Dyspnea, nausea and vomiting, anorexia, fatigue, and sleep disturbances are 
common and distressing in advanced cancer. We updated previous systematic 
reviews of how these symptoms can be alleviated with targeted literature 
searches. The approach to these symptoms requires comprehensive symptom 
assessment; treating underlying causes when benefits exceed risks; prioritizing 
treatment, as patients usually have many symptoms; and addressing psychosocial 
and spiritual distress. For dyspnea, evidence supports systemic opioids and 
nonpharmacological treatments such as a fan. The strongest evidence supports 
metoclopramide for cancer-related nausea and octreotide for bowel obstruction. 
For anorexia, enteral or parenteral nutrition is indicated with obstruction and 
expected prognosis of at least 6 weeks. Evidence supports several drugs for 
appetite affecting quality of life. For fatigue, evidence supports psychosocial 
interventions and methylphenidate. For insomnia, evidence supports 
cognitive-behavioral therapy in cancer; no sleep agents have superior 
effectiveness.