Symptom Management and Supportive Care
Oncologic emergencies
Febrile neutropenia is a medical emergency: a single oral temperature of 38.3 C or higher, or 38.0 C sustained over an hour, with an absolute neutrophil count under 500 (or expected to fall below 500). Draw cultures, obtain lactate, and give empiric antipseudomonal broad-spectrum antibiotics within 60 minutes. Avoid rectal temperatures and suppositories.
Nausea and mucositis
Prophylaxis is matched to emetogenicity. Highly emetogenic regimens typically use a 5-HT3 antagonist, dexamethasone, an NK1 antagonist, and often olanzapine; delayed nausea relies on dexamethasone and olanzapine or metoclopramide. Mucositis management is supportive: saline or bicarbonate rinses, gentle oral care, avoiding alcohol-based rinses; palifermin is used in stem-cell transplant settings.
Pain and fatigue
Follow the WHO analgesic ladder, add a bowel regimen with opioids, and avoid NSAIDs during thrombocytopenia. Fatigue responds best to exercise, sleep hygiene, and energy conservation rather than stimulants.
Lymphedema and menopausal symptoms
Teach skin care, avoidance of trauma, and compression for lymphedema. For hot flashes in hormone receptor-positive disease, use nonhormonal options such as SSRIs, SNRIs, or gabapentin; systemic estrogen is avoided. Vaginal moisturizers and dilators address sexual dryness.
Traps
Treating neutropenic fever as an outpatient problem, delaying antibiotics to await cultures, prescribing estrogen for hot flashes in hormone receptor-positive disease, and using colony-stimulating factors routinely for low-risk regimens.
Rule of thumb. Fever plus chemotherapy equals cultures and antibiotics now; the count can be checked afterward.