NCCN Issues Updated Guidelines for Palliative Care
The National Comprehensive Cancer Network (NCCN) recently provided a few major updates to their palliative care guidelines.
In the palliative care general overview section, a few new indications were added, including “Complex psychosocial needs,” “Poor prognostic awareness,” and “Metastatic solid tumors and refractory hematologic malignancies.” Additionally, a few more reassessment bullet points were added, including “Re-evaluate intervention options and intensify as possible” (which is modified throughout the guidelines) and “Consult with other providers and refer to specialist if available.”
As for the criteria for consultation with a palliative care specialist, the second bullet under assessment “High-risk for persistent complex bereavement disorder” is new to the page, with the corresponding footnote: “Persistent complex bereavement disorder is a chronic heightened state of mourning that significantly impairs functioning.”
In the section for benefits and burdens of anticancer therapy, a new intervention listed in the Year to months subsection is “Encouraging advance care planning.” In the Months to weeks subsection, the new bullet “Encouraging advance care planning, if not already accomplished” is also listed. Another new bullet listed—in the Weeks to days subsection—is “Consider short course palliative radiation therapy for painful bone metastases.”
The section for nausea and vomiting features a few new updates; “Assess nausea and vomiting severity and associated symptoms” is new to the page, and “Consider palliative radiation therapy for nausea and vomiting related to brain metastases” was removed.
In the antidiarrheal interventions and screening section, “Provide immediate antidiarrheal therapy indicated by grade” is now listed, with a note that “If chemotherapy induced, decrease or delay the next dose of chemotherapy.”
The section for sleep/wake disturbances/assessment and interventions features two new pharmacologic therapies for insomnia: alpha adrenergic blockers and melatonin-receptor agonist.
“Child life services if available” and “Art and music therapy if available” are new additions to the page for social support/resource management/interventions.
The section for advance care planning and interventions now lists “Assess decision-making capacity and need for surrogate decision-maker” as the first bullet on the page. If any of the listed interventions are deemed unacceptable, “Consider ethics consult” is a new option.—Zachary Bessette