diabetes, and renal failure. Vesical tenesmus was associated with urinary cancer, antipsychotics, and anticholinergics and rectal tenesmus with pelvic cavity cancer. We found that orphan symptoms occurred in 0.5-5.0% of patients, increased over time except for pruritus, and persisted in half of the patients.

The lower the expectations in controlling the symptoms of advanced cancer patients, the better the clinical response.

The aim of this study was to compare patients' global impression (PGI) and the achievement of personalised symptom goal response (PSGR), after a comprehensive palliative care treatment in advanced cancer patients having high (HPSG) and low symptom goals (LPSG). Advanced cancer patients admitted to palliative care units rated symptoms intensity by the Edmonton Symptom Assessment Score (ESAS) at admission and then after one week of comprehensive palliative care treatment. For each symptom, patients were divided into two groups, according to their patient symptom goal (PSG): ≥4 (HPSG), and 0-2 (LPSG). PGI and PSGR were evaluated after one week of palliative care. The Memorial Delirium Assessment Scale (MDAS) was assessed at admission. After one week of palliative care, changes in ESAS items were significantly larger in the HPSG group. HPSG patients had a better PGI and reached their target more frequently than LPSG patients for pain, weakness, and poor well-being. LPSG patients were more likely to obtain their target for appetite and insomnia. HPSG patients were more likely to have a lower Karnofsky, a lower educational level, older age, or higher MDAS values for the different ESAS items. Advanced cancer patients with low expectations (HPSG) were more likely to achieve their PSGR after a comprehensive palliative care treatment, reporting also a better PGI for some leading symptoms such as pain, weakness, and poor well-being. More fragile patients seem to have lower expectations and to be more likely to be satisfied.

Effects of transcutaneous electrical nerve stimulation on physical symptoms in advanced cancer patients receiving palliative care.

Transcutaneous electrical nerve stimulation (TENS) is primarily used for pain, but might be useful for various other physical symptoms, including nausea, fatigue, dyspnea, and constipation. However, few studies have used TENS for treating the physical symptoms of patients with advanced cancer. In this crossover trial, we assess the effects of TENS on pain and other physical symptoms in 20 in-patients with advanced cancer receiving palliative care. For 5-day phases between wash out periods of 5 days, patients received TENS or non-TENS. TENS was delivered at four points: the center of the back for mainly nausea and dyspnea, on the back at the same dermatomal level as the origin of the pain (100 Hz), and on both ankle joints for constipation (10 Hz). The intensity of pain and the total opioid dose used during phases were recorded. Physical symptoms were evaluated using the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 15 Palliative Care (QLQ-C15-PAL). Hematological and biochemical data were recorded before and after the TENS phase. The average pain and total number of opioid rescue doses were significantly reduced by TENS. TENS tended to improve nausea and appetite loss, but not constipation. There were no effects on hematological and biochemical parameters. Use of TENS could safely improve pain, nausea, and appetite loss in patients with advanced cancer. Although it cannot be used as a substitute for opioids and other pharmaceutical treatment, it may be useful to support palliative care.

Weight Loss and Gastrointestinal Symptoms in Advanced Cancer Patients Treated with Platinum-based Chemotherapy

Weight Loss and Gastrointestinal Symptoms in Advanced Cancer Patients Treated with Platinum-based Chemotherapy

Frequency and characteristics of drowsiness, somnolence, or daytime sleepiness in patients with advanced cancer.

Cancer-related drowsiness (CRD) is a distressing symptom in advanced cancer patients (ACP). The aim of this study was to determine the frequency and factors associated with severity of CRD. We also evaluated the screening performance of Edmonton Symptom Assessment Scale-drowsiness (ESAS-D) item against the Epworth Sedation Scale (ESS). We prospectively assessed 180 consecutive ACP at a tertiary cancer hospital. Patients were surveyed using ESAS, ESS, Pittsburgh Sleep Quality Index, Insomnia Severity Index, and Hospital Anxiety Depression Scale. Ninety of 150 evaluable patients had clinically significant CRD (ESS); median (interquartile ratio): ESS. 11 (7-14); ESAS-D. 5 (2-6); Pittsburgh Sleep Quality Index. 8 (5-11); Insomnia Severity Index. 13 (5-19); Stop Bang Scoring 3 (2-4), and Hospital Anxiety Depression Scale-D 6 (3-10). ESAS-D was associated with ESAS (r, p) sleep (0.38, <0.0001); pain (0.3, <0.0001); fatigue (0.51, <0.0001); depression (0.39, <0.0001); anxiety (0.44, <0.0001); shortness of breath (0.32, <0.0001); anorexia (0.36, <0.0001), feeling of well-being [(0.41, <0.0001), ESS (0.24, 0.001), and opioid daily dose (0.19, 0.01). Multivariate-analysis showed ESAS-D was associated with fatigue (odds ratio [OR] = 9.08, p < 0.0001), anxiety (3.0, p = 0.009); feeling of well-being (OR = 2.27, p = 0.04), and insomnia (OR = 2.35; p = 0.036). Insomnia (OR = 2.35; p = 0.036) cutoff score ≥3 (of 10) resulted in a sensitivity of 81% and 32% and specificity of 70% and 44% in the training and validation samples, respectively. Clinically significant CRD is frequent and seen in 50% of ACP. CRD was associated with severity of insomnia, fatigue, anxiety, and worse feeling of well-being. An ESAS-D score of ≥3 is likely to identify most of the ACP with significant CRD.

Factors Influencing Lower Urinary Tract Symptoms in Advanced Cancer Patients With Chemotherapy-Induced Peripheral Neuropathy.

PurposeThis study aimed to investigate the severity of lower urinary tract symptoms (LUTS) and to identify factors that influenced LUTS in advanced cancer patients with chemotherapy-induced peripheral neuropathy (CIPN).MethodsThis cross-sectional study included a total of 158 advanced cancer patients with CIPN. A structured questionnaire including the International Prostate Symptom Score and the Functional Assessment of Cancer Therapy/Gynecology Oncology Group/Neurotoxicity scale was used. Data were analyzed using the Pearson correlation coefficient and multiple regression analysis.ResultsNocturia was the most prevalent LUTS. A positive relationship was found between CIPN symptoms and LUTS. The duration of cancer diagnosis and the severity of CIPN were key factors that influenced LUTS.ConclusionsThe severity of CIPN symptoms was the most important predictor of LUTS. Nurses’ care for advanced cancer patients should incorporate a comprehensive health assessment, which includes a history of treatment and physical neuropathic symptoms, for any patient complaining of CIPN symptoms.

(248) - Profile of the pharmacological approach needed in order to achieve the best pain control in a population of advanced cancer patients

Pain is still a challenging symptom in advanced cancer patients. The World Health Organisation set up the three-step analgesic ladder in order to better clarify the optimal pharmacological approach in order to achieve a good balance between pain control and adverse related effects. The objective of this study is to analyse the changes observed in the use of the WHO analgesic ladder drugs in relation of pain intensity in a population of advanced cancer patients attended in the out-patient clinic (OPC).The study was carried out on a consecutive sample of advanced cancer patients attended at the OPC. Inclusion criteria: age >18 years, diagnosis of advanced cancer, lack of cognitive impairment (Pfeiffer test ≤ 4), pain with VAS > 3 on first evaluation and agreed to participate. Variables recorded: Categorical variables were summarized as percentages (absolute numbers). The sample was divided according to pain intensity on the first evaluation (VAS < 7 vs ≥7) and the analgesic regime used according to the WHO analgesic ladder (first/second/third step). The third step was further divided in long acting opioid (LAO), short acting opioids (SAO) and rapid onset opioids (ROO).We used the chi-squared test to compare groups. For the significative differences (P < 0,05) the McNemar test was applied. A total of 211 patients were included in the study. Mean of age 64, 0 ± 14 years. Men 87, 2%. Lung cancer 41, 2%; Upper-digestive 15, 6%. 136 patients with an initial VAS ≥ 7 (64,45%). Differences were found in the second step of the WHO on pain control (P = .045). Regarding the third step, the differences were related to the first evaluation: third step (global) P = .002, LAO (P = .028) and ROO (P = .043). Those data suggest that significative differences can be found between the use of the different analgesics the WHO ladder and pain intensity.

Effect of low-frequency rotary magnetic fields on advanced gastric cancer: Survival and palliation of general symptoms.

The tumor inhibition by magnetic fields (MFs) has been reported in many in vivo and in vitro studies, while clinical trials have been rare. This report aimed to evaluate the improvement of survival and general symptoms in advanced cancer patients treated with MFs. In this study, we investigated 21 patients with advanced gastric cancer (AGC) treated with 420 r/min, 0.4-T low-frequency rotary MFs. The treatment area encompassed the primary tumor sites, metastatic sites, and metastatic lymph nodes. In addition, the patients were treated 2 h per day, 5 days per week for 6-12 weeks. The toxicity pilot human study was approved by the competent ethical committee. Toxicity and side effects were assessed according to the WHO criteria. The changes of general symptoms were analyzed during low-frequency rotary MFs treatment and 2 weeks after the end of therapy. Electrocardiogram, chest X-ray, physical examination, blood cell count and complete blood chemistry, biochemical, and kidney function tests were performed before and after the end of the treatment. All 21 patients were followed up by outpatient service or telephone interview. Our results demonstrated that low-frequency rotary MFs improved abdominal pain in 9/21 (42.9%), nausea/vomiting in 4/21 (19.0%), weight loss in 11/21 (52.4%), ongoing blood loss in 2/21 (9.5%), physical strength in 5/21 (23.8%), and sleep quality in 4/21 (19.0%) patients. No severe toxicity and side effect were observed in our trial. The median survival time was 8.0 months (95% confidence interval, 5.190-10.810). The 1-year survival rate was 25.8%. Low-frequency rotary MFs may prolong survival and improve general symptom of AGC patients, as an effective, well-tolerated, and safe treatment choice.

Symptoms in Advanced Cancer Patients in a Greek Hospital: a Descriptive Study

Background:Advanced cancer patients experience several physical or psychological symptoms which require palliative care for alleviation.Purpose:To assess the prevalence and intensity of symptoms among cancer patients receiving palliative care in a Greek hospital and to examine the association between reported symptoms and social clinical and demographic characteristics.Material-methods:This descriptive research was conducted during a six-month period using a convenient sample of 123 advanced cancer patients. All participants were assessed for their symptoms using the Edmonton Symptom Assessment System (ESAS) with a questionnaire covering demographic and clinical characteristics.Results:The mean age was 63.8± 10.8 years, with lung and breast (58.5% and 11.4%, respectively) as the most common primary cancer types. The most severe symptoms were fatigue, sleep disturbance, dyspnea, depression and anxiety. Negative correlations were revealed between age and the following symptoms: pain (r = -0.354, p = 0.001), fatigue (r = -0.280, p = 0.002), nausea (r = -0.178, p = 0.049), anorexia (r = -0.188, p = 0.038), dyspnea (r = -0.251, p = 0.005), and depression (r = -0.223, p = 0.013). Advanced breast cancer patients scored higher in pain, fatigue and dyspnea compared to those with other cancers.Conclusions:Hospitalized cancer patients in Greece experience several symptoms during the last months of their life. These are influenced by demographic characteristics. Appropriate interventions are strongly advised with appropriate recognition and evaluation of symptoms by health professionals.

Symptomatic treatment of dyspnea in advanced cancer patients : Anarrative review of the current literature.

Dyspnea is acommon, very distressing symptom in advanced cancer patients that challenges them, their relatives, and healthcare professionals. This narrative review summarizes important literature dealing with the evidence for opioids, benzodiazepines, oxygen, and steroids for treating dyspnea in advanced cancer patients. Aselective literature search was undertaken in PubMed, Embase, and the Cochrane Library and extended with literature from the reference lists of included studies up to April 2016. Inclusion criteria were that patients were suffering from advanced cancer and were receiving either opioids, benzodiazepines, corticosteroids, or oxygen. The outcome of interest was the reduction of dyspnea measured via avisual analogue scale (VAS), anumerical rating scale (NRS), or aBorg scale. This narrative review describes in detail the findings of 13studies. Nine studies deal with the effectiveness of opioids for reducing dyspnea in advanced cancer patients. Five of these found asignificant benefit to the use of opioids compared to aplacebo. Three found no significant improvements, and two favored combinations of opioids and benzodiazepines. Few high-quality studies were available that used benzodiazepines (n= 3, no difference, significant improvement with midazolam+ morphine, significant difference for midazolam) or oxygen (n= 2, both without significant difference). Only one study examined treating dyspnea with steroids in patients with advanced cancer, and that study indicated abenefit of steroids compared to aplacebo. Opioids are the drug of choice for treating refractory dyspnea in advanced cancer patients. Neither benzodiazepines nor oxygen showed significant benefit. In addition, there is insufficient literature available to draw aconclusion about the effectiveness of steroids for treating persistent dyspnea in advanced cancer patients.

1565P - Association between systemic inflammation and symptoms in advanced cancer patients

Background: There is growing evidence relating inflammation as a prognostic factor in cancer patients. Previous reports have found a small but significant association between systemic inflammation and symptoms in advanced cancer patients. The aim of this study was to analyse the relationship between systemic inflammatory response markers with the symptoms and performance status of advanced cancer patients that have been admitted to an Acute Palliative Care Unit (PCU). Methods: We conducted an observational study including all cancer patients admitted in the PCU between January 2012 and April 2015. We performed a correlation analysis (spearman’s rho) between serum C-reactive-protein (CRP), the modified Glasgow Prognostic Score (mGPS) and Neutrophil-to Lymphocyte Ratio (NLR) with patients symptoms recorded as the Edmonton Symptom Assessment Sytem (ESAS) and performance status recorded as Eastern Cooperative Oncology Group (ECOG), Barthel Index and Palliative Performance Scale (PPS). All data were collected within the first two days of admission. Results: Data of 951 patients were available. The median survival was 17 days. CRP was significantly correlated with ECOG (ρ:0.180, P:0.000), dyspnoea (ρ:0.079, p:0.019), fatigue (ρ:0.162, p < 0.001), anorexia (ρ: 0.103, p:0.002), somnolence (ρ:0.096, p.0.009), wellbeing (ρ:0.012, p < 0.001), Barthel (ρ:-0.178, p < 0.001) and PPS (ρ:0.173, p < 0.001). In relation to mGPS, a significant correlation was found with ECOG (0.116, p:0.001), fatigue (ρ:0.184, p < 0.001), anorexia (ρ:0.107, p.0.003), somnolence (ρ:0.080, p.037), Barthel (ρ:-0.127, p < 0.001) and PPS (ρ:-0.125, p < 0.001). Finally, NLR was significantly correlated with ECOG (ρ:0.112, p0.001), dyspnoea (ρ:0.117, p < 0.001), fatigue (ρ:0.107, p:0.002), Barthel (ρ:-0.115, p < 0.001) and PPS (ρ:-0.100, p:0.002). Conclusions: There is a small but significant correlation between systemic inflammation and symptoms. Further studies are needed to confirm the results and to test this relation in earlier phases of the disease. Legal entity responsible for the study: Hospital Universitario La Paz Funding: None Disclosure: All authors have declared no conflicts of interest.

Does physical exercise improve quality of life of advanced cancer patients?

We discuss the principal issues about physical activity in advanced cancer patients through the analyses of the last articles and our experience in this field. The efficacy of exercise training intervention could improve quality of life (QOL), fatigue and well being in advanced cancer patients. Several published studies have included, nevertheless, patients with early stage of disease and more recently, populations of patients with local advanced tumors of the breast, rectum and lung, who are undergoing neoadjuvant therapy. Despite the insufficient sample of patients in these studies, physical exercise is considered to improve both cardiopulmonary function and physical muscle fitness. Cancer-related fatigue is a devastating symptom in advanced cancer patients that implies loss of mobility and independence. Physical exercise could be a treatment to increase skeletal muscle endurance and improve well being. In palliative medicine, physical activity could be applied to medical assistance or to design prospective and controlled trials so as to evaluate possible usefulness.

Methylnaltrexone or laxatives for the Management of Opioid-induced Constipation among Palliative Patients on Opioid Therapy: Evidencebased Review

Constipation is a common symptom in advanced cancer patients. Studies have demonstrated that 40 to 80% of patients on a palliative care service have constipation, this proportion increases to ≥ 90% when patients are treated with opioids. Opioids are very effective analgesics, frequently prescribed in cancer pain, despite proven analgesic efficacy; the use of opioids is commonly associated with frequently dose-limiting constipation that seriously impacts on patients’ quality of life, almost all patients on opioids report constipation as the major side-effect. The aim of this article is to determine the effectiveness of methylnaltrexone and laxatives in the management of opioidinduced constipation among cancer patients in palliative care setting, with focus on randomized clinical trials. A comprehensive and extensive online database search of Science Direct Database, PubMed, Springer Online Database, and HINARI/WHO Database was conducted; also reference lists of related studies were searched, six studies fulfilling the inclusion criteria from 1991 to 2009 were selected and formed the basis for this paper. In three studies the laxatives lactulose, senna, co danthramer, misrakasneham, and magnesium hydroxide with liquid paraffin were evaluated, in three methylnaltrexone. In studies comparing the different laxatives evidence was inconclusive. Evidence on subcutaneous methylnaltrexone was clearer; evidence on laxatives for management of constipation remains limited due to insufficient RCTs. Ultimately it can be suggested from the data presented here that subcutaneous methylnaltrexone is effective in inducing laxation in palliative care patients with opioid-induced constipation and where conventional laxatives have failed.

Patient-reported sleep disturbance in advanced cancer: frequency, predictors and screening performance of the Edmonton Symptom Assessment System sleep item

AimsSleep Disturbance (SD) is a severe debilitating symptom in advanced cancer patients (ACP). However, routine screening of SD is uncommon. The primary aim of this study was to determine the...

Treatment of dyspnoea in advanced cancer patients: ESMO Clinical Practice Guidelines

Dyspnoea is a frequent symptom in advanced cancer patients with the highest prevalence in lung cancer (up to 74%) increasing in the terminal phase (up to 80%) with major impact on the quality of life of the patient, his or her family, as well as the caregivers [1–5]. Patients describe dyspnoea as suffocating, choking or tightness of breath. Qualitative data have shown that the symptom can be described along three dimensions: