Steffen T Simon1, Anne Pralong, Lukas Radbruch, Claudia Bausewein, Raymond Voltz. 1. University of Cologne, Faculty of Medicine and University Hospital, Department of Palliative Medicine; University of Cologne, Faculty of Medicine and University Hospital, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD); Department of Palliative Medicine, University Hospital Bonn; Ludwig-Maximilians-University Munich, Munich University Hospital, Department of Palliative Medicine.
Abstract
BACKGROUND: The purpose of palliative medicine is to optimize the quality of life of patients with incurable, progressive diseases. The care delivered in actual clinical practice is not uniform and often takes insufficient account of the currently available scientific evidence. METHODS: In accordance with the methodological directives on systematic literature reviews and consensus-finding that have been issued by the German Oncology Guideline Program (Leitlinienprogramm Onkologie), a nationwide, representative group of experts updated the previously published seven chapters of the S3 (evidence-based and consensus-based) guideline and formulated new recommen- dations on a further eight topics in palliative care. RESULTS: Non-drug options for the treatment of fatigue include aerobic exercise and psycho-educative methods, particularly cognitive behavioral therapy. Sleep distur- bances can be treated with improved sleep hygiene and relaxation techniques, as well as with drugs: Z substances for short-term and sedating antidepressants for intermediate-term treatment. For nausea and vomiting, the first line of treatment consists of antidopaminergic drugs, such as haloperidol, or drugs with an antido- paminergic effect combined with a further receptor affinity, such as metoclopramide. For patients suffering from malignant intestinal obstruction (MIO), an important con- sideration for further treatment is whether the obstruction is complete or incomplete. Psychotherapeutic interventions are indicated for the treatment of anxiety. CONCLUSION: Multiple studies have confirmed the benefit of the early integration of palliative care for achieving the goals of better symptom control and maintenance of derate quality of evidence supporting the management of certain symptoms in patients with incurable cancers.
BACKGROUND: The purpose of palliative medicine is to optimize the quality of life of patients with incurable, progressive diseases. The care delivered in actual clinical practice is not uniform and often takes insufficient account of the currently available scientific evidence. METHODS: In accordance with the methodological directives on systematic literature reviews and consensus-finding that have been issued by the German Oncology Guideline Program (Leitlinienprogramm Onkologie), a nationwide, representative group of experts updated the previously published seven chapters of the S3 (evidence-based and consensus-based) guideline and formulated new recommen- dations on a further eight topics in palliative care. RESULTS: Non-drug options for the treatment of fatigue include aerobic exercise and psycho-educative methods, particularly cognitive behavioral therapy. Sleep distur- bances can be treated with improved sleep hygiene and relaxation techniques, as well as with drugs: Z substances for short-term and sedating antidepressants for intermediate-term treatment. For nausea and vomiting, the first line of treatment consists of antidopaminergic drugs, such as haloperidol, or drugs with an antido- paminergic effect combined with a further receptor affinity, such as metoclopramide. For patients suffering from malignant intestinal obstruction (MIO), an important con- sideration for further treatment is whether the obstruction is complete or incomplete. Psychotherapeutic interventions are indicated for the treatment of anxiety. CONCLUSION: Multiple studies have confirmed the benefit of the early integration of palliative care for achieving the goals of better symptom control and maintenance of derate quality of evidence supporting the management of certain symptoms in patients with incurable cancers.
Authors: Jeannette Vogt; Franziska Beyer; Jochen Sistermanns; Jonas Kuon; Christoph Kahl; Bernd Alt-Epping; Susanne Stevens; Miriam Ahlborn; Christian George; Andrea Heider; Maria Tienken; Carmen Loquai; Kerstin Stahlhut; Anne Ruellan; Thomas Kubin; Andreas Dietz; Karin Oechsle; Anja Mehnert-Theuerkauf; Birgitt van Oorschot; Michael Thomas; Olaf Ortmann; Christoph Engel; Florian Lordick Journal: Oncologist Date: 2021-03-30
Authors: Steffen T Simon; Anne Pralong; Michael Hallek; Christoph Scheid; Udo Holtick; Marco Herling Journal: Ann Hematol Date: 2021-05-06 Impact factor: 3.673
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