Symptom Management

Many people living with advanced disease struggle with the physical and emotional effects of their illness and treatment. Regardless of where they are in their journey, patients sometimes need help to manage their pain, nausea, anxiety or other symptoms.

Assessment Tools

ESAS (Edmonton Symptom Assessment Score) is a valid and reliable patient self-assessment tool that can be used to screen for the intensity of nine common symptoms experienced by patients: pain, tiredness, nausea, depression, anxiety, drowsiness, lack of appetite, well-being and shortness of breath. ESAS has been translated into many languages. At cancer centres across the province, symptom severity is routinely screened using the ESAS.
Palliative Performance Scale (PPS)
Ken Rockwood 9 point Frailty Tool (Dalhousie University)

Symptom Management Guides

The Ontario Cancer Symptom Management Collaborative was established to improve the quality and consistency of managing cancer patient's symptoms. This collaborative has developed numerous symptom management guides to help healthcare professionals and patients assess and appropriately manage cancer-related symptoms.

Access the Symptom Management Guides via the following web link: https://www.cancercareontario.ca/en/symptom-management

Symptom	Clinician Guide	Patient Guides
Pain	Algorithm Guide-to-Practice	Pain – Information from BC Cancer Agency Pain – Information from the National Cancer Institute Tips for Managing Pain – Canadian Cancer Society The American Chronic Pain Association: Check out their communication tools section, guided meditations and videos How to do Progressive Muscle Relaxation – Information from Anxiety Canada Pain Diary: A tool to track your pain from the American Cancer Society American Cancer Society Guide to Pain Control: Book (order online or check your hospital or local library)
Dyspnea	Algorithm Pocket Guide* Guide-to-Practice Video Series: Managing Shortness of Breath (YouTube)	Getting the air you need – Booklet from Juravinski Cancer Centre Managing Shortness of Breath – A series of videos from Trillium Health Partners Managing your breathing – Information from Trillium Health Partners Breathlessness – Information from BC Cancer Agency How to do Progressive Muscle Relaxation – Information from Anxiety BC
Nausea & Vomiting	Algorithm Guide-to-Practice	Nausea: Information from BC Cancer Agency Nausea: Information from the National Cancer Institute Antinausea drugs: Information from the Canadian Cancer Society Goes Down Easy: Recipes for Coping with the Challenge of Eating During Cancer Treatment - Book by Elise Mecklinger and the Princess Margaret Hospital Dietitians (order online or check your hospital or local library) What to Eat During Cancer Treatment: Book from the American Cancer Society (order online or check your hospital or local library)
Delirium	Algorithm Pocket Guide* Guide-to-Practice
Loss of Appetite	Algorithm Pocket Guide* Guide-to-Practice	Dietitians of Canada Unlock Food – Website including information and recipes and speak to a dietitian for free over the phone Nourish – website by Registered Dietitians to help with nutrition when you have cancer How to manage loss of appetite – Booklet from Cancer Care Ontario Loss of appetite – website from Canadian Cancer Society Eating hints before, during and after cancer treatment – Booklet from the American Cancer Society Goes Down Easy: Recipes for Coping with the Challenge of Eating During Cancer Treatment - Book by Elise Mecklinger and the Princess Margaret Hospital Dietitians (order online or check your hospital or local library)
Bowel Care	Algorithm Pocket Guide* Guide-to-Practice	Constipation – Information from BC Cancer Agency Constipation – Information from Cancer Care Manitoba American Chronic Pain Association: Opioid-induced constipation conversation guide - Use this tool to keep track of factors that could be related to your constipation Diarrhea – Information from BC Cancer Agency Diarrhea – Information from the National Cancer Institute Eating Tips for People with Diarrhea: For patients who have diarrhea during cancer treatment - Booklet from Princess Margaret Cancer Centre
Oral Care	Mucositis Algorithm Xerostomia Algorithm Infections Algorithm Dysgeusia Algorithm Oral Care Plans Pocket Guide* Guide-to-Practice	Ontario Dental Association Unlock Food Mouth & Teeth – Information from BC Cancer Agency Mouth Care – Information from Canadian Cancer Society Three good reasons to see a dentist before cancer treatment – Information from the National Institute of Dental and Craniofacial Research Goes Down Easy: Recipes for Coping with the Challenge of Eating During Cancer Treatment - Book by Elise Mecklinger and the Princess Margaret Hospital Dietitians (order online or check your hospital or local library) Mouth and throat changes – Information from the National Cancer Institute
Anxiety **	Algorithm Guideline	Canadian Mental Health Association Anxiety and Distress – Information from the National Cancer Institute The Healing Journey – An online or in-person course offered through Wellspring that can help with depression, anxiety and other symptoms The Emotional Facts of Life with Cancer – An online booklet from the Canadian Association of Psychosocial Oncology Mood Gym – a free and interactive self-help program to learn cognitive behavioural therapy Reframe Health Lab – Video about stress and a helpful resource list How to do Progressive Muscle Relaxation – Information from Anxiety BC Guided Mindfulness Meditations – Free online audio files from the UCLA Mindful Awareness Research Center The Scarborough Hospital Mental Health App Library – A list of apps to help you learn ways to manage depression and anxiety
Depression **	Algorithm Guideline	Canadian Mental Health Association Depression – Information from the National Cancer Institute The Healing Journey – An online or in-person course offered through Wellspring that can help with depression, anxiety and other symptoms The Emotional Facts of Life with Cancer – An online booklet from the Canadian Association of Psychosocial Oncology Mood Gym – a free and interactive self-help program to learn cognitive behavioural therapy Reframe Health Lab – Video about depression and a list of helpful resources How to do Progressive Muscle Relaxation – Information from Anxiety BC Guided Mindfulness Meditations – Free online audio files from the UCLA Mindful Awareness Research Center The Scarborough Hospital Mental Health App Library – A list of apps to help you learn ways to manage depression and anxiety
Fatigue **	Algorithm Guideline	Manage Cancer Fatigue : Video and information from Dr. Mike Evans and Sunnybrook Fatigue : Information from BC Cancer Agency Fatigue : Information from the National Cancer Institute Reclaim your Energy : Booklet from the University Health Network Eating Well for Fatigue : Tip sheet from Sunnybrook Cancer-Related Fatigue : Information from the American Cancer Society Prepare to return to work after treatment for cancer – Booklet from University Health Network Cancer-Related Fatigue - Free online learning module from Princess Margaret Cancer Centre Sleep Journal : Keep track of your sleep habits with this tool from Health Links BC Meals on Wheels of Ontario : Call to arrange meal delivery for when your energy is too low to cook yourself
Sleep Disturbances**	Algorithm and Guideline	Sleep Journal : Keep track of your sleep habits with this tool from Health Links BC

** Developed by the Cancer Journey Advisory Group and the Canadian Association of Psychosocial Oncology, with support from the Canadian Partnership Against Cancer, in collaboration with the Ontario Cancer Symptom Management Collaborative.

Prostate Cancer Guides

Bowel Function	Clinical Guide
Hormonal Symptoms/Vitality	Clinical Guide
Sexual Function	Clinical Guide
Urinary Incontinence	Clinical Guide
Urinary Obstruction	Clinical Guide

These tools represent current evidence and best practice and replace previously published guidelines distributed through CCO, including the Telephone Nursing Practice and Symptom Management Guidelines and KFL&A Palliative Care Integration Project Symptom Management Guidelines.