The second international symposium on "Supportive Care in Cancer Patients" took place March 1-3, 1990-again in St. Gallen in eastern Switzerland. It was an honor once more to welcome dozens of internationally recognized experts in the field and more than 800 participants from over 30 countries around the world: Australia, Canada, China, USSR, USA and many countries in Europe. The international nature of the grade facilitated lively and exciting contributions and critical discussions, aimed at fostering professional knowledge and skills and rethinking our personal attitudes toward cancer patients in all stages of their disease. Cancer patients need various types of tailored support, whether during active initial (curative) therapies, in phases of worrying relapsing disease, or during the demanding terminal stage of their illness. The symposium tried to bridge the strange "gap" between "curative" and "palliative" cancer care: it must be our aim to be and remain "supportive" for our patients during both curative and palliative treatment strategies This requires extended knowledge and even more and flexible professional skills. The symposium was designed to promote improved approaches that are helpful and supportive for all our oncology patients, not just for a selected disease-or stage dependent minority."

The symposium on supportive care in cancer patients, which took place in St. Gallen, Switzerland, on February 18-21, 1987, wel comed renowned experts in the field and more than 600 partici pants from 25 countries with the aim of stimulating discussion on how to improve our professional skills and personal attitudes to ward cancer patients in all stages of their disease. Why did we or ganize such a symposium on supportive care in cancer patients? Recent decades have witnessed remarkable success in cancer treat ment, and we have learned how to cure a finite number of neoplas tic diseases. Some malignant tumors that previously entailed high fatality rates, such as leukemias, lymphomas, and testicular can cers, can now be cured, even when at an advanced stage. Yet it seems to many that our struggle to improve results and to fight death from cancer has also imposed greater toxicity on patients. Conventional scientifically based oncology has only recently made adequate efforts to improve the subjective quality of life of cancer patients, for example through prophylaxis against emesis, nausea, and scalp hypothermia, pain control and the development of psy chosocial support structures. The search for less toxic and yet equally effective treatment measures has not been one of our pri mary goals in the past. Supportive care has always been part of nurses' professional aim, even though many have not known how best to offer it.

Current literature shows that there is a gap in our knowledge about how tired ness/fatigue in cancer patients should be defined and measured. Existing fa tigue-related research in cancer patients shows conceptual and measurement differences (Piper 1993). There is no continuum of tiredness/fatigue in univer sal use. What do patients mean if they fill in a visual analogue scale indicating that they feel "very tired"? Is it an indicator of general well-being, and thus an 1993)? Most articles estimate of general quality of life (Hiirny and Bernhard written by English authors use the word fatigue to identify extreme tired ness. It could be said that in the English language, tiredness that is perceived as unusual, continuing distress is fatigue rather than tiredness. In the German language, tiredness (Mudigkeit) is not primarily a term for distress attributed to disease or unusual effort. But tiredness becomes a distressing phenomenon when it no longer regulates a healthy balance between rest and activity but represents unusual, abnormal or excessive whole-body tiredness that is dis proportionate to or unrelated to activity or excessive exertion (Piper 1993). As there is no word for fatigue in the German language, the definition "extreme, unusual tiredness" (in German: extreme, unubliche Mudigkeit), is used to explain the term "fatigue: ' This clarification is needed to ensure that future fatigue research conducted in German-speaking countries can be com pared with such research carried out elsewhere."

Abhandlung der psychischen, sozialen, rehabilitativen sowie pflegerischen Aspekte der Betreuung Krebskranker, die an- l{ lich des Kongresses "Supportive Care in Cancer Patients" 1987 in St. Gallen von Krankenschwestern und -pflegern vor- getragen wurden. Fortbildungsgrundlage f}r das onkologische Assistenzpersonal.