MANAGEMENT OF SPECIFIC SYMPTOM COMPLEXES IN PATIENTS RECEIVING PALLIATIVE CARE

DURING THE PAST 10 YEARS THERE HAVE BEEN MAJOR CHANGES in the manageme nt of the most common symptoms of terminal cancer. Opioid agonists rem ain the mainstay in the management of cancer pain. Slow-release prepar ations are currently available for several of these agents. The increa sed use of opioids has led to the recognition of opioid-induced neurot oxic effects and to the development of effective adjuvant drugs and ot her strategies to counteract these side effects. A number of drugs are available for the management of symptoms of cachexia, including corti costeroids and progestational drugs. Prokinetic drugs, either alone or in combination with other agents such as corticosteroids, are highly effective in the treatment of chronic nausea. For patients with asthen ia, it should first be determined whether there are any reversible cau ses; if not, corticosteroids and psychostimulants may diminish the sym ptoms. Haloperidol, other neuroleptics and benzodiazepines may be requ ired to manage hyperactive delirium. Oxygen and opioids are effective in treating dyspnea, whereas there is limited evidence that benzodiaze pines provide any relief of this symptom. More research on the assessm ent and management of these devastating clinical symptoms of cancer is badly needed.