NCCN Guidelines® Insights: Palliative Care, Version 2.2021

Featured Updates to the NCCN Guidelines

Authors:
Maria Dans Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine;

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Jean S. Kutner University of Colorado Cancer Center;

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Rajiv Agarwal Vanderbilt-Ingram Cancer Center;

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Justin N. Baker St. Jude Children's Research Hospital/The University of Tennessee Health Science Center;

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Jessica R. Bauman Fox Chase Cancer Center;

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Anna C. Beck Huntsman Cancer Institute at the University of Utah;

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Toby C. Campbell University of Wisconsin Carbone Cancer Center;

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Elise C. Carey Mayo Clinic Cancer Center;

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Amy A. Case Roswell Park Comprehensive Cancer Center;

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Shalini Dalal The University of Texas MD Anderson Cancer Center;

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Danielle J. Doberman The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins;

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Andrew S. Epstein Memorial Sloan Kettering Cancer Center;

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Leslie Fecher University of Michigan Rogel Cancer Center;

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Joshua Jones Abramson Cancer Center at the University of Pennsylvania;

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Jennifer Kapo Yale Cancer Center/Smilow Cancer Hospital;

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Richard T. Lee Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute;

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Elizabeth T. Loggers Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance;

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Susan McCammon O'Neal Comprehensive Cancer Center at UAB;

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William Mitchell UC San Diego Moores Cancer Center;

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Adeboye B. Ogunseitan Robert H. Lurie Comprehensive Cancer Center of Northwestern University;

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Diane G. Portman Moffitt Cancer Center;

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Kavitha Ramchandran Stanford Cancer Institute;

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Linda Sutton Duke Cancer Institute;

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Jennifer Temel Massachusetts General Hospital Cancer Center;

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Melissa L. Teply Fred & Pamela Buffett Cancer Center;

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Stephanie Y. Terauchi UT Southwestern Simmons Comprehensive Cancer Center;

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Jane Thomas Dana-Farber Cancer Institute;

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Anne M. Walling UCLA Jonsson Comprehensive Cancer Center;

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Finly Zachariah City of Hope National Medical Center; and

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Mary Anne Bergman National Comprehensive Cancer Network.

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Ndiya Ogba National Comprehensive Cancer Network.

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Mallory Campbell National Comprehensive Cancer Network.

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Palliative care has evolved to be an integral part of comprehensive cancer care with the goal of early intervention to improve quality of life and patient outcomes. The NCCN Guidelines for Palliative Care provide recommendations to help the primary oncology team promote the best quality of life possible throughout the illness trajectory for each patient with cancer. The NCCN Palliative Care Panel meets annually to evaluate and update recommendations based on panel members’ clinical expertise and emerging scientific data. These NCCN Guidelines Insights summarize the panel’s recent discussions and highlights updates on the importance of fostering adaptive coping strategies for patients and families, and on the role of pharmacologic and nonpharmacologic interventions to optimize symptom management.

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  • 1.

    Siegel RL , Miller KD , Jemal A. Cancer statistics, 2020. CA Cancer J Clin 2020;70:730.

  • 2.

    Centers for Disease Control and Prevention. Cancer survivors—United States, 2007. MMWR Morb Mortal Wkly Rep 2011;60: 269272.

  • 3.

    Ferris FD , Bruera E , Cherny N , et al. Palliative cancer care a decade later: accomplishments, the need, next steps – from the American Society of Clinical Oncology. J Clin Oncol 2009;27:30523058.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4.

    Seow H , Barbera L , Sutradhar R , et al. Trajectory of performance status and symptom scores for patients with cancer during the last six months of life. J Clin Oncol 2011;29:11511158.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Murray SA , Kendall M , Mitchell G , et al. Palliative care from diagnosis to death. BMJ 2017;356:j878.

  • 6.

    Ferrell BR , Temel JS , Temin S , et al. Integration of palliative care into standard oncology care: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 2017;35:96112.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7.

    LeBlanc TW , El-Jawahri A. When and why should patients with hematologic malignancies see a palliative care specialist? Hematology (Am Soc Hematol Educ Program) 2015;2015:471478.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8.

    The SUPPORT Principal Investigators. A controlled trial to improve care for seriously ill hospitalized patients. The study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT). JAMA 1995;274:15911598.

    • Search Google Scholar
    • Export Citation
  • 9.

    Malin JL. Bridging the divide: integrating cancer-directed therapy and palliative care. J Clin Oncol 2004;22:34383440.

  • 10.

    Meyers FJ , Linder J. Simultaneous care: disease treatment and palliative care throughout illness. J Clin Oncol 2003;21:14121415.

  • 11.

    Greer JA , Jackson VA , Meier DE , et al. Early integration of palliative care services with standard oncology care for patients with advanced cancer. CA Cancer J Clin 2013;63:349363.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Davis MP , Bruera E , Morganstern D. Early integration of palliative and supportive care in the cancer continuum: challenges and opportunities. Am Soc Clin Oncol Educ Book 2013;33:144150.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13.

    El-Jawahri A , Forst D , Fenech A , et al. Relationship between perceptions of treatment goals and psychological distress in patients with advanced cancer. J Natl Compr Canc Netw 2020;18:849855.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Nipp RD , Greer JA , El-Jawahri A , et al. Coping and prognostic awareness in patients with advanced cancer. J Clin Oncol 2017;35:25512557.

  • 15.

    Seaman JB , Lakin JR , Anderson E , et al. Interdisciplinary or interprofessional: why terminology in teamwork matters to hospice and palliative care. J Palliat Med 2020;23:11571158.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Berger A , Portenoy R , Weissman D , eds. Practice and Principles of Supportive Oncology. Philadelphia, PA: Lippincott-Raven; 1998.

  • 17.

    Doyle D , Hanks GWC. MacDonald N , eds. Oxford Textbook of Palliative Medicine, 2nd ed. Oxford, England: Oxford University; 1998.

  • 18.

    Emanuel LL , von Gunten CF , Ferris FD , eds. The Education for Physicians on End-of-Life Care (EPEC) Curriculum. Princeton, NJ: The Robert Wood Johnson Foundation; 1999.

    • Search Google Scholar
    • Export Citation
  • 19.

    Carrera PM , Kantarjian HM , Blinder VS. The financial burden and distress of patients with cancer: Understanding and stepping-up action on the financial toxicity of cancer treatment. CA Cancer J Clin 2018;68:153165.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Smith TJ , Temin S , Alesi ER , et al. American Society of Clinical Oncology provisional clinical opinion: the integration of palliative care into standard oncology care. J Clin Oncol 2012;30:880887.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 21.

    Temel JS , Greer JA , Muzikansky A , et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 2010;363:733742.

  • 22.

    Bakitas MA , Tosteson TD , Li Z , et al. Early versus delayed initiation of concurrent palliative oncology care: patient outcomes in the ENABLE III randomized controlled trial. J Clin Oncol 2015;33:14381445.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Hamano J , Yamaguchi T , Maeda I , et al. Multicenter cohort study on the survival time of cancer patients dying at home or in a hospital: does place matter? Cancer 2016;122:14531460.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Prigerson HG , Bao Y , Shah MA , et al. Chemotherapy use, performance status, and quality of life at the end of life. JAMA Oncol 2015;1:778784.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 25.

    Chen AB , Cronin A , Weeks JC , et al. Palliative radiation therapy practice in patients with metastatic non-small-cell lung cancer: a Cancer Care Outcomes Research and Surveillance Consortium (CanCORS) study. J Clin Oncol 2013;31:558564.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Zafar SY , Malin JL , Grambow SC , et al. Chemotherapy use and patient treatment preferences in advanced colorectal cancer: a prospective cohort study. Cancer 2013;119:854862.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Sano M , Fushimi K. Association of palliative care consultation with reducing inpatient chemotherapy use in elderly patients with cancer in Japan: analysis using a nationwide administrative database. Am J Hosp Palliat Care 2017;34:685691.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Ferrell B , Levy MH , Paice J. Managing pain from advanced cancer in the palliative care setting. Clin J Oncol Nurs 2008;12:575581.

  • 29.

    Lutz S , Balboni T , Jones J , et al. Palliative radiation therapy for bone metastases: update of an ASTRO evidence-based guideline. Pract Radiat Oncol 2017;7:412.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Westhoff PG , de Graeff A , Monninkhof EM , et al. Quality of life in relation to pain response to radiation therapy for painful bone metastases. Int J Radiat Oncol Biol Phys 2015;93:694701.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    McDonald R , Ding K , Brundage M , et al. Effect of radiotherapy on painful bone metastases: a secondary analysis of the NCIC Clinical Trials Group Symptom Control Trial SC.23. JAMA Oncol 2017;3:953959.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 32.

    Park KR , Lee CG , Tseng YD , et al. Palliative radiation therapy in the last 30 days of life: a systematic review. Radiother Oncol 2017;125:193199.

  • 33.

    Qi He Mabel L , Drury VB , Hong PW. The experience and expectations of terminally ill patients receiving music therapy in the palliative setting: a systematic review. JBI Library Syst Rev 2010;8:10881111.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 34.

    Gutgsell KJ , Schluchter M , Margevicius S , et al. Music therapy reduces pain in palliative care patients: a randomized controlled trial. J Pain Symptom Manage 2013;45:822831.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35.

    Kutner JS , Smith MC , Corbin L , et al. Massage therapy versus simple touch to improve pain and mood in patients with advanced cancer: a randomized trial. Ann Intern Med 2008;149:369379.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36.

    Lim JA , Choi SH , Lee WJ , et al. Cognitive-behavioral therapy for patients with chronic pain: Implications of gender differences in empathy. Medicine (Baltimore) 2018;97:e10867.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 37.

    Feliu-Soler A , Montesinos F , Gutiérrez-Martínez O , et al. Current status of acceptance and commitment therapy for chronic pain: a narrative review. J Pain Res 2018;11:21452159.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38.

    Syrjala KL , Jensen MP , Mendoza ME , et al. Psychological and behavioral approaches to cancer pain management. J Clin Oncol 2014;32:17031711.

  • 39.

    Coelho A , Parola V , Cardoso D , et al. Use of non-pharmacological interventions for comforting patients in palliative care: a scoping review. JBI Database Syst Rev Implement Reports 2017;15:18671904.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 40.

    Kumar NB , Kazi A , Smith T , et al. Cancer cachexia: traditional therapies and novel molecular mechanism-based approaches to treatment. Curr Treat Options Oncol 2010;11:107117.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 41.

    Laviano A , Meguid MM , Inui A , et al. Therapy insight: cancer anorexia-cachexia syndrome—when all you can eat is yourself. Nat Clin Pract Oncol 2005;2:158165.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 42.

    Oberholzer R , Hopkinson JB , Baumann K , et al. Psychosocial effects of cancer cachexia: a systematic literature search and qualitative analysis. J Pain Symptom Manage 2013;46:77–95.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 43.

    Martin L , Birdsell L , Macdonald N , et al. Cancer cachexia in the age of obesity: skeletal muscle depletion is a powerful prognostic factor, independent of body mass index. J Clin Oncol 2013;31:15391547.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 44.

    Dy SM , Lorenz KA , Naeim A , et al. Evidence-based recommendations for cancer fatigue, anorexia, depression, and dyspnea. J Clin Oncol 2008;26:38863895.

  • 45.

    Dy SM , Apostol CC. Evidence-based approaches to other symptoms in advanced cancer. Cancer J 2010;16:507513.

  • 46.

    Mercadante S , Aielli F , Adile C , et al. Prevalence of oral mucositis, dry mouth, and dysphagia in advanced cancer patients. Support Care Cancer 2015;23:32493255.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 47.

    Roeland EJ , Bohlke K , Baracos VE , et al. Management of cancer cachexia: ASCO guideline. J Clin Oncol 2020;38:24382453.

  • 48.

    Pascual López A , Roqué i Figuls M , Urrútia Cuchi G , et al. Systematic review of megestrol acetate in the treatment of anorexia-cachexia syndrome. J Pain Symptom Manage 2004;27:360369.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 49.

    Ruiz Garcia V , López-Briz E , Carbonell Sanchis R , et al. Megestrol acetate for treatment of anorexia-cachexia syndrome. Cochrane Database Syst Rev 2013;3:CD004310.

    • Search Google Scholar
    • Export Citation
  • 50.

    Yavuzsen T , Davis MP , Walsh D , et al. Systematic review of the treatment of cancer-associated anorexia and weight loss. J Clin Oncol 2005;23:85008511.

  • 51.

    Miller S , McNutt L , McCann MA , et al. Use of corticosteroids for anorexia in palliative medicine: a systematic review. J Palliat Med 2014;17:482485.

  • 52.

    Navari RM , Brenner MC. Treatment of cancer-related anorexia with olanzapine and megestrol acetate: a randomized trial. Support Care Cancer 2010;18:951956.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 53.

    By the 2019 American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2019 Updated AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc 2019;67:674694.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 54.

    Bolen JC , Andersen RE , Bennett RG. Deep vein thrombosis as a complication of megestrol acetate therapy among nursing home residents. J Am Med Dir Assoc 2000;1:248252.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 55.

    Ruiz Garcia V , López-Briz E , Carbonell Sanchis R , et al. Megestrol acetate for treatment of anorexia-cachexia syndrome. Cochrane Database Syst Rev 2013;2013:CD004310.

    • Search Google Scholar
    • Export Citation
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