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Doctors need more education in treating cancer symptoms, as opposed to just killing malignant cells, according to Dr. Laura Shoemaker. Both cancer itself and cancer treatments produce serious symptoms that impair quality of life, possibly to the point of interfering with the patient's ability to recover from the disease.
The first step for doctors is to recognize symptoms. This is where patients can make significant contributions to their own care. Shoemaker and collaborators reported that most patients fail to report cancer symptoms unless the physician inquires carefully. They suggested patients have low expectations for their well-being during cancer treatment. In a survey of their palliative care patients, the median number of symptoms in the initial complaint was only 1, whereas systematic assessment produced a median number of 10 symptoms. Some patients have 25 or more symptoms.
The most common symptoms for patients with advanced cancer are:
1. Pain, in 89 percent
2. Fatigue, in 69 percent
3. Weakness, in 66 percent
4. Anorexia (loss of appetite), in 66 percent
5. Lack of energy, in 61 percent
6. Nausea, in 60 percent
7. Dry mouth, in 57 percent
8. Constipation, in 52 percent
9. Early satiety (difficulty in eating enough), in 51 percent
10. Dyspnea (trouble breathing), in 50 percent
11.Vomiting, in 30 percent
One of the most distressing but least effectively treated symptoms is dyspnea, which includes the sensation of breathlessness, chest tightness, air hunger, suffocation or increased work of breathing. Palliative sedation is used more frequently for dyspnea than for pain. However, many cases can be treated effectively with opiod drugs. These drugs are underutilized, according to the Cleveland Clinic article, because they can cause respiratory depression in high doses. Appropriate doses make breathing easier for the patient. Pure oxygen may be useful for other reasons, but does not improve the symptoms of dyspnea.
There are many pharmacological and non-pharmacological treatments for the gastrointestinal symptoms of anorexia, nausea, dry mouth, constipation, early satiety and vomiting. The appropriate treatment depends on the cause, which could be gastric outlet obstruction, intracranial pressure or other conditions in addition to chemotherapy side effects.
Fatigue symptoms are also common in cancer patients. Reversible causes include anemia, insomnia, malnutrition, pain, depression and other illness. Individualized programs for rest and exercise can be helpful.
Dr. Timothy Gilligan, deputy editor of the Cleveland Clinic Journal of Medicine, reported that patient advocacy is the primary motivation for medical researchers to focus more on treating cancer symptoms.
References:
1. Shoemaker LK et al, “Symptom management: An important part of cancer care”, Cleveland Clinic Journal of Medicine 2011 January; 78(1): 25-34.
2. Gilligan T, “To better manage cancer symptoms”, Cleveland Clinic Journal of Medicine 2011 January; 78(1): 24.
Linda Fugate is a scientist and writer in Austin, Texas. She has a Ph.D. in Physics and an M.S. in Macromolecular Science and Engineering. Her background includes academic and industrial research in materials science. She currently writes song lyrics and health articles.
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