Supportive Care and Symptom Management
Supportive care and symptom control
Supportive care is active treatment, not a last resort. Candidates should understand multimodal pain management, scheduled antiemetics, oral care for mucositis, bowel regimens for opioid-induced constipation, nutrition and hydration support, fatigue management, transfusion practice, growth factor use, and prevention of infection. Assess pain with age-appropriate tools and treat before procedures; use nonpharmacologic methods alongside medication. Mucositis pain may require topical anesthetics and systemic opioids; not all mucositis is infection, but neutropenic patients with mucositis need careful fever surveillance. Transfusion reactions range from febrile nonhemolytic to acute hemolytic, allergic, and transfusion-related acute lung injury; stop the transfusion and follow protocol for any new fever, chills, rash, dyspnea, or back pain.
Traps include withholding opioids because of exaggerated addiction concerns, starting around-the-clock opioids without a bowel regimen, giving antiemetics only after vomiting, and attributing all symptoms to chemotherapy without reassessing. Do not use aspirin in children because of Reye syndrome risk. Regularly reassess sedation, respiratory status, and pain after opioid doses.
Worked example: a child on scheduled morphine develops no bowel movement for three days and abdominal discomfort. Before adding another opioid, assess for constipation and start or escalate a stimulant laxative with fluids and activity, while continuing pain control. Prevention is easier than disimpaction.
Rule of thumb: when starting regular opioids, start a bowel regimen at the same time.