The goal of this article is to review important developments in symptom management, drugs, complications and communication pertaining to the palliative management of advanced cancer. Pain and fatigue are the most common symptoms of advanced cancer. Pain is often well controlled with analgesics, although some cancer pain is more difficult to control. Risk factors for refractory pain include breakthrough and neuropathic pain, both of which will be discussed in this review. Methadone and gabapentin both have a role in the management of neuropathic pain and will be discussed in detail. Complications of advanced cancer amenable to medical treatment include delirium and bowel obstruction. Good communication is paramount in the management of advanced cancer. The issues of how to deliver prognostic information and hold a family conference will be covered by this review.
