Management of common symptoms in terminally ill patients: Part I. Fatigue,anorexia, cachexia, nausea and vomiting

Physical symptoms other than pain often contribute to suffering near the en d of life. In addition to pain, the most common symptoms in the terminal st ages of an illness such as cancer or acquired immunodeficiency syndrome are fatigue, anorexia, cachexia, nausea, Vomiting, constipation, delirium and dyspnea. Management involves a diagnostic evaluation for the cause of each symptom when possible, treatment of the identified cause when reasonable, a nd concomitant treatment of the symptom using nonpharmacologic and adjuncti ve pharmacologic measures. Part I of this two-part article discusses fatigu e, anorexia, cachexia, nausea and vomiting. Fatigue is the most common symp tom at the end of life, but little is known about its pathophysiology and s pecific treatment. Education of the patient and family is the foundation of treatment, with the possible use of adjunctive psychostimulants. Anorexia and cachexia caused by wasting syndromes are best managed with patient and family education, as well as a possible trial of appetite stimulants such a s megestrol or dexamethasone. For appropriate pharmacologic treatment, it i s helpful to identify the pathophysiologic origin of nausea in each patient .