Objectives
  • To be able to understand, evaluate and provide supportive care to patients with cancer, including management of symptoms from the cancer and side effects of therapy from the time of diagnosis until death or until rehabilitation and survivorship issues have been successfully managed

  • To know the indications for the different supportive treatments and their limitations and side effects

  • To be aware of the importance of a multidisciplinary approach

Awareness
  • Appreciation of common symptoms of malignant disease

  • Appreciation of the pathophysiology of symptoms of malignant disease

  • Awareness of common side effects of antineoplastic therapies

  • Appreciation of the prevention and management of side effects of antineoplastic therapies

  • Recognition of the need for multidisciplinary approach to supportive care

  • Awareness of evidence-based supportive care guidelines—usage and limitations

  • Awareness of agents used in the management of symptoms associated with the treatment of malignant disease

KnowledgeHaematological disease-related complications and toxicity
Infections and neutropenia
  • Understanding of treatment-related and patient risk factors for neutropenia and infections

  • Understanding of the use of appropriate and timely antibiotics in neutropenic patients

  • Understanding of the use of growth factor support

  • Understanding of the evaluation, prophylaxis and treatment of febrile neutropenia in different patient populations

Anaemia and thrombocytopenia
  • Understanding of the causes of anaemia and evaluation

  • Understanding of the role for transfusion support (red cell and platelets)

  • Understanding of the indications for growth factor support

  • Understanding of the toxicities of blood transfusions and growth factor support

Thrombosis/Thromboembolism
  • Understanding of the pathophysiology of cancer-induced thrombosis/thromboembolism

  • Understanding of the prophylaxis and management of thrombosis/thromboembolism

Lymphoedema
  • Understanding of the pathophysiology of cancer-induced and treatment-induced lymphoedema

  • Understanding of the prophylaxis and management of lymphoedema

Cardiovascular disease-related complications and toxicity
Cardiac toxicity
  • Understanding of the cardiac toxicities of antineoplastic therapies:

    • Chemotherapeutic agents—dose restrictions

    • Targeted agents

  • Knowledge of appropriate cardiac supportive treatment

Pericardial effusion (see Respiratory disease-related complications and toxicity)
Superior/inferior vena cava syndrome
  • Understanding of the diagnosis and treatment of superior/inferior vena cava syndrome

Respiratory disease-related complications and toxicity
Pulmonary toxicity
  • Understanding of pulmonary toxicities of antineoplastic therapies:

    • Chemotherapeutic agents―dose restrictions

    • Targeted agents

Malignant effusions
  • Understanding of the pathophysiology of malignant pericardial and pleural effusions and of ascites

  • Understanding of the management of malignant pericardial and pleural effusions and of ascites

  • Knowledge of appropriate respiratory supportive treatment

Gastrointestinal disease-related complications and toxicity
Nausea and vomiting
  • Understanding of the pathophysiology of nausea and vomiting:

    • Acute, delayed and anticipatory nausea and vomiting from chemotherapy

    • Radiotherapy-induced nausea and vomiting

    • Nausea and vomiting from combined radio-chemotherapy

    • Nausea and vomiting not induced by cancer therapy but tumour-related with bowel obstruction, brain metastases, electrolyte disturbances

  • Understanding of the mechanisms of action of antiemetic therapies

  • Understanding of the emetogenic potential of antineoplastic therapies and patient-related risk factors

  • Knowledge of appropriate antiemetic therapy prophylaxis based on treatment regimen

Oral
  • Understanding of the pathophysiology diagnosis and management of:

    • Dental problems

    • Hyposalivation

    • Xerostomia

    • Mucositis (oral and gastrointestinal)

  • Understanding of common causes of mucositis

  • Understanding of the prevention and treatment of mucositis

  • Understanding of osteonecrosis of jaw

Liver
  • Understanding of liver toxicities of antineoplastic agents

Constipation
  • Understanding of constipation induced by antineoplastic/supportive agents

  • Understanding of tumour-induced constipation

  • Understanding of the prevention and treatment of constipation

Diarrhoea
  • Understanding of the pathophysiology, diagnosis and management of:

    • Diarrhoea induced by chemotherapy

    • Diarrhoea induced by targeted agents, including immune therapy

    • Diarrhoea induced by radiation therapy

    • Tumour-induced diarrhoea

  • Understanding of the prevention and treatment of diarrhoea

Ascites (see Respiratory disease-related complications and toxicity)
Fistula
  • Understanding of the symptomatology and management of tumour-associated fistulas

Nutritional support
  • Understanding of the role for use of nutritional support

  • Understanding of the limitations and toxicities of nutritional support

  • Knowledge when nutritional support should be withheld or withdrawn

Urological disease-related complications and toxicity
  • Understanding of the pathophysiology and management of:

    • Renal toxicities of antineoplastic agents

    • Ureteric obstruction

    • Incontinence

    • Haematuria

    • Urethral obstruction

    • Vesicovaginal and vesicoenteric fistulas

Gynaecological disease-related complications and toxicity
  • Understanding of the pathophysiology and management of:

    • Lymphoedema (see Lymphoedema complications and toxicity)

    • Malignant intestinal obstruction

    • Vaginal bleeding

    • Fistulas (see Gastrointestinal and urological disease-related complications and toxicity)

    • Sexual dysfunction

Neurological disease-related complications and toxicity
Central nervous system symptoms
  • Headache, seizures, encephalopathy, cognitive impairment due to cancer or therapy

Peripheral neuropathy
  • Understanding of common therapies that cause peripheral neuropathy

  • Understanding of the evaluation of peripheral neuropathy

  • Understanding of the treatments for peripheral neuropathy

Eye symptoms and toxicity
  • Eye symptoms such as cataract, glaucoma and blepharitis induced by chemotherapy, targeted agents and immunotherapy

Reproductive disease-related complications and toxicity
Hormonal effects
  • Understanding of menopausal symptoms from cancer therapies

  • Understanding of the management of menopausal symptoms

  • Understanding of the long-term effects of induced hypogonadism in males and females

Fertility preservation
  • Understanding of the causes of infertility related to antineoplastic therapies

  • Understanding of prevention and preservation strategies

Sexuality
  • Understanding of sexual complications from antineoplastic therapies

Skin disease-related complications and toxicity
  • Skin toxicity induced by:

    • Chemotherapy

    • Targeted agents

    • Immunotherapy

  • Understanding of the prevention and treatment of skin toxicity

Extravasation
  • Knowledge of common vesicant chemotherapeutic agents

  • Understanding of strategies for prevention of extravasation

  • Understanding of the treatment of acute extravasation

Alopecia
  • Knowledge of common chemotherapeutic agents causing hair loss

  • Knowledge of indications for scalp cooling as a preventive tool for alopecia

Endocrine and metabolic disease-related complications and toxicity
  • Understanding of the pathophysiology, symptomatology and management of:

    • Hypopituitarism

    • Hypothyroidism, eg, induced by targeted therapy

    • Adrenal insufficiency

    • Tumour lysis syndrome (oncological emergencies)

    • Electrolyte disturbances, eg, hypomagnesaemia, hypercalcaemia

    • Tumour-related fever

Bone disease-related complications and toxicity
  • Knowledge of skeletal complications of cancer therapies

  • Understanding of the mechanism of action of bone-active agents

  • Understanding of preventive and treatment strategies for skeletal complications

Supportive care in the special subpopulation of geriatric patients
  • Knowledge how to evaluate the elderly patient as part of a multidisciplinary team

  • Understanding of comorbidity and polypharmacy in the elderly patient

  • Knowledge how to manage complications and toxicity of particular high risk in elderly patients, eg, neutropenia, osteoporosis, undernutrition

Oncological emergencies
  • Knowledge of common oncological emergencies

  • Knowledge how to evaluate and treat oncological emergencies

Paraneoplastic syndromes
  • Understanding of the common paraneoplastic syndromes

Education (see section 8. Patient education)
Fatigue (see chapter 4.4.2 Palliative care)
Psychosocial aspects (see section 5. Psychosocial aspects of cancer)
Pain (see chapter 4.4.2 Palliative care)
Skills
  • Ability to provide supportive care measures to manage successfully all cancer-related symptoms of any tumour entity

  • Ability to counsel patients on side effects of therapy:

    • Sexual

    • Hormonal

    • Fertility

    • Nausea

    • Cardiac

    • Renal

  • Ability to provide preventive and treatment strategies for common side effects of therapy

  • Ability to manage oncological emergencies