Authors' objectives:

Despite dramatic advances in cancer biology and a widening array of treatment options, cancer continues to cause devastating suffering not only in the hundreds of thousands of patients who die of it each year in the United States, but also in some patients who are successfully treated and become cancer survivors. This report was produced on request from the Office of Medical Applications of Research, National Institutes of Health, and the National Cancer Institute for a Consensus Development Conference.

Authors' results and conclusions: The prevalence of cancer pain varied from 14 to 100 percent, depending on the setting. More than 100 scales or instruments have been used to assess pain. Studies published in the interim since our earlier evidence report on the management of cancer pain do not change the conclusions of that report. Randomized controlled trials establish that many current treatment modalities can individually reduce cancer pain. Treatment trials rarely separate efficacy according to putative mechanism of pain. For specific problems such as postherpetic neuralgia and oral mucositis, there are sufficient trials upon which to base specific treatment recommendations. The prevalence rates for major depressive disorder and clinically significant depressive symptoms are about 10 to 25 percent. Although a clinical interview is the standard for assessing depression, many instruments are available for screening and the assessment of severity for depressive symptoms. There is currently no evidence on how widely they are used clinically or to suggest that they affect clinical care and outcomes. The benefit of psychosocial interventions for cancer-related depression seems to be modest. All medication trials that use antidepressants and lasted at least 5 weeks demonstrated some efficacy. There are no controlled trials of the effect of alternative treatments on cancer-related depression. Extremely wide prevalence rates of fatigue (4 to 91 percent) were found in association with chemotherapy, radiation therapy, and other treatments. The prevalence of fatigue in the palliative setting was 48 to 75 percent and in cancer survivors 17 to 56 percent. Most studies used multi-item, multidimensional assessment instruments. Clinical interpretation of results is problematic due to the heterogeneity of assessment methods. There are few randomized, controlled trials of treatments for cancer-related fatigue. Only one of these strongly supports a specific intervention for fatigue, i.e., treatment with epoetin alfa in anemic patients receiving chemotherapy.

Authors' recommendations: Pain, depressive symptoms, and fatigue are common problems in patients with cancer. Despite numerous instruments having been developed to assess these symptoms, optimal and standardized methods for the assessment of these symptoms in clinical practice have not been determined. Even in areas where efficacious treatment options exist, there are few high- quality randomized trials to guide the selection of optimal treatment alternative. Additional studies are needed to measure the prevalence and impact of these symptoms in cancer, to determine the clinical significance of these measurements, and to define factors that correlate with these symptoms. For cancer-related fatigue, current treatment options are limited unless reversible factors contributing to fatigue can be identified and corrected. For all of the topics examined in this evidence report, there is a paucity of studies in the pediatric population and research in children is urgently needed to address the symptoms of pain, depression, and fatigue.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.ahrq.gov/clinic/epcsums/csympsum.htm

Year Published: 2002

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: Agency for Healthcare Research and Quality

Contact Address: Center for Outcomes and Evidence Technology Assessment Program, 540 Gaither Road, Rockville, MD 20850, USA. Tel: +1 301 427 1610; Fax: +1 301 427 1639;

Contact Name: martin.erlichman@ahrq.hhs.gov

Contact Email: martin.erlichman@ahrq.hhs.gov

Copyright: Agency for Healthcare Research and Quality (AHRQ)