Tumor Zentrum Aarau and Hirslanden Clinic Aarau, Aarau, Switzerland.
Medical Oncology, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy.
Am Soc Clin Oncol Educ Book. 2021 Mar;41:1-11. doi: 10.1200/EDBK_320041.
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.
支持性治疗旨在预防和管理癌症及其治疗在整个疾病过程中的不良反应。专门中心的研究和临床经验表明，早期适当的支持性治疗干预可以以具有成本效益的方式改善症状、生活质量和总体生存率。挑战在于使用经过验证的工具定期评估症状和需求，理想情况下，在就诊之间进行评估；电子患者报告结果测量和专用的易于访问的支持性护理单元可以提供帮助。随着某些问题的管理得到改善，其他问题开始出现。癌症相关的疲劳和营养不良非常常见，需要定期筛查、评估可治疗的原因，并及早干预以改善。药物和植物药的作用不大，但其他干预措施很有价值：体育锻炼、疲劳咨询、认知行为疗法/身心干预（例如，用于疲劳）。营养应该是口服的，富含蛋白质，并伴有适应患者病情的肌肉训练。心理和社会咨询通常很有用；恶心或其他问题，如胃肠道动力障碍或代谢紊乱，必须加以解决。化疗引起的周围神经病变经常会降低生活质量，而且没有既定的预防策略（尽管目前对冷冻疗法和压缩疗法感兴趣），因此需要仔细评估患者易患该病的倾向，并考虑可行的剂量和治疗替代方案。当出现疼痛时，度洛西汀有助于缓解疼痛。非药物策略，包括针灸、体育锻炼、冷冻疗法/压缩疗法和 scrambler 疗法，很有前途，但需要进行大型 III 期试验才能成为公认的标准。基于现实目标的化疗个体化是关键。
