Cancer Symptoms

Andree Kurniawan

Mata Kuliah pilihan Paliatif Onkologi

Program studi Pendidikan Dokter Fakultas Kedokteran Universitas Pelita Harapan
Ilustarasi kasus
• Pasien karsinoma nasofaring usia 34 tahun laki-laki stadium IVa saat
ini menjalani radioterapi di RS di Jakarta. Ia sudah tidak bekerja,
namun memiliki tanggungan anak yang berusia 4 tahun. Istri pasien
berjualan makanan jajanan pasar.
• Sebelum menjalani terapi: Ia merasakan lemas, fatigue, tidak nafsu
makan, cepat kenyang, berat badan menurun 15 kg dalam 3 bulan
terakhir. Ia merasakan cemas, khawatir akan penyakitnya.
• Selama menjalani terapi: berat badan semakin menurun, nafsu makan
tidak ada, mulut kering, nyeri di mulut dan gusi, kulit leher semakin
hitam, aktifitas perlu dibantu selama melakukan kegiatan sehari-hari.
Introduction
• Cancer is systemic disease requiring early intervention and treatment
by multidisciplinary, multi-professional, multimodality and palliative
approach to adapt intervention to the clinical target and goals of
patients
• Cancer symptoms will affect the quality of life despite the successful
of cancer treatment
• Supportive care in the curative and palliative intend is needed to
support cancer patients during their lifetime.

ESMO
ASCO
In the cancer management there is still unmet
patients symptoms
Palliative care in cancer patients

ESPEN LLL course nutrition in cancer 2020

Cancer symptoms classification
• At diagnosis
• During treatment
• Survival cancer
• End stage cancer
At diagnosis
• Local symptoms (tumor infiltration)
• Systemic or paraneoplastic syndrome
Symptoms at cancer diagnosis
Local symptoms

Koo MM. Lancet Oncol 2020; 21: 73–79

Koo MM. Lancet Oncol 2020; 21: 73–79
Chronic symptoms
• Fatigue  anemia, medications, endocrinopathies such as hypothyroidism,
hypogonadism, or adrenal insufficiency, and electrolyte imbalance
• Neurocognitive and neurobehavioral
• Mood disorders and behavioral change
• Insomnia
• Pain
• Gastrointestinal symptoms
• Thermal dysregulation
• Anorexia, cachexia, and weight loss
Murphy, B., & Epstein, J. (2020). Chronic systemic symptoms in
cancer patients. Translational Systems Medicine and Oral
Disease, 353–369. doi:10.1016/b978-0-12-
Survival cancer patients
• Fatigue
• Malaise
• Pain
• Anxiety
During treatment
• Treatment toxicity
• Mucositis
• Diarrhea
• Hair loss
• Skin toxicity
• Fatigue  anemia
• Procedure complication
• Longer hospitalization
• Malnutrition
• Cachexia or sarcopenia
Factors related to quality of life
• Performances status (ADL) • Coping mechanism
• Cancer symptoms burden • Social support
• Nutritional status • Level of education
• Low muscle mass • Social economy status
• Staging • Treatment completion
• Treatment delay • Complementary alternative
• Comorbidities medicine
• Illness perception
What should we do?
• Identification the symptoms  questionnaire, patients reported
outcomes
• Work as team in multi disciplinary oncology teams with patient
centered approach
• Focus on the patients symptoms, not always with drugs, psychosocial
support and behavior therapy
• Malnutrition screening  NRS  nutrition support
• Social support  family or care giver