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Overview of managing common non-pain symptoms in palliative care

Authors
Eduardo Bruera, MD
Rony Dev, DO
Section Editor
Robert M Arnold, MD
Deputy Editor
Diane MF Savarese, MD

INTRODUCTION

Most patients in the terminal phase of a serious and/or life-threatening illness such as cancer develop potentially devastating physical and psychosocial symptoms in the weeks to months before death [1]. Patients admitted to tertiary palliative care units are likely to present with more frequent and severe symptoms compared with those admitted to community hospices or acute care hospital beds, although the frequency of symptoms is high in all groups (table 1).

Effective treatment will successfully alleviate and may even eliminate the majority of symptoms (pain, dyspnea, nausea/vomiting, fatigue, etc) that arise in terminally ill patients.

Palliative care is an interdisciplinary medical specialty that focuses on preventing and relieving unnecessary suffering by supporting the best possible quality of life for patients and their families facing serious and/or life-threatening illness. The primary tenets of palliative care are symptom management; establishing goals of care that are in keeping with the patient’s values and preferences; consistent and sustained communication between the patient and all those involved in his or her care; psychosocial, spiritual, and practical support both to patients and their family; and coordination across sites of care. Palliative care aims to relieve suffering in all stages of disease and is not limited to end of life care. Within an integrated model of medical care, palliative care is provided at the same time as curative or life-prolonging treatments. (See "Benefits, services, and models of subspecialty palliative care".)

Referral to palliative care at an earlier stage of an advanced serious or life threatening illness may reduce the symptom burden of patients and prepare family caregivers for the last stages of life. In a seminal study of patients with metastatic non-small-cell lung cancer, early palliative care consultation led to modest improvements in quality of life and mood, longer median survival, and less chemotherapy administered within 14 days before death [2]. (See "Benefits, services, and models of subspecialty palliative care", section on 'Definitions'.)

This topic will provide a brief overview of the management of common non-pain symptoms in adult palliative care patients. The comprehensive assessment of palliative care patients, and issues related to symptom assessment in particular, management of cancer-related pain, as well as other pertinent issues that arise during palliative care, such as ethical, legal, and psychosocial issues, hospice, palliative care for children, and specific concerns that arise in the setting of the intensive care unit, are discussed elsewhere:

                           

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Literature review current through: Nov 2016. | This topic last updated: Fri Nov 06 00:00:00 GMT+00:00 2015.
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