"Impediments to management of depression in cancer patients include many of the same factors described for pain," the panel said. Major barriers to effective management of fatigue include a lack of awareness that fatigue is the most prevalent symptom, lack of knowledge of the causes of fatigue, and lack of proven methods to treat fatigue.
A common strategy for improving cancer symptom management involves regular symptom assessment, the panel said, followed by quality improvement interventions that include educating providers and patients, following treatment algorithms, and regular reassessment and follow-up of symptom scores.
"Strategies for decreasing system barriers need to be addressed at the national or regional level," the report said. "Regulatory barriers need to be revised to maximize convenience, benefit, and compliance, and to minimize cost and narcotic diversion for illegal purposes." It specifically urged refills for opioid prescriptions, refills by telephone, stocking by pharmacies of appropriate products, and adequate reimbursement for medications and symptom management.
The panel’s list of areas for future research ranged from conceptual models to direct systematic research into pain, depression, and fatigue, to enhanced training of physicians and other health care providers in managing the symptoms of cancer and its treatment.
It suggested research to determine whether these symptoms differ qualitatively and quantitatively between cancer and noncancer patients; to provide accurate estimates of symptom incidence; to explore patients’ psychological and physiological accommodations to cancer symptoms; and to develop tumor-specific and pain-specific treatments. The full text of the report in draft form is available at http://consensus.nih.gov.