title: Palliative Care of Adult Patients With Cancer.
abstract: BACKGROUND
  In Germany, the annual mortality rate from cancer in the year 2011 was 269.9 deaths per 100 000 persons; every fourth death was due to cancer. A central objective of palliative care is to maintain the best possible quality of life for cancer patients right up to the end of their lives.
  
  
  METHODS
  The PubMed, Embase, and Cochrane Library databases were systematically searched for pertinent publications, and the ones that were selected were assessed as recommended by the Scottish Intercollegiate Guidelines Network. As part of the German Guideline Program in Oncology, recommendations for the S3 Guideline on Palliative Care concerning seven different topics in the management of adult patients with incurable cancer were developed by a representative expert panel employing a consensus process.
  
  
  RESULTS
  Opioids are the drugs of first choice for severe and moderately severe cancer-related pain, and for breathlessness. No clinically relevant respiratory depression was observed in any study. When opioids are used, accompanying medication to prevent constipation is recommended. Drugs other than opioids are ineffective against breathlessness, but clinical experience has shown that benzodiazepines and opioids can be used in combination in advanced stages of disease, or if the patient suffers from marked anxiety. Depression should be treated even in patients with a short life expectancy; psychotherapy is indicated, and antidepressant medication is indicated as well if depression is at least moderately severe. Communication skills, an essential component of palliative care, play a major role in conversations between the physician and the patient about the diagnosis, the prognosis, and the patient's wish to hasten death. When the dying phase begins, tumor-specific treatments should be stopped.
  
  
  CONCLUSIONS
  Palliative care should be offered to cancer patients with incurable disease. Generalist and specialist palliative care constitute a central component of patient care, with the goal of achieving the best possible quality of life for the patient.
authors.affiliation: Department of Palliative Medicine, University Hospital Munich, Campus Grosshadern, Department of Palliative Medicine, University Hospital Cologne, Department of Palliative Medicine, University Hospital Bonn, Department of Palliative Medicine, University Medical Center Göttingen.
authors.forename: Claudia
authors.initials: C
authors.lastname: Bausewein
authors.forename: Steffen T
authors.initials: ST
authors.lastname: Simon
authors.forename: Anne
authors.initials: A
authors.lastname: Pralong
authors.forename: Lukas
authors.initials: L
authors.lastname: Radbruch
authors.forename: Friedemann
authors.initials: F
authors.lastname: Nauck
authors.forename: Raymond
authors.initials: R
authors.lastname: Voltz
mesh_terms: D000328:Adult; D000698:Analgesia / Q000592:standards*; D000072716:Cancer Pain / Q000517:prevention & control / Q000523:psychology; D004417:Dyspnea / Q000517:prevention & control / Q000523:psychology; D019317:Evidence-Based Medicine; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008495:Medical Oncology / Q000592:standards; D009369:Neoplasms / Q000523:psychology* / Q000628:therapy*; D059408:Pain Management / Q000523:psychology / Q000592:standards*; D010166:Palliative Care / Q000592:standards*; D017060:Patient Satisfaction; D011788:Quality of Life / Q000523:psychology*; D016896:Treatment Outcome