Clinical Problems in Oncology

A Practical Guide to Management

Sing Yu Moorcraft, Daniel Lee, David D. Cunningham

• Publisher: Wiley-Blackwell
• Year: 2014
• Print ISBN: 9781118673829
• eBook ISBN: 9781118673812
• Edition: 1
• Topic: Medicine
• Subtopic: Oncology

Clinical Problems in Oncology: A Practical Guide to Management is an easy-to-use, compact
reference with essential, practical information on managing oncological emergencies, as well as
the side effects and complications of cancer and its treatment. Because patient responses can vary
widely, depending on the type of treatment prescribed, this resource offers medical professionals
the specific information they need to improve the evaluation and treatment of cancer patients at
the point of care.

The compact format includes a wide range of clinical information, from the dose of drugs that would
typically be used, through guidance on the practical procedures that are frequently used
to treat oncology patients. Some of the book's highlights include:

• Toxicity grading and management, including at-a-glance summaries of the most common toxicities associated with chemotherapy
• Prescribing guidelines, including how to write up electrolyte replacement properly
• Information on specialised oncology procedures (such as SIR spheres), and how to manage complications
• Types of vascular access lines and how to check their position, access them and troubleshoot problems With an expert team of writers who have contributed materials in their areas of expertise, Clinical
Problems in Oncology is an ideal reference for oncologists in training, oncologists in non-training
positions, oncology registrars and general practitioners.

Chapter 1
Introduction to clinical problems in oncology

Sing Yu Moorcraft

The Royal Marsden NHS Foundation Trust, UK

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CHAPTER MENU

1. General approach to the management of oncology patients
2. Performance status
3. Tumour markers

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Cancer is currently a major healthcare problem. For example, in the UK, approximately 33% of the population will develop some form of cancer during their lifetime. A person's risk of developing cancer is dependent on age and therefore the importance of oncology is likely to grow even further in the coming decades as the average age of the population increases. Oncology is one of the fastest developing specialities in medicine, with increasingly complex treatments entering daily practice and a significant number of patients in clinical trials. In the UK, the specialty is comprised of clinical oncology and medical oncology. The main difference is that clinical oncologists deliver radiotherapy, while medical oncologists do not and have historically been more heavily involved in drug research and clinical trials.

Patients may present to their oncology team, local hospital, A&E or GP with symptoms due to their cancer (e.g. pain), secondary complications (e.g. bowel obstruction) or side effects from their treatment. This book aims to provide practical guidance on how to manage the most commonly occurring problems experienced by oncology patients. However, this book is not designed to replace local or national guidelines and patients who require admission to hospital should be discussed with their oncology team or the acute oncology team in accordance with local procedures.

General approach to the management of oncology patients

Types of treatment

Oncology treatments can be local or systemic. Local treatments include surgery and radiotherapy. Systemic treatments include chemotherapy, endocrine treatments, immunotherapy and targeted therapies (e.g. monoclonal antibodies or small molecules which target specific receptors or cell signalling pathways).

This book provides guidance on the management of toxicities associated with oncology treatment. It is important to consider the aims of treatment when deciding on the most appropriate management strategy. The aims of treatment can be:

• Curative: treatment given as the definitive treatment for cure.
• Radical: usually refers to chemotherapy or chemoradiotherapy given with curative intent.
• Neoadjuvant: treatment given before a definitive treatment with the aim to facilitate the procedure and/or improve the chances of curing the patient.
• Adjuvant: treatment given after a definitive treatment, with the aim to reduce the risk of recurrence (and therefore increase the chances of curing the patient) by destroying micrometastatic disease.
• Palliative: the aims of treatment are to improve patients’ symptoms and quality of life. The treatment may (but not necessarily) prolong the patient’s life and will not cure the patient.

The management of toxicities should be discussed with the patient’s oncology team, but in general, if a patient is receiving treatment with curative intent, it is important to try to minimise dose delays and reductions, whenever possible, to maintain treatment efficacy. However, in patients receiving palliative treatment, quality of life is the most important consideration.

Tumour types and extent of disease

In oncology, treatment decisions are often heavily influenced by both the type and extent of a patient’s tumour. This involves grading and staging their disease.

• Grading: the grade of a tumour gives an indication of how well differentiated a tumour is. This often reflect...

Table of contents

• Cover
• Title page
• Copyright page
• List of contributors
• Preface
• Acknowledgements
• List of abbreviations
• Chapter 1: Introduction to clinical problems in oncology
• Chapter 2: Oncological emergencies
• Chapter 3: Side effects and complications of cancer and its treatment
• Chapter 4: Introduction to radiotherapy
• Chapter 5: Radiotherapy side effects andtheir management
• Chapter 6: Endocrine therapy, immunotherapy and targeted therapies
• Chapter 7: Electrolyte abnormalities
• Chapter 8: Palliative care and pain management
• Chapter 9: Oncology procedures and their complications
• Chapter 10: Cancer drug development and funding
• Appendices
• Supplemental Images
• Index
• End User License Agreement