[Principles of symptom control in palliative medicine]

Palliative care is the active total care of patients whose disease is not or no more responsive to curative treatment. Its action strategies should be applied at the time when the goals change from cure to care. Palliative care is total care of body, mind and spirit. Control of pain, of other symptoms and of psychosocial, social and spiritual problems, is paramount. The goal of palliative care is the achievement of the best quality of life for patients and their families. Psychosocial support plays a vital role in the assessment and treatment of anxiety and depression in patients with advanced illness. Appropriate intervention of psychosocial distress in patients and families can ease the family bereavement period. It can also decrease occupational stress and burnout in the professional caregivers. One of the principal functions of palliative care is the prevention and control of distressing symptoms. Freeing sick people, emancipating them from pain and unendurable symptoms is one of the conditions that sick and dying people need most. This allows them to live their remaining time as fully as possible. The general principles of treating dyspnoea and pain are the same as for any other aspect of treatment in palliative care: 1. to define and treat the underlying cause of dyspnoea wherever possible and reasonable for the patient. This includes oncological interventions such as chemotherapy and radiotherapy as far as the patient's status allows it. 2. to relieve dyspnoea without adding new problems by way of sideeffects, interactive effects, social or financial burdens. The rule of proportionality to treatment affirms that symptom control and life-prolonging treatment are contraindicated when they cause more suffering than benefit. 3. to consider whether a treatment will be worthwhile for the patient and his family bearing in mind his prognosis and adverse effects of invasive procedures. 4. to discuss all reasonable treatment options (including the decision of "no intervention") with the patient and his family, allowing them to make the final decision as far as possible by themselves.