12 General introduction Despite advances in the diagnosis and treatment of human malignancy [1-5], cancer remains among the leading causes of morbidity andmortality worldwide, with 19.3million new cancer cases and 10.0 million deaths attributed to cancer in 2020 [6, 7]. Based on population growth and aging, the global cancer burden is expected to grow to 29.5 million cases annually in 2040 [8]. In the Netherlands, the number of new cancer cases has more than doubled in the last 30 years, from 55,732 in 1989 to 115,047 in 2020 [9]. Each year, around 38,000 patients are diagnosed with metastatic cancer in the Netherlands [9]. Advanced or metastatic cancer is generally considered incurable. Most patients with cancer experience symptoms throughout the disease trajectory, the prevalence and severity of which vary according to cancer type, stage, disease-directed treatment(s), and comorbidities [10-13]. Optimal symptommanagement is associatedwith improved patient and family quality of life (QoL) [13-15], greater treatment compliance [16, 17], and improved survival [17-20]. Palliative care is an approach that improves the QoL of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification, assessment and treatment of distressing symptoms, physical, psychosocial and spiritual [21]. After cancer diagnosis, palliative care, which is also refered to as supportive care [22], is provided along with anticancer treatment to prevent or treat cancer symptoms and the adverse effects of cancer-directed treatment. At the end of active treatment, palliative care focuses on reviewing the patient’s goals of care, adjusting care strategies to reflect any changes in those goals, and cancer symptom management to enhance the quality of living and dying in the last phase of life in terminally ill patients. Palliative care / supportive care must be evidence-based; research is essential to generate scientific evidence to improve symptom control and QoL in cancer patients. [23, 24]. The observed quantity and quality of studies conducted to address the issues of patients with advanced cancer in palliative care suggest that greater efforts are needed so that effective, evidence-based interventions can be proposed to cancer patients at each stage of their illness [25]. Aims of this thesis The overall aim of this thesis is to improve the prevention and management of symptoms and treatment-related adverse effects that often occur in patients with advanced or metastatic cancer. In specific, we focus on: Cisplatin-induced acute kidney injury Chemotherapy-induced nausea and vomiting Delirium
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