title: Common symptoms in advanced cancer.
abstract: The key points of this article are anorexia and cachexia are: A major cause of cancer deaths. Several drugs are available to treat anorexia and cachexia. Dyspnea in cancer usually is caused by several factors. Treatment consists of reversing underlying causes, empiric bronchodilators, cortico-steroids--and in the terminally ill patients-opioids, benzodiazepines,and chlorpromazine. Delirium is associated with advanced cancer. Empiric treatment with neuroleptics while evaluating for reversible causes is a reasonable approach to management. Nausea and vomiting are caused by extra-abdominal factors (drugs,electrolyte abnormalities, central nervous system metastases) or intra-abdominal factors (gastroparesis, ileus, gastric outlet obstruction, bowel obstruction). The pattern of nausea and vomiting differs depending upon whether the cause is extra- or intra-abdominal. Reversible causes should be sought and empiric metoclopramide or haloperidol should be initiated. Fatigue may be caused by anemia, depression, endocrine abnormalities,or electrolyte disturbances that should be treated before using empiric methylphenidate. Constipation should be treated with laxatives and stool softeners. Both should start with the first opioid dose.
authors.affiliation: The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Center, The Cleveland Clinic Foundation, 9500 Euclid Avenue, M76 Cleveland, OH 44195, USA. lagmanr@ccf.org
authors.forename: Ruth L
authors.initials: RL
authors.lastname: Lagman
authors.forename: Mellar P
authors.initials: MP
authors.lastname: Davis
authors.forename: Susan B
authors.initials: SB
authors.lastname: LeGrand
authors.forename: Declan
authors.initials: D
authors.lastname: Walsh
mesh_terms: D000855:Anorexia / Q000503:physiopathology / Q000628:therapy; D002100:Cachexia / Q000503:physiopathology / Q000628:therapy; D003248:Constipation / Q000503:physiopathology / Q000628:therapy; D003693:Delirium / Q000503:physiopathology / Q000628:therapy; D004417:Dyspnea / Q000503:physiopathology / Q000628:therapy; D005221:Fatigue / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D009325:Nausea / Q000503:physiopathology / Q000628:therapy; D009369:Neoplasms / Q000503:physiopathology*; D010166:Palliative Care; D014839:Vomiting / Q000503:physiopathology / Q000628:therapy