Supportive Care: Low Cost, High Value

Abstract

Supportive care aims to prevent and manage adverse effects of cancer and its treatment across the entire disease continuum. Research and clinical experience in dedicated centers have demonstrated that early appropriate supportive care interventions improve symptoms, quality of life, and overall survival in a cost-effective manner. The challenge is to assess symptoms and needs with validated tools regularly and, ideally, between clinic appointments; electronic patient-reported outcome measures and dedicated easily accessible supportive care units can help. As management of certain problems improves, others come to the fore. Cancer-related fatigue and malnutrition are very frequent and need regular screening, assessment of treatable causes, and early intervention to improve. Pharmacologic agents and phytopharmaceuticals are of little use, but other interventions are valuable: physical exercise, counseling on fatigue, and cognitive behavioral therapy/mind-body interventions (e.g., for fatigue). Nutrition should be oral, rich in proteins, and accompanied by muscle training adapted to the patient’s condition. Psychological and societal counseling is often useful; nausea or other problems such as gastrointestinal dysmotility or metabolic derangements must be tackled. Chemotherapy-induced peripheral neuropathy frequently worsens quality of life and has no established prevention strategy (notwithstanding current interest in cryotherapy and compression therapy) and thus requires careful assessment of patient predisposition to develop it with the consideration of feasible dose and treatment alternatives. When painful, duloxetine helps. Nonpharmacologic strategies, including acupuncture, physical exercise, cryotherapy/compression, and scrambler therapy, are promising but require large phase III trials to become the accepted standard. Personalization of chemotherapy, dependent on realistic goals, is key.

Financial Burden of Drugs Prescribed for Cancer-Associated Symptoms

“… 34 Additionally, for fatigue, addressing comorbid conditions and optimizing sleep and exercise are likely to be more effective than costly modafinil. 47 Payer noncoverage and high out-of-pocket costs of nonpharmacologic interventions (such as acupuncture or exercise regimens) for symptom control are partly responsible for their underutilization. 48 Our data demonstrate that even simple, seemingly innocuous drug prescriptions can cause significant economic consequences to patients.…”

Brentuximab-Induced Peripheral Neurotoxicity: A Multidisciplinary Approach to Manage an Emerging Challenge in Hodgkin Lymphoma Therapy

“…Exercise may be beneficial for patients with HL receiving BV, even though evidence that exercise rehabilitation strategies may be effective in patients with CIPN is limited to date and no definitive data to conclude that exercise interventions ameliorate established CIPN are available. With respect to the latter, this is in part due to small sample sizes, variable outcome measure selection, and little data on how exercise affects CIPN mechanistically [ 127 , 128 ]. Similarly, there is a growing body of literature to suggest that exercise could even prevent CIPN [ 129 ].…”

Heart rate variability as an indicator of the beneficial effects of Qigong and mindfulness training on the mind–body well-being of cancer survivors

“…In extreme cases, CRF can limit the ability of cancer survivors to reintegrate into normal life and return to work [ 6 ], and FOR can lead to despair, low morale, and even suicidal thoughts [ 7 ], creating a heavy burden. Clinical studies and experiences have shown that appropriate early mind–body interventions can improve cancer patients’ physical and mental symptoms, QOL, and overall survival rate [ 11 ]; enhance their self-management ability and confidence through lifestyle changes [ 12 ].…”

“…However, malnutrition is very common in cancer survivors [ 11 , 34 , 35 ]; 89% of cancer survivors believe that nutrition is extremely important in cancer care, and 57% indicate that more nutrition interventions are needed [ 35 ]. Appropriate nutritional assessment and early intervention can reduce the physical and mental stress caused by cancer [ 2 ], improve cancer survivors’ overall physical and mental health and QOL and reduce the risk of cancer progression [ 34 ].…”