NIH News Release
Office of the Director

Office of Medical Applications of Research

Wednesday, July 17, 2002
Kelli Marciel (OMAR)
(301) 496-4819

NCI Press Office
(301) 496-6641

Panel Calls for Greater Attention to Cancer Patients' Pain, Depression, and Fatigue

Health care professionals, caregivers, and patients all have an important role in symptom management throughout the course of cancer. Evidence suggests that pain is often undertreated, despite the availability of effective interventions. Cancer-related depression and fatigue are less clearly defined, but are extremely common and have a profound impact on patients' well-being. In the research community, more resources need to be devoted to studying the occurrence, causes, and impediments to effective treatments of these symptoms.

These findings emerged from an NIH State-of-the-Science conference on Symptom Management in Cancer: Pain, Depression and Fatigue that began Monday, July 15 at the NIH campus in Bethesda, Maryland. The conference brought together national experts to address key questions regarding the occurrence, assessment, and treatment of these symptoms, barriers to their effective treatment, and directions for future research in the area.

"Currently, cancer-related pain, depression, and fatigue are undertreated and this situation is simply unacceptable — there are effective strategies to manage these symptoms and all patients should have optimal symptom control," said panel chair Dr. Donald Patrick, Professor and Director of the Social and Behavioral Research Program in the School of Public Health and Community Medicine at the University of Washington in Seattle.

Despite advances in early detection and effective treatment, cancer remains one of the most feared diseases, not only because of its association with death but with diminished quality of life. While research is producing new insights into the causes and cures of cancer, efforts to manage the symptoms of the disease and its treatments have not kept pace. There are nearly 9 million people in the U.S. with a history of cancer. An estimated 1.3 million will be diagnosed with cancer this year and of those, 60% will be alive in 5 years. Addressing the total quality of life of cancer patients, including the effective management of symptoms is an increasingly critical aspect of efforts to reduce the burden of cancer.

The panel members found that the available evidence supports a variety of interventions for treating cancer patients' pain, depression, and fatigue. The panel noted, however, numerous factors that can interfere with adequate symptom management. Among them are: incomplete effectiveness of some treatments; a lack of sufficient knowledge regarding effective treatment strategies; patient reluctance to report symptoms to caregivers; a belief that such symptoms are simply a part of the cancer experience that must be tolerated; and inadequate coverage and reimbursement for some treatments. The panel pointed out the additional difficulty presented by the interactions among these three symptoms for example, a successful treatment for depression might also alleviate fatigue, but conversely, adequate pain management may exacerbate fatigue.

The panel's statement concluded that: clinicians should use brief assessment tools routinely to ask patients about pain, depression, and fatigue and to initiate evidence-based treatments; current evidence to support the concept of cancer symptom clusters is insufficient, and additional theoretically driven research is warranted; research is needed on the definition, occurrence, treatment of pain, depression, and fatigue alone and together in adequately funded prospective studies; all patients with cancer should have optimal symptom control from diagnosis throughout the course of illness, irrespective of personal and cultural characteristics.

The primary sponsors of this meeting were the National Cancer Institute and the NIH Office of Medical Applications of Research. Cosponsors include the National Institute on Aging, the National Institute of Mental Health, the National Center for Complementary and Alternative Medicine, the National Institute of Dental and Craniofacial Research, the National Institute of Neurological Disorders and Stroke, the National Institute of Nursing Research, and the U.S. Food and Drug Administration.

Among the evidence considered by the state-of-the-science panel was an evidence report prepared by the New England Medical Center Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ). EPC evidence reports are comprehensive, systematic reviews and analyses of published scientific evidence. A summary of the Evidence Report on Management of Cancer Symptoms: Pain, Depression, and Fatigue will be available following the conference at Copies are also available from the AHRQ Publications Clearinghouse, by calling 1-800-358-9295. The full report will be available on-line shortly thereafter. In addition, the National Library of Medicine prepared an extensive bibliography on this topic, available at

The full text of the panel's statement will be available in draft form following the conference at Statements from past conferences are available at the same Web site, or by calling 1-888-NIH-CONSENSUS (1-888-644-2667).

The panel's statement is an independent report and is not a policy statement of the NIH or the Federal government. The NIH Consensus Development Program, of which this conference was a part, was established in 1977 as a mechanism to judge, in an unbiased impartial manner, controversial topics in medicine and public health. NIH has conducted 116 consensus development conferences and 22 state-of-the-science (formerly "technology assessment") conferences addressing a wide range of issues. The conferences bring together biomedical investigators, practicing physicians, consumers, and representatives of public interest groups to evaluate scientific information and resolve controversial issues in clinical practice.

Note to TV Editors: The news conference at 1 p.m. on Wednesday, July 17, 2002 will be broadcast live via satellite on the following coordinates:
Galaxy 3 R Transponder 5
Downlink Frequency: 95 degrees West
Polarity: 3800 Horizontal
Audio: 6.2 / 6.8

Test Time: 12:30 - 1:00 p.m.
Broadcast: 1:00 - 2:00 p.m.

Note to Radio Editors: An audio report of the conference results will be available after 4 p.m. July 17, 2002 from the NIH Radio News Service by calling 1-800-MED-DIAL (1-800-633-3425).