THE USES OF PSYCHOTROPICS IN SYMPTOM MANAGEMENT IN ADVANCED CANCER

Approximately 50% of patients diagnosed with cancer die because of pro gressive disease. Psychotropic drugs are frequently used for the manag ement of physical and psychosocial symptoms in these patients. Thalido mide, cannabinoids and melatonin are emerging agents for the managemen t of cachexia. Psychostimulants have a defined role in the management of opioid-induced sedation. Haloperidol, tricyclic anti-depressants an d newer anti-depressants also have an established role in the manageme nt of neuropsychiatric symptoms such as delirium or depression. Cancer patients present unique challenges for successful psychotropic therap y including older age, malnutrition, autonomic failure, borderline cog nition, opioid and psychotropic therapy. A practical clinical approach which defines a specific target symptom, an outcome latency period, e xpected side effects, and reviews possible drug interactions, and freq uent monitoring is outlined. Continued research is needed to further d efine the role of psychotropics in the management of the different phy sical and psychosocial symptoms in advanced cancer patients. (C) 1998 John Wiley & Sons, Ltd.