PURPOSE The experience of patients with
cancer often involves symptoms of
fatigue,
anorexia, depression, and
dyspnea. METHODS We developed a set of standards through an iterative process of structured literature review and development and refinement of topic areas and standards and subjected recommendations to rating by a multidisciplinary expert panel. Results For
fatigue, providers should screen patients at the initial visit, for newly identified advanced
cancer, and at
chemotherapy visits; assess for depression and
insomnia in newly identified
fatigue; and follow up
after treatment for
fatigue or a secondary cause. For
anorexia, providers should screen at the initial visit for
cancer affecting the oropharynx or gastrointestinal tract or advanced
cancer, evaluate for associated symptoms, treat underlying causes, provide nutritional counseling for patients undergoing treatment that may affect nutritional intake, and follow up patients given
appetite stimulants. For depression, providers should screen newly diagnosed patients, those started on
chemotherapy or
radiotherapy, those with newly identified advanced disease, and those expressing a desire for hastened death; document a treatment plan in diagnosed patients; and follow up response
after treatment. For general
dyspnea, providers should evaluate for causes of new or worsening
dyspnea, treat or symptomatically manage underlying causes, follow up to evaluate treatment effectiveness, and offer
opioids in advanced
cancer when other treatments are unsuccessful. For
dyspnea and
malignant pleural effusions, providers should offer thoracentesis, follow up after thoracentesis, and offer
pleurodesis or a drainage procedure for patients with reaccumulation and
dyspnea. CONCLUSION These standards provide a framework for evidence-based screening, assessment, treatment, and follow-up for
cancer-associated symptoms.