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Simon, Steffen T.; Pralong, Anne; Radbruch, Lukas; Bausewein, Claudia; Voltz, Raymond (2020): The Palliative Care of Patients With Incurable Cancer. In: Deutsches Ärzteblatt International, Vol. 117, No. 7: pp. 108-115
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Abstract

Background: The purpose of palliative medicine is to optimize the quality of life of patients with incurable, progressive diseases. The care delivered in actual clinical practice is not uniform and often takes insufficient account of the currently available scientific evidence. Methods: In accordance with the methodological directives on systematic literature reviews and consensus-finding that have been issued by the German Oncology Guideline Program (Leitlinienprogranun Onkologie). a nationwide, representative group of experts updated the previously published seven chapters of the S3 (evidence-based and consensus-based) guideline and formulated new recommendations on a further eight topics in palliative care. Results: Non-drug options for the treatment of fatigue include aerobic exercise and psycho-educative methods, particularly cognitive behavioral therapy. Sleep disturbances can be treated with improved sleep hygiene and relaxation techniques, as well as with drugs: Z substances for short-term and sedating antidepressants for intermediate-term treatment. For nausea and vomiting. the first line of treatment consists of antidopaminergic drugs, such as haloperidol, or drugs with an antidopaminergic effect combined with a further receptor affinity, such as metoclopramide. For patients suffering from malignant intestinal obstruction NI% an important consideration for further treatment is whether the obstruction is complete or incomplete. Psychotherapeutic interventions are indicated for the treatment of anxiety. Conclusion: Multiple studies have confirmed the benefit of the early integration of palliative care for achieving the goals of better symptom control and maintenance of quality of life. There is currently a low or moderate quality of evidence supporting the management of certain symptoms in patients with incurable cancers.