Supportive Care, Palliative Care, and Oncologic Emergencies
Core concepts
Supportive care spans antiemetics (5-HT3, NK1, dexamethasone per emetogenicity), G-CSF for febrile neutropenia risk, pain management (WHO ladder, opioids, adjuvants), nutrition, psychosocial support, fertility preservation, and survivorship. Palliative care: symptom control (dyspnoea, pain, nausea, constipation, delirium), advance care planning, goals-of-care discussions, and end-of-life care. Oncologic emergencies: febrile neutropenia (empiric broad-spectrum antibiotics within 1 hour), tumour lysis syndrome (hydration, allopurinol/rasburicase), spinal cord compression (dexamethasone + urgent imaging + RT/surgery), SVC obstruction, hypercalcaemia (IV fluids + bisphosphonate/denosumab), brain metastases/raised ICP, cardiac tamponade, and airway obstruction. Recognise immune-related adverse events as emergencies (colitis, pneumonitis, myocarditis).
Traps
Questions test time-critical interventions (antibiotics within 1 hour in febrile neutropenia; dexamethasone before imaging in cord compression if safe). Distinguish hypercalcaemia of malignancy from other causes; know corrected calcium. Do not forget prophylaxis (G-CSF, allopurinol, antiemetics). Watch for opioid toxicity (sedation, respiratory depression) and delirium.
Worked example / rule of thumb
A neutropenic patient (ANC <0.5) with fever ≥38.3 °C: obtain cultures and start empiric anti-pseudomonal β-lactam within 1 hour; add vancomycin if line infection/MRSA suspected. Rule of thumb: fever + neutropenia = antibiotics now, not after cultures return.