Supportive Care & Survivorship
Supportive care and survivorship covers everything that keeps a patient well enough to receive treatment, and well afterwards.
Anti-emetics, growth factors, scalp cooling, cardio-oncology, fertility preservation, geriatric assessment, palliative integration, exercise oncology, financial toxicity mitigation, and long-term survivorship monitoring. Under-studied relative to its impact.
Watching very small papillary thyroid cancers with ultrasound instead of operating, because most never grow and almost none cause harm.
An ADC payload neutraliser is an antibody given alongside an ADC that mops up the poison once it leaks into the bloodstream, so the ADC can hit the tumour with fewer side effects.
The drugs that stopped chemotherapy from meaning days of vomiting: 5-HT3 blockers (ondansetron, palonosetron), NK1 blockers (aprepitant), dexamethasone and olanzapine, given by the emetic risk of each regimen.
A small tube placed by endoscope or through the skin reopens a blocked bile duct, relieving jaundice so chemotherapy can be given.
Zoledronic acid and denosumab reduce fractures, spinal cord compression and bone pain from bone metastases and myeloma, prevent treatment-induced bone loss, and in postmenopausal breast cancer modestly reduce recurrence in bone.
Cachexia pharmacotherapy covers three drug approaches to cancer wasting: a new antibody that blocks the hormone suppressing appetite, an appetite hormone mimic approved only in Japan, and a very cheap old tablet. None is yet standard everywhere; all beat what came before.
Treating the wasting that kills many cancer patients, by blocking the hormone that suppresses appetite.
Tumours recruit nerves and use nerve signals to grow. Blocking that traffic, with beta-blockers or botulinum toxin, is being tested.
Systematic treatment of cancer pain with opioids, adjuvant drugs, radiation and procedures such as nerve blocks and intrathecal pumps. Most pain can be controlled, yet under-treatment remains common, especially where opioids are unavailable.
Blood clots are the second commonest cause of death in people with cancer. Risk scores identify who should take preventive blood thinners during chemotherapy, and direct oral anticoagulants have largely replaced injections for treatment.
Protecting the heart from cancer treatments, which is increasingly important as patients live longer.
Giving the same drug at a different time of day, because the body clock changes how much damage it does and how well the immune system responds.
The clinics where most cancer patients are actually treated, increasingly organised into large networks that also run trials.
Running parts of a trial at home or locally, with telehealth, home nursing, and remote monitoring, so patients far from big centres can take part.
Most people on cancer treatment take supplements, often without telling their team. Antioxidants, St John's wort, high-dose vitamins and some herbs can blunt chemotherapy or radiotherapy or interact with targeted drugs.
Being overweight after breast cancer is linked with more recurrence, so a 3,000-woman trial tested a two-year telephone weight-loss programme. Women lost weight, but the trial did not clearly show fewer recurrences.
Specialist care for symptoms, decision-making and quality of life given alongside cancer treatment from diagnosis, not just at the end. Trials show it improves quality of life and mood and may lengthen survival.
Patients report symptoms weekly through an app or web form, and nurses respond to alerts. Randomised trials showed this simple system improved quality of life, cut emergency visits and, in one trial, extended survival by five months.
Apps and sensors that let patients report symptoms between visits, which in trials improved survival and cut emergency visits.
Instead of starving patients before and after an operation, modern surgical pathways feed them early, give carbohydrate drinks the night before, and get them walking the next day. Complications and hospital stays fall.
Nutrition support means tube feeding into the gut, or nutrition into a vein when the gut cannot be used. It is life-saving in the right patient, harmful or futile in the wrong one.
Using complementary approaches with real evidence, such as acupuncture for nausea and pain, yoga and mindfulness for anxiety and fatigue, alongside standard treatment, while steering patients away from unproven 'alternative' therapies that can shorten life.
Structured exercise during and after treatment, which the CHALLENGE trial showed improves survival in colon cancer.
Moderate exercise while on chemotherapy is safe and reduces fatigue, helps people finish their planned doses, and may protect the heart and nerves.
Cancer treatment can bankrupt patients even with insurance. Financial navigation programmes screen for money problems and connect patients to assistance, insurance optimisation and legal help, and trials show they reduce distress and debt.
Keeping cheap, essential chemotherapy drugs like cisplatin available; shortages in 2023 forced rationing in US hospitals.
Geriatric assessment is a structured check of an older patient's fitness, memory, and support that predicts treatment tolerance better than age.
Seventy percent of cancer deaths occur in low- and middle-income countries, where radiotherapy machines, pathologists, essential medicines and palliative care are scarce. Global oncology works on affordable, adapted care and the systems to deliver it.
Injections of filgrastim or its long-acting form pegfilgrastim after chemotherapy make white cells recover faster, cutting the risk of life-threatening infections and allowing chemotherapy on schedule.
Care in the last months of life focused entirely on comfort, at home or in a hospice, when cancer treatment no longer helps. Enrolling earlier than the typical two to three weeks gives patients and families more benefit.
Infusion devices are the implanted ports, smart pumps, and take-home pumps that deliver chemotherapy safely, including 46-hour infusions patients carry home.
Changing the gut bacteria of a patient whose immunotherapy stopped working, in the hope of restarting the response.
Screening for malnutrition, dietitian-led counselling, supplements and tube or intravenous feeding where indicated, plus treatment of cancer cachexia, the muscle-wasting syndrome that affects up to 80% of advanced patients.
Protecting the ability to have children before cancer treatment that damages eggs, sperm or the womb: sperm and egg or embryo freezing, ovarian tissue freezing, ovarian shielding and, for some breast cancers, temporary ovarian suppression.
The ordering and record systems oncologists use every day, including built-in treatment pathways that steer drug choice.
Specialist nurses deliver most cancer treatment and much of its safety, education and support; nurse-led clinics, navigation and symptom management improve outcomes and are the backbone of care in low-resource settings.
Nutrition screening means weighing every patient, asking a few screening questions, and referring those at risk to a dietitian. It is simple, guideline-endorsed, and still not done routinely.
Robots and closed systems that prepare chemotherapy doses safely, protecting pharmacists from hazardous drugs and patients from errors.
Short courses of radiation, often a single treatment, to relieve pain from bone metastases, stop bleeding, open blocked airways or protect the spinal cord. Among the most cost-effective treatments in cancer.
Prehabilitation is a few weeks of structured exercise, nutrition and psychological preparation between diagnosis and surgery to make patients fitter for the operation and speed recovery.
Antibiotics in the weeks before immunotherapy are linked with worse outcomes, and shop-bought probiotics may not help and might hurt. Avoiding both where possible is a low-cost precaution.
Psycho-oncology recognises and treats the anxiety, depression, fear of recurrence and existential distress that affect a third of people with cancer, using screening, psychotherapy adapted to cancer, and medication.
Lifting weights and eating enough protein is the only treatment shown to build muscle in people with cancer wasting, but most are too unwell to do it alone and the trials are small.
A cold cap worn during chemotherapy that reduces hair loss by narrowing blood vessels in the scalp.
Chemotherapy leaves behind zombie cells that will not divide but poison their neighbours. Senolytics aim to clear them.
Half of people with cancer sleep badly, so sleep and body-clock interventions matter. Talking therapy for insomnia works well and is under-used; whether fixing sleep or body-clock disruption changes the cancer itself is unproven.
Stopping smoking after a cancer diagnosis improves survival, reduces treatment complications and second cancers, and is the single most effective supportive intervention that oncology services still routinely fail to deliver.
A supervised, coached exercise programme for three years after bowel cancer treatment cut recurrence and death in a large randomised trial. It is the first lifestyle intervention proven to work like an adjuvant drug.
Organised follow-up for the 18 million US and 50+ million global cancer survivors: watching for recurrence and second cancers, managing long-term side effects such as heart damage, infertility, neuropathy and fatigue, and helping people return to work and life.
Video visits, remote monitoring and home delivery of some cancer treatments expanded massively during COVID-19 and have stayed; they reduce travel burden, especially for rural patients, without evidence of worse outcomes.
Video visits, remote second opinions, and slides reviewed from afar, which let rural and low-resource patients reach specialists.
Red cell and platelet transfusions, iron and erythropoiesis-stimulating agents keep patients safe through chemotherapy and marrow failure; restrictive thresholds and ESA caution reflect trials showing more is not better.
For colon cancer survivors, a prescribed, supported exercise programme is now an evidence-based treatment with a survival benefit comparable to many drugs. Health systems will need to fund exercise consultants as they fund chemotherapy. The trial does not tell us whether unsupervised advice achieves the same.
Older patients are more likely to be harmed by standard-dose chemotherapy, and a structured assessment of function, cognition, nutrition and social support lets oncologists adjust treatment safely. Starting lower does not appear to shorten life. Most older patients still do not get such an assessment.
Routinely asking patients how they feel between visits, and acting on the answers, is a treatment in itself. It catches problems early, keeps people on effective therapy longer and appears to extend life. Cancer centres now build symptom monitoring into electronic records, though implementation is uneven.
Palliative care is not what happens when treatment stops; it works best alongside cancer treatment from the start. Patients feel better, are less depressed and may live longer. Access remains the constraint: most of the world's patients never see a palliative care specialist.