Current Issues in Cancer Palliative careBMJ 1994; 308 doi: https://doi.org/10.1136/bmj.308.6940.1359 (Published 21 May 1994) Cite this as: BMJ 1994;308:1359
- C L Davis,
- J R Hardy
- Royal Marsden Hospital, Sutton, Surrey SM2 5PT Royal Marsden Hospital, London SW3 6JJ
- Correspondence to: Dr Davis.
Though many of the treatment strategies used in palliative care have never been subjected to clinical trial, it has been argued that advances in palliative care have outstripped those in many other specialties. This article is not a comprehensive review of therapeutic options, nor even of recent advances in this topic, but concentrates on the latest developments and controversies in the pharmacological treatment of four frequent and important symptoms: neuropathic pain, anorexia and cachexia, intestinal obstruction, and breathlessness. It is difficult to perform blinded, randomised trials in patients with advanced disease and poor performance status, yet it is these patients who may gain most from the adoption of new well evaluated treatment strategies. “Palliative treatment is no longer regarded as a negative lack-of- treatment, or as a ragbag of therapies which are vaguely thought of as supportive.”1 has been defined in many ways, but perhaps the most apposite is that recently adopted by the World Health Organisation - “the active, total care of a person whose condition is not responsive to curative treatment.”2 This definition highlights the fact that such care should not be restricted to patients with malignant disease and that terminal care is but one aspect of palliative care, if a very important one. The concept of palliative care embraces optimal symptom control and quality of life as well as appropriate rehabilitation.3 The patient is regarded as part of a unit which also includes his or her family, friends, and carers.
Issues in pain management
Pain is one of the most common and probably most feared symptoms of advanced cancer. A recent highly publicised court case centred on the symptomatic management of a patient with severe rheumatoid arthritis4 served to illustrate that pain is not always responsive to conventional analgesics.
The semantics of pain are complicated and to …