What is the management approach for cancer physiology?

Management Approach for Cancer Physiology

The management of cancer physiology requires a multidisciplinary team-based approach integrating surgery, radiotherapy, systemic treatments, rehabilitation, and supportive care to optimize patient outcomes in terms of morbidity, mortality, and quality of life. 1

Multidisciplinary Team Structure

• Cancer care should be delivered in specialized cancer centers by a team consisting of medical oncologists, surgeons, radiation oncologists, radiologists, pathologists, and specialized nurses 1
• The team should have access to rehabilitation specialists, psychologists, physiotherapists, and geneticists when appropriate 1
• A specialized nurse or healthcare practitioner should serve as a patient navigator throughout the cancer journey 1

Physiological Assessment and Monitoring

• Initial assessment should include comprehensive evaluation of functional capacity through tests of body composition, aerobic capacity (6-minute walk), strength (30-second sit-to-stand), flexibility, and balance 2
• Clinical symptoms alone are not reliable in diagnosing underlying physiological changes; comprehensive investigation is required if symptoms don't respond to simple interventions 2
• Validated symptom questionnaires or patient-reported outcome measures should be routinely used to ensure accurate assessment 2

Exercise and Rehabilitation Interventions

• Exercise therapy should be integrated across the entire cancer continuum, from diagnosis through survivorship 2
• For patients with severe fatigue (7-10 on ESAS), light exercises are recommended while avoiding high-intensity activities 2
• For patients with fall risk, incorporate core and lower extremity strength, balance, and coordination exercises 2
• For patients with cytopenia, consider supervised, low-impact exercises with fall prevention strategies 2
• For patients with bone metastases, obtain medical clearance and focus on balance and isometric exercises 2

Managing Cancer-Related Symptoms

• Cancer treatments frequently cause multiple gastrointestinal symptoms that require identification of physiological deficits through appropriate testing 2
• Most patients developing symptoms after cancer treatment have more than one cause for their symptoms 2
• Common treatable physiological changes include bile acid diarrhea, carbohydrate intolerance, pancreatic exocrine insufficiency, and small intestinal bacterial overgrowth 2
• Investigating symptoms during active treatment is feasible and beneficial when symptoms impact treatment 2

Mind-Body Approaches

• Mind-body modalities that focus on interactions among brain, mind, body, and behavior can be effective adjunct therapies for managing symptoms like pain, dyspnea, and fatigue 2
• Massage therapy techniques including Swedish massage, aromatherapy massage, and reflexology can help reduce anxiety, depression, and pain in cancer patients 2
• Acupuncture and associated techniques have demonstrated efficacy in treating cancer-related nausea/vomiting and pain 2

Nutritional Management

• Nutritional counseling should be recommended as part of survivor care for all obese patients 2
• For patients with cancer cachexia, assessment of changes in patient-reported outcomes including symptoms and quality of life should guide interventions 2
• Early nutritional interventions should be considered in patients with metastatic cancer 2

Follow-up Care

• Regular clinical assessments should be conducted to provide optimal symptom management and maintain quality of life 1
• Ipsilateral and contralateral mammography is recommended every 1-2 years for breast cancer survivors 2
• Regular exercise provides functional and psychological benefits and may reduce recurrence risk 2
• Hormone replacement therapy increases recurrence risk and should be discouraged 2

Common Pitfalls and Challenges

• Administrative barriers often limit implementation of integrated models of care 2
• Guideline implementation is challenged by staffing limitations, workforce knowledge gaps, and clinical workflow issues 2
• Patients may not receive appropriate rehabilitation services if functional assessments aren't properly linked to referral pathways 1
• There is currently no comprehensive rehabilitation guideline or clinical pathway for cancer care, despite evidence supporting its importance 2

Patient Education and Involvement

• Information on diagnosis and treatment options should be provided repeatedly, both verbally and in writing 1
• Patients should be actively involved in all management decisions 1
• Patients need clear information about treatment purposes, potential side effects, and impacts on functional, emotional, and social well-being 1
• Post-cancer treatment can be isolating; patients often hesitate to ask for help with long-term side effects that impact quality of life 2