Supportive Care   

There was a recall on viscous lidocaine and many of our patients cannot find it. What would you recommend as alternatives?

How does this strategy change depending on the acuity or chronicity of the symptoms?

After the randomized Phase IIb showed decreased mucositis, are you incorporating this agent?  Please share your regimen and any tips. 

For instance, carboplatin/etoposide in extensive-stage SCLC

How can these interactions be improved? 

Are there any protocols in place? Aside from telling patients to use ice packs or bags or immerse hands/feet in ice water baths from 15" before to 15"...

If so, do you use it for all patients or only cisplatin doses >= 70 mg/m2? What dose of mannitol do you use?

Do you prophylactically start all patients on B12, B-complex, and/or omega-3? If so, what dose? What about ice mittens and booties?

If you do not use prophylaxis, what skin care strategy do you employ?

In patients who continue to have insomnia despite diphenhydramine, benzos, and trazodone, are there other evidence based treatments that are helpful?

Do you routinely check IgG levels during therapy, if not indicated by a study protocol?

Do you routinely recommend any dietary changes or is the evidence not convincing?

Are there other supportive care interventions that would otherwise be covered by hospice?

If yes, by what mechanism? 

If a patient has a large femoral metastasis that cannot be resected, but is to be stabilized with ORIF which will push tumor into the distal end of th...

Do you discuss patient visits and associated costs when making this decision?

Are there any effective non-pharm or pharm interventions?

What non-pharmacological interventions do you recommend? Do you routinely prescribe prophylactic laxatives to patients initiating opioids? How do you ...

Would you recommend the patient stop testosterone upon this new diagnosis? If the patient is not amenable to stopping, would you incorporate an AI in ...

If you do test, do you have a preferred testing method?

If so, do you avoid pegfilgrastim given that <12 days will lapse between its administration and the next cycle?

This includes handling saliva, vomit, sweat, vaginal secretions, semen, urine, and stool. Are there recommendations for intimacy, sex, laundry, and&nb...

Is there concern for impaired healing? Do you pause therapy and for how long?

Do you prescribe creams (e.g., urea) to prevent HFS, or is their use generally more reactive? 

After optimizing symptoms and reversible factors, and attempting cognitive-behavioral interventions and exercise, do you recommend pharmacologic agent...

What steroid-sparing strategies do you use?

What advice do you give regarding dietary practices, feeding tubes / parenteral nutrition, and pharmacotherapy specifically for cachexia?

Can it be prevented? How do you evaluate patients? What non-pharmacologic or pharmacologic interventions do you use for treatment?

There are conflicting reports of increased incidence of bleomycin-induced lung toxicity with G-CSF.

Obviously, patient and caregiver preferences are paramount. But, what factors do you consider? Does expanded hospice (e.g., Medicare Care Choices) inf...

What factors other than the Khorana score influence your decision regarding prophylactic anticoagulation in these patients? If prescribing an agent, w...

Is there specific workup you perform? Are there preventive measures? Once established, are there non-pharmacological and pharmacological treatments yo...

Is dental evaluation indicated for edentulous patients?

How would you manage symptoms? How would you adjust the adjuvant regimen (dose reduce, omit paclitaxel etc)? What strategies would you consider for pr...

e.g., subungual hemorrhage and onycholysis?

i.e. doxorubicin, ifosfamide + RT. Do you worry about decreased locoregional control or increased toxicities with the use of G-CSF in combination with...

In addition to gabapentin and Lyrica, what else can you do for chemotherapy induced neuropathy?

If yes, what dosage and do you use it continuously or intermittently? Regarding provera, many patients with ER/PR (+) breast cancer worry about taking...

What is your treatment algorithm?

Many women are distressed when asked to discontinue hormone replacement therapy or use intravaginal estrogen suppositories.

We often counsel patients that they shouldn't take very high doses of antioxidants but taking a daily multivitamin with antioxidants is OK. Do you thi...