National Comprehensive Cancer Network

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NCCN Guidelines and Compendium Updated

Flash Update Sent April 3, 2012

NCCN has published updates to the NCCN Guidelines for Palliative Care. These NCCN Guidelines are currently available as Version 1.2012.

  • The definition of palliative care has been extensively modified to read: Palliative care is a special kind of patient and family-centered health care that focuses upon effective management of pain and other distressing symptoms, while incorporating psychosocial and spiritual care according to patient/family needs, values, beliefs, and cultures. The goal of palliative care is to anticipate, prevent, and reduce suffering and to support the best possible quality of life for patients and their families, regardless of the stage of the disease or the need for other therapies. Palliative care begins at diagnosis and should be delivered concurrently with disease-directed, life-prolonging therapies and should facilitate patient autonomy, access to information, and choice. Palliative care becomes the main focus of care when disease-directed, life-prolonging therapies are no longer effective, appropriate, or desired. Palliative care should be initiated by the primary oncology team and then augmented by collaboration with an interdisciplinary team of palliative care experts.
  • "Institutions should develop processes for integrating palliative care into cancer care, both as part of usual oncology care and for patients with specialty palliative care needs" was added to the list of Standards of Palliative Care.
  • For dyspnea associated with excessive secretions, glycopyrrolate 0.2-0.4 mg IV or SQ q 4 hr prn was added as a treatment option.
  • For anorexia/cachexia associated with depression, mirtazapine 7.5-30 mg hs was added as a potential treatment.
  • For anorexia/cachexia, prednisone 10-20 mg BID was added as an option for appetite stimulation.
  • For treatment of sleep/wake disturbances, the following pharmacologic interventions were added:
    • For insomnia: (1) trazodone 25-100 mg PO at bedtime and (2) mirtazapine 7.5-30 mg PO at bedtime
    • For daytime sedation: (1) caffeine 100-200 mg PO q 6 hrs, last dose 4 PM and (2) Dextroamphetamine 2.5 mg up to 5-10 mg BID no later than noon
  • For advance care planning, "Document patient values and preferences and any decisions in accessible site in medical record (including MOLST/POLST if completed)" was added to the list of interventions.
  • For palliative sedation, "pentobarbital: Initial infusion 2 -3 mg per kg load then 1-2 mg per kg/h" was added as a sedative option.

NCCN has published updates to the NCCN Guidelines and the NCCN Drugs & Biologics Compendium (NCCN Compendium®) for Ovarian Cancer. These NCCN Guidelines are currently available as Version 3.2012.

  • The primary chemotherapy/primary adjuvant therapy regimens for Stage II-IV disease were updated to include bevacizumab-containing regimes (per the ICON7 and GOG-0218 trials) as category 3 recommendations.
  • The Discussion section was updated to reflect the changes in the algorithm.


For the complete updated version of these and all NCCN Guidelines, visit