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LEARNING OBJECTIVES

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LEARNING OBJECTIVES

Upon completion of the chapter, the reader will be able to:

  1. Describe the impact of various supportive care interventions on the prognosis of patients with cancer.

  2. Discuss the scientific basis for providing various supportive care interventions in the oncology patient population.

  3. Identify patient-related and disease-related risk factors in defining a population for whom supportive care interventions would be of benefit.

  4. Recognize typical presenting signs and symptoms of common complications and emergencies that require supportive care interventions.

  5. Outline an appropriate prevention and management strategies for various supportive care interventions.

  6. Prepare a monitoring plan to evaluate the efficacy and toxicity of pharmacotherapy interventions for supportive care problems.

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KEY CONCEPTS

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  • Image not available. The optimal method of managing chemotherapy-induced nausea/vomiting (CINV) is to provide adequate pharmacologic prophylaxis given a patient's risk level for emesis.

  • Image not available. The fundamental approach to lessen the severity of mucositis begins with basic, good oral hygiene.

  • Image not available. A risk assessment should be performed at presentation of febrile neutropenia (FN) to identify low-risk patients for potential outpatient treatment. Patients who do not meet low-risk criteria should be hospitalized for immediate parenteral administration of broad-spectrum antibacterials before culture results are obtained.

  • Image not available. The primary goal of treatment of superior vena cava syndrome (SVCS) is to relieve obstruction of the superior vena cava (SVC) by treating the underlying malignancy.

  • Image not available. Because patients with spinal metastases are generally incurable, the primary goal of treatment of spinal cord compression is palliation. The most important prognostic factor for patients presenting with spinal cord compression is the underlying neurologic status.

  • Image not available. The goals of treatment of brain metastases are to manage symptoms and improve survival by reducing cerebral edema, treating the underlying malignancy both locally and systemically.

  • Image not available. The use of effective prevention strategies can decrease the incidence of hemorrhagic cystitis to less than 5% in patients receiving cyclophosphamide or ifosfamide. There are three methods to reduce the risk: administration of Mesna, hyperhydration, and bladder irrigation with catheterization.

  • Image not available. The primary goal of treatment for hypercalcemia is to control the underlying malignancy. Therapies directed at lowering the calcium level are temporary measures that are useful until anticancer therapy begins to work.

  • Image not available. The primary goals of management of tumor lysis syndrome (TLS) are (a) prevention of renal failure and (b) prevention of electrolyte imbalances. Thus, the best treatment for TLS is prophylaxis to enable delivery of cytotoxic therapy for the underlying malignancy.

  • Image not available. Chemotherapy extravasation may be avoided in many cases by the use of successful prevention strategies. The most important preventative measure is proper patient education.

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INTRODUCTION

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Patients with cancer are at risk for serious adverse events that result from their treatment, the cancer, or both. The management of these complications is generally referred to as supportive care (or symptom management). Treatment-related complications include chemotherapy-induced nausea and vomiting (CINV), febrile neutropenia (FN), extravasation, hemorrhagic cystitis, mucositis, and tumor lysis syndrome (TLS). Tumor or cancer-related complications include superior vena cava (SVC) obstruction, spinal ...

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