Palliative Care Clinical Practice Guidelines in OncologyNCCN Categories of Evidence and ConsensusCategory 1: The recommendation is based on high-level evidence (e.g., randomized controlled trials) and there is uniform NCCN consensus.Category 2A: The recommendation is based on lower-level evidence and there is uniform NCCN consensus.Category 2B: The recommendation is based on lower-level evidence and there is nonuniform NCCN consensus (but no major disagreement).Category 3: The recommendation is based on any level of evidence but reflects major disagreement.All recommendations are category 2A unless otherwise noted.Clinical trials: The NCCN believes that the best management for any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged.OverviewPalliative care is both a philosophy of care and an organized, highly structured system for delivering care to persons with life-threatening or debilitating illness. Palliative care is patient- and family-centered care that focuses on effective management of pain and other distressing symptoms, while incorporating psychosocial and spiritual care according to patient/family needs, values, beliefs, and cultures. The goal of palliative care is to prevent and relieve suffering and to support the best possible quality of life for patients and their families, regardless of disease stage or the need for other therapies. Palliative care can be delivered concurrently with life-prolonging care or as the main focus of care.The standards of palliative care are as follows:• Institutions should develop a process ensuring that all patients have access to palliative care services from the initial visit....

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References

  • 1

    ASCO Task Force for Cancer Care at the End of Life. Cancer care during the last phase of life. J Clin Oncol1998;16:19861996.

  • 2

    BergerAPortenoyRKWeissmanDE eds. Practice and Principles of Supportive Oncology. Philadelphia: LippincottRaven; 1998.

  • 3

    DoyleDHanksGWMacDonaldN eds. Oxford Textbook of Palliative Medicine. Oxford: Oxford University; 1998.

  • 4

    EmanuelLLvon GuntenCFFerrisFD. The Education for Physicians on End-of-Life Care (EPEC) Curriculum. Princeton: The Robert Wood Johnson Foundation; 1999.

    • Search Google Scholar
    • Export Citation
  • 5

    JemalASiegelRWardE. Cancer statistics, 2008. CA Cancer J Clin2008;58:7196.

  • 6

    LevyMH. Living with cancer: hospice/palliative care. J Natl Cancer Inst1993;85:12831287.

  • 7

    LevyMH. Supportive oncology: forward. Semin Oncol1994;21:699798.

  • 8

    MacDonaldN. Palliative care—the fourth phase of cancer prevention. Cancer Detect Prev1991;15:253255.

  • 9

    Cancer pain relief and palliative care: report of a WHO expert committee. Geneva: WHO; 1990.

  • 10

    ElsayemASwintKFischMJ. Palliative care inpatient service in a comprehensive cancer center: clinical and financial outcomes. J Clin Oncol2004;22:20082011.

    • Search Google Scholar
    • Export Citation
  • 11

    EarleCCNevilleBALandrumMB. Trends in the aggressiveness of cancer care the end of life. J Clin Oncol2004;22:315321.

  • 12

    FoleyKMGelbandH. Improving Palliative Care for Cancer. Washington, DC: National Academy Press; 2001.

  • 13

    MalinJL. Bridging the divide: integrating cancer directed therapy and palliative care. J Clin Oncol2004;22:34383440.

  • 14

    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). The SUPPORT Principal Investigators. JAMA1995;274:15911598.

    • Search Google Scholar
    • Export Citation
  • 15

    FieldMJCasselCK eds. Approaching Death: Improving Care at the End of Life. Washington, DC: National Academy Press; 1997.

  • 16

    MeyersFJLinderJ. Simultaneous care: disease treatment and palliative care throughout illness. J Clin Oncol2003;21:14121415.

  • 17

    DavisMP. Integrating palliative medicine into an oncology practice. Am J Hosp Palliat Care2005;22:447456.

  • 18

    LevyMH. NCCN Task Force reports: supportive and palliative care. Oncology1999;13:517522.

  • 19

    WeissmanDE. Decision making at a time of crisis near the end of life. JAMA2004;292:17381743.

  • 20

    KimAFallPWangD. Palliative care: optimizing quality of life. J Am Osteopath Assoc2005;105:S914.

  • 21

    ChochinovHM. Dying, dignity, and new horizons in palliative end-of-life care. CA Cancer J Clin2006;56:84103.

  • 22

    de HaesHTeunissenS. Communication in palliative care: a review of recent literature. Curr Opin Oncol2005;17:345350.

  • 23

    SinclairCT. Communicating a prognosis in advanced cancer. J Support Oncol2006;4:201204.

  • 24

    National Institutes of Health. National Institutes of Health State-of-the-Science Conference: Statement on Improving End-of-Life Care. Available at: http://consensus.nih.gov/2004/2004EndOfLife CareSOS024html.htm. Accessed February 24 2009.

    • Search Google Scholar
    • Export Citation
  • 25

    LorenzKALynnJMortonSC. Methodological approaches for a systematic review of end-of-life care. J Palliat Med2005;8(Suppl 1):S411.

  • 26

    National Consensus Project for Quality Palliative Care (2004). Clinical practice guidelines for quality palliative care. Available at: http://www.nationalconsensusproject.org. Accessed February 24 2009.

    • Search Google Scholar
    • Export Citation
  • 27

    National Institute for Clinical Excellence. Supportive and palliative care. Available at: www.nice.org.uk/page.aspx?o=csgsp. Accessed February 24 2009.

    • Search Google Scholar
    • Export Citation
  • 28

    SingerPAMartinDKKelnerM. Quality endoflife care: patients’ perspectives. JAMA1999;281:163168.

  • 29

    LevyMH. Supportive oncologypalliative care: what’s in a name?Semin Oncol2005;32:131133.

  • 30

    KhatcheressianJCasselJBLyckholmL. Improving palliative and supportive care in cancer patients. Oncology (Williston Park). 2005;19:13651376; discussion 1377–1378 1381–1382 1384 passim.

    • Search Google Scholar
    • Export Citation
  • 31

    MorrisonRMeierD. Palliative care. N Engl J Med2004;350:25822590.

  • 32

    WeeksJCCookEFO’DaySJ. Relationship between cancer patients’ predictions of prognosis and their treatment preferences. JAMA1998;279:17091714.

    • Search Google Scholar
    • Export Citation
  • 33

    LoBRustonDKatesLW. Discussing religious and spiritual issues at the end of life: a practical guide for physicians. JAMA2002;287:749754.

    • Search Google Scholar
    • Export Citation
  • 34

    PrommerE. Guidelines for the use of palliative chemotherapy. AAHPM Bulletin2004;5:213.

  • 35

    PientaKJSmithDC. Advances in prostate cancer chemotherapy: a new era begins. CA Cancer J Clin2005;55:300318.

  • 36

    GuarneriVConteP. The curability of breast cancer and the treatment of advanced disease. Eur J Nucl Med Mol Imaging2004;31:S149161.

  • 37

    FreeloveRWallingAD. Pancreatic cancer: diagnosis and management. Am Fam Physician2006;73:485492.

  • 38

    AjaniJA. Evolving chemotherapy for advanced gastric cancer. Oncologist2005;10(Suppl 3):4958.

  • 39

    BrownJThorpeHNappV. Assessment of quality of life in the supportive care setting of the big lung trial in non-small cell lung cancer. J Clin Oncol2005;23:74177427.

    • Search Google Scholar
    • Export Citation
  • 40

    SilvestriGARiveraMP. Targeted therapy for the treatment of advanced nonsmall cell lung cancer: a review of the epidermal growth factor receptor antagonists. Chest2005;128:39753984.

    • Search Google Scholar
    • Export Citation
  • 41

    KinzbrunnerBM. Hospice: what to do when anticancer therapy is no longer appropriate, effective, or desired. Semin Oncol1994;21:792798.

    • Search Google Scholar
    • Export Citation
  • 42

    HigginsonIJFinlayIGGoodwinDM. Is there evidence that palliative care teams alter end-of-life experiences of patients and caregivers?J Pain Syndrome Manage2003;25:150168.

    • Search Google Scholar
    • Export Citation
  • 43

    TemelJSPirlWFLynchTJ. Comprehensive symptom management in patients with advanced-stage non-small cell lung cancer. Clin Lung Cancer2006;7:241249.

    • Search Google Scholar
    • Export Citation
  • 44

    JenningsALDaviesANHigginsJP. A systematic review of the use of opioids in the management of dyspnoea. Thorax2002;57:939944.

  • 45

    NaviganteAHCerchiettiLCCastroMA. Midazolam as adjunct therapy to morphine in the alleviation of severe dyspnea perception in patients with advanced cancer. J Pain Symptom Manage2006;31:3847.

    • Search Google Scholar
    • Export Citation
  • 46

    DavisMPFursteA. Glycopyrrolate: a useful drug in the palliation of mechanical bowel obstruction. J Pain Symptom Manage1999;18:153154.

    • Search Google Scholar
    • Export Citation
  • 47

    LavianoAMeguidMMInuiA. Therapy insight: cancer anorexiacachexia syndrome—when all you can eat is yourself. Nat Clin Pract Oncol2005;2:158165.

    • Search Google Scholar
    • Export Citation
  • 48

    YavuzsenTDavisMPWalshD. Systematic review of the treatment of cancerassociated anorexia and weight loss. J Clin Oncol2005;23:85008511.

    • Search Google Scholar
    • Export Citation
  • 49

    RavascoPMonteiroGrilloIVidalPMCamiloME. Dietary counseling improves patient outcomes: a prospective, randomized, controlled trial in colorectal cancer patients undergoing radiotherapy. J Clin Oncol2005;23:14311438.

    • Search Google Scholar
    • Export Citation
  • 50

    IsenringEACapraSBauerJD. Nutrition intervention is beneficial in oncology outpatients receiving radiotherapy to the gastrointestinal or head and neck area. Br J Cancer2004;91:447452.

    • Search Google Scholar
    • Export Citation
  • 51

    SchwartzbergL. Chemotherapy-induced nausea and vomiting: state of the art in 2006. J Support Oncol2006;4(2 Suppl 1):38.

  • 52

    BeckerGGalandiDBlumHE. Peripherally acting opioid antagonists in the treatment of opiate-related constipation: a systematic review. J Pain Symptom Manage2007;34:547565.

    • Search Google Scholar
    • Export Citation
  • 53

    ManciniIBrueraE. Constipation in advanced cancer patients. Support Care Cancer1998;6:356364.

  • 54

    American Pain Society. Principles of Analgesic Use in the Treatment of Acute Pain and Cancer Pain. 5th ed. Glenview: American Pain Society; 2003.

    • Search Google Scholar
    • Export Citation
  • 55

    ThomasJKarverSCooneyGA. Methylnaltrexone for opioidinduced constipation in advanced illness. N Engl J Med2008;358:23322343.

  • 56

    PortenoyRKThomasJMoehl BoatwrightML. Subcutaneous methylnaltrexone for the treatment of opioid-induced constipation in patients with advanced illness: a double-blind, randomized, parallel group, dose-ranging study. J Pain Symptom Manage2008;35:458468.

    • Search Google Scholar
    • Export Citation
  • 57

    MercadanteSCasuccioAMangioneS. Medical treatment for inoperable malignant bowel obstruction: a qualitative systematic review. J Pain Symptom Manage2007;33:217223.

    • Search Google Scholar
    • Export Citation
  • 58

    Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994:124133.

  • 59

    LacasseHPerreaultMMWilliamsonDR. Systematic review of antipsychotics for the treatment of hospitalassociated delirium in medically or surgically ill patients. Ann Pharmacother2006;40:19661973

    • Search Google Scholar
    • Export Citation
  • 60

    CaraceniANanniOMaltoniM. Impact of delirium on the short term prognosis of advanced cancer patients. Italian Multicenter Study Group on Palliative Care. Cancer2000;89:11451149.

    • Search Google Scholar
    • Export Citation
  • 61

    KehlKA. Treatment of terminal restlessness: a review of the evidence. J Pain Palliat Care Pharmacother2004;18:530.

  • 62

    SwarmRAnghelescuDLBenedettiC. Adult cancer pain. J Natl Compr Canc Netw2007;5:726751.

  • 63

    MockVAtkinsonABarsevickAM. Cancer-related fatigue. Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw2007;5:10541078.

  • 64

    HollandJCAndersenBBreitbartWS. Distress management. J Natl Compr Canc Netw2007;5:6698.

  • 65

    ElsayemAFJenkinsRParmleyL. The impact of a palliative care service on overall hospital mortality in a comprehensive cancer center [abstract]. J Clin Oncol2004;22(Suppl 1):Abstract 8034.

    • Search Google Scholar
    • Export Citation
  • 66

    HanBRemsburgREMcAuleyWJ. National trends in adult hospice use: 1991-1992 to 1999-2000. Health Aff2006;25:792799.

  • 67

    LevyMHCohenSC. Sedation for the relief of refractory symptoms in the imminently dying: a fine intentional line. Semin Oncol2005;32:237246.

    • Search Google Scholar
    • Export Citation
  • 68

    WeinS. Sedation in the imminently dying patient. Oncology (Williston Park)2000;14:585592.

  • 69

    CowanJDPalmerTW. Practical guide to palliative sedation. Curr Oncol Rep2002;4:242249.

  • 70

    ChernyNIPortenoyRK. Sedation in the management of refractory symptoms: guidelines for evaluation and treatment. J Palliative Care1994;10:3138.

    • Search Google Scholar
    • Export Citation
  • 71

    BraunTCHagenNAClarkT. Development of a clinical practice guideline for palliative sedation. J Palliat Med2003;6:345350.

  • 72

    ByockI. Dying Well: The Prospect for Growth at the End of Life. New York: Riverhead Books; 1997.

  • 73

    HartmannLC. Unrealistic expectations. J Clin Oncol2005;23:42314232.

  • 74

    KalemkerianGP. Commentary on “Unrealistic Expectations.”J Clin Oncol2005;23:42334234.

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