National Comprehensive Cancer Network

About NCCN

NCCN Flash Update: NCCN Guidelines® for Palliative Care

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Palliative Care. These NCCN Guidelines® are currently available as Version 1.2018.

  • “High-risk for persistent complex bereavement disorder" is listed under assessment for Criteria for Consultation with Palliative Care Specialist with the following corresponding footnote: "Persistent complex bereavement disorder is a chronic heightened state of mourning that significantly impairs functioning." (PAL-8)

  • "Educate patient/family/caregiver on patient's condition and risk/benefits of treatment options" is listed as an intervention for patients throughout the guideline for all symptoms.

  • Alpha adrenergic blockers and melatonin-receptor agonist are new pharmacologic therapy options for insomnia. (PAL-22)

  • “Assess decision-making capacity and need for surrogate decision-maker” is a new recommendation for advance care planning. (PAL-29)

  • First bullet regarding palliative sedation modified to include “Palliative sedation to unconsciousness, in which the intended effect is deep sedation, remains controversial.”

    • Corresponding reference: ten Have H, Welie JV. Palliative sedation versus euthanasia: an ethical assessment. J Pain Symptom Manage 2014;47(1):123-136. (PAL-33)

  • Palliative Care Drug Appendix has been modified as follows:

    • Insomnia (PAL-A 4 of 5)

      • Quetiapine, 2.5-5 12.5-25 mg PO at bedtime

      • For phase shift disorder consider ramelteon (8 mg 30 minutes before bedtime) or melatonin (30 minutes before bedtime; dosage may vary by formulation)

    • Restless Legs Syndrome (PAL-A 4 of 5)

      • Ropinirole, 0.25 mg PO 1-3 hours before bedtime

      • Pramipexole, starting dose 0.125 mg PO at bedtime, may require titration

      • May also consider pregabalin, carbidopa-levodopa, or low-dose methadone with dopamine agonist; however, all of these medications are off-label for RLS

*For your reference, the previous update (Version 2.2017) to the NCCN Guidelines for Palliative Care, published on June 1, 2017, is available at the following link:

For the complete updated versions of the NCCN Guidelines, NCCN Guidelines with NCCN Evidence Blocks™, the NCCN Drugs & Biologics Compendium (NCCN Compendium®), the NCCN Biomarkers Compendium®, the NCCN Chemotherapy Order Templates (NCCN Templates®), the NCCN Radiation Therapy Compendium™, and the NCCN Imaging Appropriate Use Criteria (NCCN Imaging AUC™), please visit

To view the NCCN Guidelines for Patients®, please visit

Free NCCN Guidelines apps for iPhone, iPad, and Android smartphones & tablets are now available! Visit

About NCCN Flash Updates™
NCCN Flash Updates™ is a subscription service from NCCN that provides timely notification of updated and new information appearing in the NCCN Guidelines, the NCCN Compendium®, and other NCCN Content. 

Subscribe to NCCN Flash Updates™ 

National Comprehensive Cancer Network® (NCCN®)
275 Commerce Drive, Suite 300
Fort Washington, PA 19034
Telephone: +1 215.690.0300 Fax: +1 215.690.0280 

Access information on permissions and licensing of NCCN Content  

© 2017 National Comprehensive Cancer Network. All Rights Reserved.