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NCCN Guidelines for Patients


Stomach Cancer, Version 1.2016


Treatment guide

Metastatic cancer

Supportive care

Metastatic cancer that is rated M1 cannot be treated

with local treatments. Metastatic cancer includes

stage IV. Instead, supportive care is given to slow

down cancer growth. When used for advanced

cancers, supportive care is often called palliative


The goal of supportive care is to prevent and relieve

discomfort you may have since the cancer can’t be

cured. Supportive care may also extend life, improve

your eating, and help you feel better overall.

People with non-metastatic cancer also receive

supportive care. If surgery isn’t an option, systemic

treatment to control cancer growth may be an option.

Systemic therapy treats cancer anywhere in the body.

Other aspects of supportive care, such as symptom

control, are useful for many people with any stage of

stomach cancer.

Guide 10

lists the options used to manage

metastatic and other advanced cancers. Options

are based on your performance status, which is

your ability to do activities. Your doctor will rate your

performance status by one of two scales:










Performance Scale

• A

score of 0

means you are fully active.

• A

score of 1

means you are able to do all

self-care activities but are unable to do hard

physical work.

• A

score of 2

means you are able to do all

self-care activities and spend most of waking

time out of bed but you are unable to do any


• A

score of 3

means you are unable to do all

self-care activities and any work and spend

most of waking time in bed.

• A

score of 4

means you are fully disabled.









• A

score of 0 to 49

means you are unable to

care for yourself.

• A

score of 50 to 79

means you are unable to

work and some assistance is needed.

• A

score of 80 to 100

means you are able to

do your normal work and activities.

Chemotherapy can cause severe side effects. As

such, it is only given if your health hasn’t seriously

limited your activities.

If you have an ECOG score of 2 or less or a KPS

score of 60 more, you have two options. The first

option is supportive care with systemic therapy. A

second option is to join a clinical trial testing a new

systemic therapy. A third option is supportive care

without systemic therapy.

Systemic therapies recommended by NCCN experts

are listed on page 64. Symptom control is addressed

on page 66.

Supportive care that excludes systemic therapy is an

option if you have an ECOG score of 3 or more or

a KPS score of less than 60. You may receive other

types of care to improve your quality of life.