meeting grants, cooperative group renewals, or instances where the keyword match was not a fit for the topic. The matches could be classified as (1) descriptive or health services research, (2) studies of interventions or clinical trials, or (3) basic science investigations. The search results are presented in Table 8-1, illustrating the dearth of research on end-of-life issues and symptoms in patients with advanced cancer.

This section reviews recent research on the following cancer-related symptoms: pain, anorexia and cachexia, cognitive failure (including delirium and cognitive impairment such as problems with memory and reasoning), dyspnea, fatigue, gastrointestinal symptoms, and psychiatric symptoms (including depression and anxiety). It includes information about the current status of treatment, what is known about the mechanisms responsible for the symptom, and what types of clinical and basic research should be carried out to improve the management of the symptom.

Biomedical symptom research is closest to the clinical research model in place at NIH and many other funding agencies and is therefore more likely to be funded than descriptive or health services research. However, a search of currently funded grants for each symptom (basic and clinical) suggests little support for these investigations, even though relatively small increments in our basic and clinical knowledge base are liable to substantially improve care for very ill patients.

One somewhat artificial barrier to progress in this type of research is the balkanization of the research establishment. For example, several NIH institutes are working relatively independently on problems in neuroscience, molecular biology, and the general biology of cancer treatment that might contribute to a better understanding of mechanisms common to the expression of these symptoms. An excellent example is the potential role of inflammatory processes in pain, wasting, cognitive deficit, depression, and fatigue, where relevant research is being funded by several NIH Institutes.

TABLE 8-1 Results of CRISP Searches for Current Research on End-of-Life, Palliative Care, and Symptom Control (numbers of currently-funded projects as of April 2000)

Search Term + Cancer

Hits (Matches)

Descriptive and Health Services Research

Interventions and Clinical Trials

Basic Science

Palliative

54 (7)

4

2

1

End of life

14 (9)

7

2

0

Bereavement

11 (6)

3

3

0

Symptoms

125 (27)

11

13

3



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