Symptom Clusters in Supportive and Palliative Care: Moving Toward the New Frontier in Managing Cancer Patients

Faculty

Needs Statement

Cancer patients may experience multiple concurrent symptoms—symptom clusters—caused by their disease, their treatment, or a combination of both. The complex relationships between and among symptoms, as well as their clinical antecedents and consequences, have not been well described. Studying the complex symptoms of oncology patients will yield increased understanding of the patterns of association, interaction, and synergy among symptoms that produce specific clinical outcomes. It will also provide a scientific basis and new directions for clinical assessment and intervention. The majority of clinical studies on symptoms associated with cancer are focused on a single symptom rather than on clusters. Although this approach has led to advances in our understanding of a particular symptom, patients rarely present with a single symptom. Therefore, even though research focused on single symptoms needs to continue, it is imperative that symptom management research begins to focus on evaluating multiple concurrent symptoms, using cross-sectional and longitudinal study designs. In addition, research needs to focus on evaluating the relationships between symptoms, as well as specific interventions and patient outcomes. Recognition of symptom clusters should help the understanding of symptom pathophysiology and the targeting of therapies that perhaps can be used to relieve multiple symptoms in that cluster. This could result in improved quality of life for patients with advanced cancer and perhaps reduce polypharmacy, lessen drug side effects, and have pharmacoeconomic benefits. Symptom clustering in cancer patients is clearly both an emerging field of investigation and also a timely topic for continuing education regarding patient management. This monograph discusses symptom clustering involving fatigue, pain, thrombosis, nausea, and vomiting in the context of disease effects and chemotherapy-associated effects.

Objectives

1. Assess recent advances in defining and managing symptom clusters in cancer patients;
2. Discuss the management of early and delayed-onset chemotherapy-induced nausea and vomiting (CINV) and identify key elements of the American Society of Clinical Oncology ASCO) and National Comprehensive Cancer Network (NCCN) guidelines;
3. Define breakthrough cancer pain, its causes, and options for managing breakthrough pain BTP) in cancer patients;
4. Identify fatigue as an expected outcome of cancer itself in addition to cancer treatments and discuss its management;
5. Discuss the importance of recognizing and managing cancer-related thrombosis and identify key components of the recent NCCN guidelines.

Accreditation

Medicine
This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of the University of Kentucky College of Medicine and Continuing Edge, a division of Global Edge, Inc. The University of Kentucky College of Medicine is accredited by the ACCME to provide continuing medical education for physicians.

The University of Kentucky College of Medicine designates this educational activity for a maximum of 2.00 AMA PRA Category 1 Credits™. Each physician should claim only those hours of credit actually spent in the educational activity.

The University of Kentucky College of Medicine presents this activity for educational purposes only. Participants are expected to utilize their own expertise and judgment while engaged in the practice of medicine. The content of the presentations is provided solely by presenters who have been selected for presentations because of recognized expertise in their field.

Faculty Disclosure

Dr Lichtman is on the speaker's bureau for Amgen and sanofi-aventis.

Dr Ancoli-Israel discusses off-label treatments that are commonly used for insomnia. She is on the speaker's bureau for Cephalon, Inc., King Pharmaceuticals, Inc., Neurocrine Biosciences, Inc., sanofi-aventis, and Sepracor, Inc. She receives consultation fess from Acadia, Cephalon, Inc., Ferring Pharmaceuticals, GlaxoSmithKline, King Pharmaceuticals, Inc., Merck, Neurocrine Biosciences, Inc., Neurogen, Inc., sanofi-aventis, Sepracor, Inc., and Takeda Pharmaceuticals North America, Inc.

Dr Gralla discusses Abstract #9111 from the ASCO 2007 meeting which describes an investigational use of the antiemetic aprepitant. He receives consultation fees from Merck, Helsinn, MGI Pharma.

Dr Slatkin discusses unlabeled/investigational use of morphine, oxycodone, hydromorphone for cancer BTP. He is on the speaker's bureau for Pfizer, Ortho-Biotech, Cephalon, and Valeant. He receives grant/research support from Bioscience Delivery, Cephalon, Sucampo, Pfizer, Wyeth. He receives consultation fees from Valeant, Cephalon and Wyeth.

Dr Strieff is on the speaker's bureau for sanofi-aventis, GlaxoSmithKline. He receives consultation fees from sanofi-aventis and Eisai.

 

Activity Sponsorship

This activity is jointly sponsored by the University of Kentucky and Continuing Edge, a division of Global Edge, Inc. Supported by an unrestricted educational grant from, Cephalon, Merck Oncology, and GlaxoSmithKline.