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A 50-year-old Hispanic male is treated for metastatic adenocarcinoma of the lung. He complains about cough, shortness of air, and severe back pain. He does not tolerate narcotics well and appears very depressed.

Learning Objectives

  1. What are the different types of palliative care available to cancer patients?

  2. How are common symptoms in lung cancer patients evaluated and managed?

  3. How is pain in cancer patients managed?

Supportive care in cancer is the prevention and management of the symptoms and side effects of cancer and its treatment across the cancer continuum from diagnosis to the end of life. There is mounting evidence in oncology that early and effective supportive care is linked to better quality of life and survival.1,2

The delivery of palliative care can be categorized as primary, secondary, and tertiary.

  • Primary palliative care is the provision of basic symptom management and psychosocial care by -ology teams and primary care clinicians.

  • Secondary palliative care refers to consultation services provided by interdisciplinary specialist palliative care teams.

  • Tertiary palliative care denotes the situation when a palliative care team becomes the primary coordinating team.

Patients with advanced cancer have multiple symptoms and require systematic assessment. Patient descriptions of physical symptoms and their severity are the primary data for symptom assessment. Formal multiple-symptom assessment tools provide a good overview of symptoms in individual patients. A number of validated multiple-symptom assessment tools are in wide usage in palliative care settings, including

  • The revised Edmonton Symptom Assessment Scale3 (Figure 19-1)

  • Memorial Symptom Assessment Scale–Short (MSAS) Form

  • M. D. Anderson Brief Symptom Inventory

  • Rotterdam Symptom Checklist

  • Symptom Distress Scale

Figure 19-1.

Edmonton Symptom Assessment System: revised. (Reproduced with permission from Watanabe SM, Nekolaichuk C, Beaumont C, et al. A multicenter study comparing two numerical versions of the Edmonton Symptom Assessment System in palliative care patients. J Pain Symptom Manage. 2011;41:456. © 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.)

Multiple-symptom assessment tools are highly effective in recognizing unreported symptoms when combined with further patient interviewing to delineate the details of positive responses. When a specific tool has been chosen, it should be used consistently to ensure reliability in the clinical setting.

This chapter includes a discussion about assessing and treating highly prevalent symptoms in a lung cancer patient.


Cancer-related anorexia/cachexia syndrome (CACS) is a debilitating wasting syndrome that affects many patients who are undergoing treatment for a malignancy.

Cachexia is a complex metabolic syndrome associated with underlying illness and characterized by loss of muscle with or without loss of fat mass. The prominent clinical feature of cachexia is weight loss in adults (corrected for fluid retention) or ...

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