SUPPORTIVE CARE IN ONCOLOGY
L. Austin Fredrickson, MD, FACP
L. Austin Fredrickson, MD, FACP, is an Associate Professor of Internal Medicine at Northeast Ohio Medical University, where he serves as core faculty and teaches diagnostics, therapeutics, clinical skills, and health humanities. He is board-certified in general internal medicine and practices rural primary care.
Liz Fredrickson, PharmD, BCPS
Liz Fredrickson is an Associate Professor of Pharmacy Practice and Pharmaceutical Sciences at the Northeast Ohio Medical University (NEOMED) College of Pharmacy.
Topic Overview
Supportive care is an essential component of comprehensive cancer treatment that aims to improve the quality of life for patients and their families throughout their cancer journey. By implementing key strategies, healthcare providers can enhance patient comfort, reduce treatment-related complications, and support patients and their families in navigating the complexities of cancer care. This activity will discuss the principles of supportive care, emphasizing its role in addressing cancer patients' physical, emotional, and psychosocial needs. Supportive care models will be described, focusing on the critical roles of multidisciplinary care team members, including physicians and pharmacy personnel. With a deeper understanding of supportive care, healthcare providers can enhance patient comfort, reduce treatment-related complications, and support patients and their families in navigating the complexities of cancer care.
Accreditation Statement
RxCe.com LLC is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education.
Universal Activity Number (UAN): The ACPE Universal Activity Number assigned to this activity is
Pharmacist 0669-0000-24-143-H01-P
Pharmacy Technician 0669-0000-24-144-H01-T
Credits: 2 contact hour(s) (0.2 CEU(s)) of continuing education credit
Type of Activity: Knowledge
Media: Internet/Home study Fee Information: $6.99
Estimated time to complete activity: 2 contact hour(s) (0.2 CEU(s)), including Course Test and course evaluation
Release Date: October 8, 2024 Expiration Date: October 8, 2027
Target Audience: This educational activity is for pharmacists and pharmacy technicians.
How to Earn Credit: From October 8, 2024, through October 8, 2027, participants must:
Read the “learning objectives” and “author and planning team disclosures;”
Study the section entitled “Educational Activity;” and
Complete the Course Test and Evaluation form. The Course Test will be graded automatically. Following successful completion of the Course Test with a score of 70% or higher, a statement of participation will be made available immediately. (No partial credit will be given.)
Credit for this course will be uploaded to CPE Monitor®.
Learning Objectives: Upon completion of this educational activity, participants should be able to:
Recognize the definition and principles of supportive care
Describe supportive care models, including the roles of multidisciplinary care team members
Describe supportive care prevention and management strategies
Disclosures
The following individuals were involved in developing this activity: L. Austin Fredrickson, MD, FACP, Liz Fredrickson, PharmD, BCPS, and Pamela Sardo, PharmD, BS. Pamela Sardo, L. Austin Fredrickson, MD, FACP, and Liz Fredrickson, PharmD, BCPS, have no conflicts of interest or financial relationships regarding the subject matter. There are no financial relationships or commercial or financial support relevant to this activity to report or disclose by RxCe.com or any of the individuals involved in the development of this activity.
© RxCe.com LLC 2024: All rights reserved. No reproduction of all or part of any content herein is allowed without the prior, written permission of RxCe.com LLC.
Educational Activity
Supportive Care in Oncology Introduction
Supportive care is an essential component of comprehensive cancer treatment that aims to improve the quality of life for patients and their families throughout their cancer journey.1 The Multinational Association of Supportive Care in Cancer (MASCC) defines supportive care in cancer as the comprehensive prevention and management of physical and psychological side effects of cancer and its treatment.1 They state that this management addresses symptoms and side effects throughout the entire cancer journey, from diagnosis to post-treatment, to improve rehabilitation, secondary cancer prevention, survivorship, and end-of-life care.1 The primary goal of supportive care in cancer is to prevent and manage complications related to cancer and its treatment, ultimately improving the quality of life for patients and their caregivers.2 By minimizing the side effects of anticancer therapies, supportive care can also enhance treatment adherence, leading to improved outcomes such as prolonged survival or remission.2
The provision of supportive care involves the entire cancer care team, and all multidisciplinary team members must work in tandem to optimize patient care.2 This activity will discuss the principles of supportive care, emphasizing its role in addressing cancer patients' physical, emotional, and psychosocial needs. Various supportive care models will also be described, focusing on the critical roles of multidisciplinary care team members, including physicians and pharmacy personnel. With a deeper understanding of supportive care, healthcare providers can enhance patient comfort, reduce treatment-related complications, and support patients and their families in navigating the complexities of cancer care.
Terminology and Principles of Supportive Care
Definitions of supportive care vary among organizations and associations. The National Cancer Institute, or NCI, defines supportive care as “care given to improve the quality of life of people who have an illness or disease by preventing or treating, as early as possible, the symptoms of the disease and the side effects caused by treatment of the disease. Supportive care includes physical, psychological, social, and spiritual support for patients and their families. There are many components of supportive care, including pain management, nutritional support, counseling, exercise, music therapy, meditation, and palliative care. Supportive care may be given with other treatments from diagnosis until the end of life.”3 The MASCC defines supportive care as noted above and has identified numerous principles associated with supportive care (summarized in Table 1).4
Table 1
Principles of Supportive Care (MASCC)5
Supportive care aims to maintain (or improve) quality of life and to ensure that cancer patients can achieve maximum benefit from their anticancer treatment. |
| Supportive care is relevant throughout the continuum of the cancer experience, from diagnosis through treatment to post-treatment care (and encompasses cancer survivorship and palliative and end-of-life care). |
Supportive care involves a coordinated, person-centric, and holistic (whole- person) approach, which should be guided by the individual’s preferences and should include the appropriate support of their family and friends. |
Supportive care (as outlined) is a basic right for all people with cancer, irrespective of their circumstances, their type of cancer, their stage of cancer, or their anticancer treatment. It should be available in all cancer centers and other medical facilities that routinely manage people with cancer. |
In addition to creating these definitions, experts have developed consensus guidelines to provide standards for the term “best supportive care” used within clinical trials.2,5 These consensus guidelines are summarized in Table 2.5
Table 2
Consensus Guidelines for Best Supportive Care in Clinical Trials5
| Category | Patient Recommendations |
Multidisciplinary Care | - Access to palliative care specialists during anticancer therapy |
| - Access to nursing, social work, financial, and spiritual support | |
| - Standard processes to educate patients on therapy goals, symptom assessment, and management in clinical trials | |
Documentation | - Institutional review boards should ensure supportive care interventions are documented in trials with significant best supportive care components |
| - Supportive care delivery should be standardized for all patients in these trials | |
| - Journal reports should clearly describe best supportive care in relevant trials | |
Symptom Assessment | - Symptoms assessed at baseline and regularly throughout the trial |
| - Use concise, globally accessible, validated tools for symptom assessment | |
| - Symptom assessment intervals should be identical between best supportive care and intervention groups | |
Symptom Management | - Symptom control should follow evidence- based guidelines |
| - Clinical trial protocols should encourage guideline-based symptom control |
Additional definitions pertinent to the provision of supportive care are defined in Table 3.2
Table 3 Supportive Care Terminology2
| Terminology | Definition |
Supportive Care | The prevention and management of cancer's adverse effects, including physical and psychological symptoms, from diagnosis to post-treatment, aimed at improving rehabilitation, secondary prevention, survivorship, and end-of-life care. |
Palliative Care | Holistic care focuses on individuals with serious health-related suffering from severe illness, particularly those near the end of life, aiming to improve the quality of life for patients, families, and caregivers. |
Early Palliative Care | Palliative care is provided early in the course of life- threatening diseases, alongside active treatments like chemotherapy or radiotherapy in cases of advanced cancer. |
| Timely Palliative Care | Personalized palliative care is delivered at the optimal time and setting, tailored to meet patients' specific needs. |
| Best Supportive Care | No standardized definition, though consensus guidelines exist for the best supportive care in clinical trials for advanced cancer. |
Enhanced Supportive Care | An NHS England initiative to promote earlier integration of palliative care within cancer treatment, recognizing the benefits of specialist palliative care. Equivalent to early palliative care. |
Supportive Oncology | Those aspects of medical care are concerned with the physical, psychosocial, and spiritual issues faced by persons with cancer, their families, their communities, and their healthcare providers. In this context, supportive oncology describes interventions used to support patients who experience adverse effects caused by antineoplastic therapies and interventions now considered under the broad rubric of palliative care. |
Supportive Care Personnel and Models
The provision of supportive care often varies due to a lack of standard definitions, limited information regarding supportive care models, and a shortage of conceptual frameworks for supportive cancer care.6 Health care providers with a more complete understanding of these components could ultimately enhance the organization and effectiveness of supportive care services, thus improving patient outcomes.6 It is important to note that researchers have identified that supportive care needs to extend beyond just the provision of individualized service from providers but aims to become a framework for planning and delivering optimized cancer care.7 Additionally, no matter which approach to care is taken, it is vital that the model can be adapted to be utilized for all patient populations.6
Optimizing supportive patient care should involve numerous healthcare specialties, including advanced practice providers, chaplains, dietitians, nurses, occupational and physical therapists, pharmacists, physicians, psychologists, and social workers.2,6 These disciplines should collaborate as an interdisciplinary team to provide specialized, comprehensive care tailored to the diverse needs of cancer patients. Individual providers should be well- versed in supportive care knowledge and concepts.6 The services teams provide are summarized in Table 4.6
Table 4 Supportive Care Services6
| Supportive Care Services | Interventions |
| Management of Cancer- Related Symptoms/Problems | Pain management Management of other symptoms |
Management of Cancer Treatment-Related Symptoms | Prophylaxis (e.g., antiemetics for chemotherapy-induced nausea and vomiting) Treatment of side effects |
| Coordinating Management of Co-Morbidities | - Collaboration with other specialties for comprehensive care |
| Psychological Support | Support for patients Support for carers (including children) |
| Nutritional Support | - Guidance and interventions for nutritional health |
| Prehabilitation | - Preparation for treatment to improve outcomes |
| Rehabilitation | - Recovery support after treatment |
Social Care | Advocacy Assistance with financial challenges ("financial toxicity") |
Palliative Care | Early palliative care End-of-life care and bereavement support |
| Survivorship Care | - Support for post-treatment health and wellness |
| Integrative Therapies | - Complementary therapies to enhance quality of life |
Care Team Timeout7
Supportive care teams should be available in outpatient and inpatient settings
These teams should closely cooperate with the patient’s primary care team and other relevant health and social care services
Barriers and challenges for care teams may include:
Lack of coordination
Poor communication between professionals and patients and among professionals
Poor continuity of care
Non-standardized approaches to care
To address these issues, new roles have emerged: e.g., Patient navigators are professionals or volunteers who assist patients and families with decision-making, accessing services, and overcoming barriers
Service-driven care has been shown to demonstrate little value to patients and health systems
The unified supportive care model consolidates leadership and fosters collaborative teamwork to deliver streamlined care to cancer patients.2 This approach ensures that all cancer patients are universally referred for supportive care, where their unmet needs are systematically screened.2 This screening process helps guide appropriate interventions and facilitates the timely involvement of specialists tailored to each patient's specific needs.2 By promoting consistent messaging and coordinated efforts among team members, the unified care model enhances the overall care experience, ensuring that patients receive comprehensive, well-coordinated support throughout their treatment journey.2 Key features of supportive care models are summarized in Table 5.
Table 5
Features of Supportive Care6
| Feature | Description |
Universal Referral | All cancer patients are automatically referred from the time of diagnosis, as everyone can benefit from these services |
Systematic Screening | Patients are regularly screened for supportive care needs during consultations and visits, enabling tailored services and appropriate follow-up intensity. |
Tailored Specialist Involvement | Specialist care is provided by an interdisciplinary supportive/palliative care team, with timely involvement of other teams (e.g., cancer pain service, rehabilitation). Survivorship teams take over care for patients post-treatment. |
Collaborative Teamwork | The integrated model fosters communication and collaboration among interdisciplinary team members, leveraging situational leadership for each discipline’s expertise. |
Streamlined Care | Patients receive multiple supportive care services in one setting, reducing wait times and duplication while ensuring consistent communication and care. |
Consolidated Leadership | A unified administrative structure promotes institutional priorities in supportive care and fosters innovative interdisciplinary initiatives. |
Improved Outcomes | This model improves access to patient- centered care, enhances outcomes, and reduces costs by eliminating service redundancies (e.g., overlapping care for pain and palliative services). |
Care Team Timeout2,7
Digital health, telehealth, and eHealth refer to healthcare services supported by telecommunications or digital technology to enhance care.
Digital health interventions include:
Patient monitoring
Symptom management
Self-management
These interventions improve service efficiency and outcomes in supportive care
Collecting electronic patient-reported outcomes and using digital interventions (e.g., psychotherapeutic, mindfulness, exercise, and rehabilitation programs) improve cancer patients' distress, symptoms, and quality of life.
Remote monitoring enhances treatment adherence and efficacy and helps detect problems or relapses early.
Digital services should complement, not replace, in-person care.
Further research is needed to optimize the integration of digital interventions into routine practice.
Information sharing is a critical supportive care need; a lack of clear, accessible, and culturally sensitive information can cause distress for patients and carers.
Involving patients and carers in service development helps meet their specific needs and preferences.
Prevention and Management Strategies
A key aspect of supportive care is managing a patient’s cancer in addition to any treatment-related symptoms.6 Numerous chemotherapy agents have the potential to cause serious side effects if not appropriately managed.8 The adverse drug reactions (ADR) related to anticancer medications result from the medication’s mechanism of action; common side effects include things such as myelosuppression, diarrhea, mucositis, and infertility.8
This will necessitate recognizing signs and symptoms of chemotherapy complications for care teams and devising strategies for supportive care management.6 Two commonly encountered issues that will be discussed in further detail below include chemotherapy-induced nausea and vomiting (or CINV) and cancer-related fatigue.
Chemotherapy-Induced Nausea and Vomiting (CINV)
Nausea and vomiting are among the most prevalent and problematic side effects of chemotherapy. CINV is defined as nausea and vomiting due to the administration of chemotherapy, which impacts patients both psychologically and physically.8 The occurrence of CINV can be devastating for patients, with resulting complications such as weight loss, inability to provide self-care, and nutritional deficiencies.8
Guidelines for managing CINV have been published in concert by MASCC and the European Society for Medical Oncology (ESMO).9 These were last updated in 2023.9 The National Comprehensive Cancer Network also provides guidelines for treatment.8 Emetogenicity is defined as the probability of an agent causing nausea and vomiting, and this ultimately factors into the antiemetic prophylaxis strategy (prevention of nausea and vomiting) implemented.8 Authors of the guidelines have identified difficulties in accurately determining the emetic risk of chemotherapy agents due to variables such as tumor types, advanced vs. non-advanced disease, whether the patient is treatment-naïve, and whether agents are used singularly or in
combination.9 Clinicians also need to take into consideration patient-specific factors such as age, gender, prior poor control of CINV, and conditions such as depression when selecting antiemetic prophylaxis.8 Anticancer therapies can be categorized into one of four groups based on emetogenic risk: highly emetogenic chemotherapy (CINV in >90% of patients), moderately emetogenic chemotherapy (CINV in 30-90% of patients), low emetogenic chemotherapy (CINV in 10-30% of patients), and minimally emetogenic (CINV in less than 10% of patients).8 Guidelines define the emetic risk of chemotherapy agents that are given intravenously as the risk of vomiting within 24 hours after starting therapy in patients who did not receive prophylaxis.9
The goal of prophylaxis is no vomiting or nausea throughout the patient’s risk period.8 CINV prophylaxis regimens are detailed in Table 6.8
Table 6
CINV Prophylaxis Regimens8
| CINV Prophylaxis Recommendations for IV Chemotherapy | ||
| Risk | Phase | Prophylaxis |
| HEC | Acute Phase | Quadruplet: 5-HT3-RA + dexamethasone + NK1-RA + olanzapine |
| Delayed Phase | Olanzapine on days 2-4 If used on day 1, oral aprepitant continues days 2-3 If regimen other than AC, dexamethasone continues days 2-3 (dose varies by which NK1 utilized) | |
| MEC | Acute Phase | Doublet: 5-HT3-RA + dexamethasone |
| Delayed Phase | Dexamethasone 8 mg PO/IV on days 2-3 only if patients receiving therapies with known potential for delayed CINV | |
| LEC | Acute Phase | Monotherapy: 5-HT3-RA or dexamethasone |
| Delayed Phase | None | |
| Minimal | Acute Phase | None |
| Delayed | None |
Role of the Primary Care Providers
Primary care providers help identify and manage symptoms of CINV.10,11 They should assess their patients for other causes of nausea and vomiting, such as dehydration, hypercalcemia, uremia, and infections.8 PCPs can also monitor for delayed-onset CINV, assess overall patient well-being, and provide early intervention by adjusting medications or referring patients back to oncology for specialized care.9,10 Also, they are instrumental in managing the broader health concerns of cancer patients, such as hydration status, electrolyte imbalances, and weight loss related to uncontrolled nausea and vomiting. 9,10 Congruent with supportive care models, these providers can ensure continuity of care by coordinating with oncologists and supportive care teams, ensuring optimal management of CINV in all treatment phases. 9,10
Role of the Pharmacist
Pharmacists play a critical role in preventing, recognizing, and managing CINV by ensuring the proper selection and administration of antiemetic therapy based on chemotherapy regimens, patient-specific factors, and established guidelines. They can also educate patients on the importance of adherence to prescribed antiemetics and potential side effects and assess patients for early signs of nausea and vomiting during routine consultations.8 By collaborating with the supportive care team, they may provide recommendations to modify antiemetic regimens when necessary and monitor
for potential drug interactions between antiemetics and other medications the patient takes. Furthermore, pharmacists may recommend over-the-counter remedies and lifestyle modifications to manage mild symptoms.8
Cancer-Related Fatigue
From diagnosis through the end of treatment, fatigue has been identified as the most common symptom of patients with cancer.12 ESMO guidelines define this fatigue as a distressing, persistent, subjective sense of physical, emotional, and/or cognitive tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent physical activity and that interferes with usual functioning.12 Cancer-related fatigue, or CRF, is particularly challenging as sleep or resting often does not relieve it.12 CRF has been reported by up to 90% of patients with cancer undergoing treatment.12
The ESMO guidelines for CRF recommended implementing a shared decision-making model wherein the healthcare professional completes the following:
Acknowledges the reality and impact of the condition and the symptoms
Provides information on the possible causes, nature, and course of CRF
Provides information about the range of interventions and management strategies available to the patient
Considers the person's age, the severity of their fatigue, their preferences and experiences, and the outcome of previous treatment(s) using a careful assessment regularly
Offers information about support groups for people with fatigue and their caregivers, if available
Patients with cancer should be screened for CRF, especially given this can overlap with other common issues, including depression.12 Management can involve nonpharmacological modalities (including increased physical
exercise and psychosocial interventions) and select medications. The ESMO guidelines have made the following recommendations in this area:12
The use of modafinil and armodafinil is not recommended for the control of CRF
Concerning the use of methylphenidate, dexmethylphenidate, long- acting methylphenidate, and dexamphetamine, the panel has not reached a consensus:
For three panel members, the psychostimulants could be considered in thoroughly selected patients, and their usefulness and safety should be evaluated after a very short time period
For the other six panel members, psychostimulants cannot be recommended because most trials failed to show the intended effects on the primary outcome measures
The use of antidepressants, and in particular paroxetine, is not recommended for the control of CRF
The use of donepezil for the control of CRF is not recommended
Short-term use of dexamethasone or methylprednisolone is recommended for the control of CRF in metastatic cancer patients
The use of eszopiclone, megestrol acetate, and melatonin is not recommended for the control of CRF
Pharmacists can assist with the management of cancer-related fatigue by ensuring the appropriate selection and use of medications tailored to individual patient needs. Pharmacists should assess the use of medications that might contribute to fatigue (e.g., opioids, sedatives) and suggest alternatives or dosage adjustments. They may also recommend non- pharmacological interventions, such as physical activity and cognitive behavioral therapy (CBT), which have improved fatigue.
Additional Resources
MASCC (Multinational Association of Supportive Care in Cancer) The National Comprehensive Cancer Network
General Role of the Pharmacy Technician
The oncology pharmacy technician plays a crucial role in supportive care for cancer patients by assisting pharmacists in preparing, dispensing, and managing chemotherapy and supportive care medications.13 Their responsibilities include ensuring accurate medication preparation, managing inventory of supportive care drugs, and helping with patient education by providing information on medication adherence and side effect management.13 They also collaborate with the oncology care team to ensure the timely and appropriate delivery of supportive care interventions, enhancing patient outcomes.13
Summary
Within oncology, supportive care is an essential component of comprehensive cancer treatment that aims to improve the quality of life for patients and their families throughout their cancer journey. By implementing key strategies, healthcare providers can enhance patient comfort, reduce treatment-related complications, and support patients and their families in navigating the complexities of cancer care.
Course Test
Which of the following best defines supportive care?
Prevention and management of cancer's adverse effects, including physical and psychological symptoms, from diagnosis to post- treatment
Holistic care focuses on individuals with serious health-related suffering from severe illness, particularly those near the end of life
Personalized palliative care delivered at the optimal time and setting
Aspects of medical care concerned with the physical, psychosocial, and spiritual issues faced by persons with cancer
Which of the following is true regarding the MASCC principles of supportive care?
Supportive care should be implemented once all standardized cancer treatments have failed
Supportive care is provider-centric and is guided by the recommendations of the oncology team
Supportive care should only be implemented in institutional healthcare settings
Supportive care is a basic right for all people with cancer, irrespective of their circumstances
“Interventions used to support patients who experience adverse effects caused by antineoplastic therapies” best describes which of the following?
Palliative care
Timely palliative care
Enhanced supportive care
Supportive oncology
Which of the following is not a barrier to implementing supportive care models?
Poor communication between healthcare professionals and patients
Poor continuity of oncology care
Standardized approaches to care
Lack of coordination among supportive care services
Which feature of supportive care models encompasses patients receiving multiple supportive care services in one setting to reduce wait times and redundancies?
Universal referral
Systematic screening
Collaborative teamwork
Streamlined care
Which of the following is not true regarding implementing digital health technologies within a supportive care model?
Digital health interventions include patient and symptom monitoring
Digital health should ultimately replace in-person visits
Remote monitoring may assist with treatment adherence
Digital health interventions (e.g., rehabilitation programs) may improve patient’s distress and quality of life
The emetic risk of intravenous chemotherapy agents is defined as the risk of vomiting within what time frame of receiving the medication?
1 hour
12 hours
24 hours
48 hours
Which of the following is true regarding the role of pharmacists in managing chemotherapy-induced nausea and vomiting?
Pharmacists can refer patients to oncology specialists
Pharmacists can manage related concerns such as hydration and electrolyte balance
Pharmacists can educate patients on the importance of adherence to antiemetic medications
Pharmacists can prescribe antiemetic agents specific to the emetic risk of the patient’s chemotherapy regimen
Which of the following is true regarding pharmacotherapeutic treatments for cancer-related fatigue?
Modafinil is not recommended for the control of CRF
Paroxetine is the gold standard for managing CRF
Long-term use of dexamethasone is appropriate for metastatic cancer patients with CRF
Nightly melatonin is recommended for managing CRF
ESMO guidelines recommend that healthcare professionals do which of the following for patients suffering from cancer-related fatigue?
Counsel patients that this is a short-term condition that will minimally impact their quality of life
Select a treatment primarily based on the patient’s age
Utilize the patient’s severity of fatigue, preferences, and experiences to determine a treatment strategy
Prescribe an intensive exercise regimen
References
MASCC. What is Supportive Care in Cancer? Available at: https://mascc.org/. Accessed September 2024.
Scotté F, Taylor A, Davies A. Supportive Care: The "Keystone" of Modern Oncology Practice. Cancers (Basel). 2023;15(15):3860. Published 2023 Jul 29. doi:10.3390/cancers15153860
National Cancer Institute NCI Dictionary of Cancer Terms: Supportive Care. [(accessed on 19 June 2023)]; Available
online: https://www.cancer.gov/publications/dictionaries/cancer- terms/def/supportive-care
Zafar S.Y., Currow D.C., Cherny N., Strasser F., Fowler R., Abernethy
A.P. Consensus-based standards for best supportive care in clinical trials in advanced cancer. Lancet Oncol. 2012;13:e77–e82.
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Krishnasamy M, Hyatt A, Chung H, Gough K, Fitch M. Refocusing cancer supportive care: a framework for integrated cancer care. Support Care Cancer. 2022;31(1):14. Published 2022 Dec 14. doi:10.1007/s00520-
022-07501-9
Clemmons AB, Glode AE. Supportive Care in Cancer. In: DiPiro JT, Yee GC, Haines ST, Nolin TD, Ellingrod VL, Posey L. eds. DiPiro’s Pharmacotherapy: A Pathophysiologic Approach, 12th Edition. McGraw Hill; 2023.
Herrstedt J, Celio L, Hesketh PJ, et al. 2023 updated MASCC/ESMO consensus recommendations: prevention of nausea and vomiting following high-emetic-risk antineoplastic agents. Support Care Cancer. 2023;32(1):47. Published 2023 Dec 21. doi:10.1007/s00520-023-
08221-4
Hesketh PJ. Chemotherapy-induced nausea and vomiting. N Engl J Med. 2008;358(23):2482-2494.
Jordan K, et al. Antiemetics in cancer patients: ESMO clinical practice guidelines. Ann Oncol. 2020;31(10):1301-1305.
Fabi A, Bhargava R, Fatigoni S, et al. Cancer-related fatigue: ESMO Clinical Practice Guidelines for diagnosis and treatment. Ann Oncol. 2020;31(6):713-723. doi:10.1016/j.annonc.2020.02.016
Lo A, Co M, Lo C, Chua D, Soltesz D. Specialized pharmacy oncology technician: experience at the ridge meadows hospital. Can J Hosp Pharm. 2010;63(2):138-141. doi:10.4212/cjhp.v63i2.899
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The information provided in this course is general in nature, and it is solely designed to provide participants with continuing education credit(s). This course and materials are not meant to substitute for the independent, professional judgment of any participant regarding that participant’s professional practice, including but not limited to patient assessment, diagnosis, treatment, and/or health management. Medical and pharmacy practices, rules, and laws vary from state to state, and this course does not cover the laws of each state; therefore, participants must consult the laws of their state as they relate to their professional practice.
Healthcare professionals, including pharmacists and pharmacy technicians, must consult with their employer, healthcare facility, hospital, or other organization, for guidelines, protocols, and procedures they are to follow. The information provided in this course does not replace those guidelines, protocols, and procedures but is for academic purposes only, and this course’s limited purpose is for the completion of continuing education credits.
Participants are advised and acknowledge that information related to medications, their administration, dosing, contraindications, adverse reactions, interactions, warnings, precautions, or accepted uses are constantly changing, and any person taking this course understands that such person must make an independent review of medication information prior to any patient assessment, diagnosis, treatment and/or health management. Any discussion of off-label use of any medication, device, or procedure is informational only, and such uses are not endorsed hereby.
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