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Michael H. Levy, Anthony Back, Costantino Benedetti, J. Andrew Billings, Susan Block, Barry Boston, Eduardo Bruera, Sydney Dy, Catherine Eberle, Kathleen M. Foley, Sloan Beth Karver, Sara J. Knight, Sumathi Misra, Christine S. Ritchie, David Spiegel, Linda Sutton, Susan Urba, Jamie H. Von Roenn and Sharon M. Weinstein

Palliative Care Clinical Practice Guidelines in Oncology NCCN Categories of Evidence and Consensus Category 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. Overview Palliative 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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Paul A. Glare

HA . Unmet needs of persons with cancer in Pennsylvania during the period of terminal care . Cancer 1988 ; 62 : 627 – 634 . 4 Ferris FD Bruera E Cherny N . Palliative cancer care a decade later: accomplishments, the need, next steps

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Amy Waller, Rob Sanson-Fisher, Nicholas Zdenkowski, Charles Douglas, Alix Hall and Justin Walsh

Doorn C O'Leary JR . Older persons' preferences for site of terminal care . Ann Intern Med 1999 ; 131 : 109 – 112 . 23. Australian Commission on Safety and Quality in Health Care . National consensus statement: essential elements for safe

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Shi-Yi Wang, Tiange Chen, Weixiong Dang, Sarah S. Mougalian, Suzanne B. Evans and Cary P. Gross

terminal care, were derived from prior literature. Utility weights for each health state were abstracted from the literature 13 , 18 , 34 – 36 and then age-adjusted at 5-year increments using previously reported trends. 37 – 39 Detailed information

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Michael H. Levy, Michael D. Adolph, Anthony Back, Susan Block, Shirley N. Codada, Shalini Dalal, Teresa L. Deshields, Elisabeth Dexter, Sydney M. Dy, Sara J. Knight, Sumathi Misra, Christine S. Ritchie, Todd M. Sauer, Thomas Smith, David Spiegel, Linda Sutton, Robert M. Taylor, Jennifer Temel, Jay Thomas, Roma Tickoo, Susan G. Urba, Jamie H. Von Roenn, Joseph L. Weems, Sharon M. Weinstein, Deborah A. Freedman-Cass and Mary Anne Bergman

Demeulenaere P . Atropine, hyoscine butylbromide, or scopolamine are equally effective for the treatment of death rattle in terminal care . J Pain Symptom Manage 2009 ; 38 : 124 – 133 . 70 Mirakhur RK Dundee JW . Glycopyrrolate: pharmacology and

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Michael Levy, Thomas Smith, Amy Alvarez-Perez, Anthony Back, Justin N. Baker, Anna C. Beck, Susan Block, Shalini Dalal, Maria Dans, Thomas R. Fitch, Jennifer Kapo, Jean S. Kutner, Elizabeth Kvale, Sumathi Misra, William Mitchell, Diane G. Portman, Todd M. Sauer, David Spiegel, Linda Sutton, Eytan Szmuilowicz, Robert M. Taylor, Jennifer Temel, Roma Tickoo, Susan G. Urba, Elizabeth Weinstein, Finly Zachariah, Mary Anne Bergman and Jillian L. Scavone

, hyoscine butylbromide, or scopolamine are equally effective for the treatment of death rattle in terminal care . J Pain Symptom Manage 2009 ; 38 : 124 – 133 . 51. Grum DF Osborne LR . Central anticholinergic syndrome following glycopyrrolate

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Ann M. Berger, Amy Pickar Abernethy, Ashley Atkinson, Andrea M. Barsevick, William S. Breitbart, David Cella, Bernadine Cimprich, Charles Cleeland, Mario A. Eisenberger, Carmen P. Escalante, Paul B. Jacobsen, Phyllis Kaldor, Jennifer A. Ligibel, Barbara A. Murphy, Tracey O'Connor, William F. Pirl, Eve Rodler, Hope S. Rugo, Jay Thomas and Lynne I. Wagner

. 183. Krishnasamy M . Fatigue in advanced cancer—meaning before measurement? Int J Nurs Stud 2000 ; 37 : 401 – 414 . 184. Lundh Hagelin C Seiger A Furst CJ . Quality of life in terminal care—with special reference to age, gender and

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Ann M. Berger, Kathi Mooney, Amy Alvarez-Perez, William S. Breitbart, Kristen M. Carpenter, David Cella, Charles Cleeland, Efrat Dotan, Mario A. Eisenberger, Carmen P. Escalante, Paul B. Jacobsen, Catherine Jankowski, Thomas LeBlanc, Jennifer A. Ligibel, Elizabeth Trice Loggers, Belinda Mandrell, Barbara A. Murphy, Oxana Palesh, William F. Pirl, Steven C. Plaxe, Michelle B. Riba, Hope S. Rugo, Carolina Salvador, Lynne I. Wagner, Nina D. Wagner-Johnston, Finly J. Zachariah, Mary Anne Bergman and Courtney Smith

A Furst CJ . Quality of life in terminal care—with special reference to age, gender and marital status . Support Care Cancer 2006 ; 14 : 320 – 328 . 185. Walsh D Donnelly S Rybicki L . The symptoms of advanced cancer: relationship to