Teaching pack: Supportive Care & Survivorship

Anti-emetics, growth factors, scalp cooling, cardio-oncology, fertility preservation, geriatric assessment, palliative integration, exercise oncology, financial toxicity mitigation, and long-term survivorship monitoring. Under-studied relative to its impact.

• Active surveillance of papillary microcarcinoma: Watching very small papillary thyroid cancers with ultrasound instead of operating, because most never grow and almost none cause harm.
• ADC payload neutralisers: An ADC payload neutraliser is an antibody given alongside an ADC that mops up the poison once it leaks into the bloodstream, so the ADC can hit the tumour with fewer side effects.
• Antiemetics for chemotherapy-induced nausea and vomiting: The drugs that stopped chemotherapy from meaning days of vomiting: 5-HT3 blockers (ondansetron, palonosetron), NK1 blockers (aprepitant), dexamethasone and olanzapine, given by the emetic risk of each regimen.
• Biliary stenting and drainage: A small tube placed by endoscope or through the skin reopens a blocked bile duct, relieving jaundice so chemotherapy can be given.
• Bone-modifying agents (bisphosphonates, denosumab): Zoledronic acid and denosumab reduce fractures, spinal cord compression and bone pain from bone metastases and myeloma, prevent treatment-induced bone loss, and in postmenopausal breast cancer modestly reduce recurrence in bone.
• Cachexia pharmacotherapy: GDF-15 blockade, anamorelin, olanzapine: Cachexia pharmacotherapy covers three drug approaches to cancer wasting: a new antibody that blocks the hormone suppressing appetite, an appetite hormone mimic approved only in Japan, and a very cheap old tablet. None is yet standard everywhere; all beat what came before.
• Cachexia-directed therapy (GDF-15 blockade): Treating the wasting that kills many cancer patients, by blocking the hormone that suppresses appetite.
• Cancer neuroscience: cutting the nerve supply: Tumours recruit nerves and use nerve signals to grow. Blocking that traffic, with beta-blockers or botulinum toxin, is being tested.
• Cancer pain management: Systematic treatment of cancer pain with opioids, adjuvant drugs, radiation and procedures such as nerve blocks and intrathecal pumps. Most pain can be controlled, yet under-treatment remains common, especially where opioids are unavailable.
• Cancer-associated thrombosis prevention and treatment: Blood clots are the second commonest cause of death in people with cancer. Risk scores identify who should take preventive blood thinners during chemotherapy, and direct oral anticoagulants have largely replaced injections for treatment.

• CHALLENGE (CCTG CO.21) (phase 3, n=889): Disease-free survival at 5 years: 80.3% vs 73.9%, HR 0.72
• ROMANA 1 and ROMANA 2 (phase 3, n=979): Change in lean body mass over 12 weeks (ROMANA 1): 0.99 kg vs -0.47 kg
• PREHAB: multimodal prehabilitation before colorectal cancer surgery (phase 3, n=251): Fewer severe complications and faster recovery with prehabilitation; surgery not delayed.
• Low-dose olanzapine for cancer anorexia (Tata Memorial) (phase 3, n=124): Weight gain greater than 5% at 12 weeks: 60% vs 9%
• Ponsegromab phase 2 in cancer cachexia (phase 2, n=187): Change in body weight at 12 weeks (placebo-adjusted): 2.81 kg vs 1.92 kg vs 1.22 kg vs 0 kg
• BWEL (Breast Cancer Weight Loss, Alliance A011401) (phase 3, n=3,181): Weight loss achieved; primary iDFS endpoint not met at first analysis (presented 2025; publication pending, verify).

1. What is exercise oncology and is there real evidence?
   Answer

   Structured exercise during and after treatment; the CHALLENGE trial (2025) randomised colon cancer survivors and showed improved disease-free and overall survival, the first level-1 evidence, plus less fatigue and neuropathy.
2. Does scalp cooling prevent hair loss from chemotherapy?
   Answer

   Partly: roughly half of patients on taxane-based regimens keep at least 50% of their hair with DigniCap or Paxman; it is less effective with anthracyclines and reimbursement varies.