Symptom Management and Supportive Care
Core concepts
Use a structured assessment (onset, character, severity, impact, associated symptoms) and treat causes before escalating drugs. Know the pillars: antiemetics matched to emetogenic risk (5-HT3 antagonist, NK1 antagonist, dexamethasone, olanzapine, dopamine antagonists), pain management by the analgesic ladder, bowel regimens with opioids, mucositis care, fatigue as a diagnosis of exclusion, and growth factor support for febrile neutropenia risk.
Traps in questions
- Breakthrough versus refractory: breakthrough nausea is treated with a different class, not a repeat of the scheduled drug alone.
- Constipation is expected with opioids - prophylaxis is required, not reactive treatment.
- Fatigue: screen for anemia, thyroid, depression, sleep, and pain before labeling it cancer-related fatigue.
- Steroids and glucose: dexamethasone raises blood glucose and can cause insomnia and mood change.
- Non-pharmacologic measures (mouth care, exercise, sleep hygiene) are testable and often the correct first step.
Rule of thumb
Assess cause, then treat, then reassess. If an option treats a symptom without assessing cause, look for the assessment option first.
Worked example
A patient on a highly emetogenic regimen has vomiting despite scheduled prophylaxis. The nurse should assess hydration and electrolytes, give a rescue antiemetic from a different class, and report the breakthrough pattern so prophylaxis can be optimized - not simply repeat the scheduled dose.