Teaching pack: Supportive Care & Survivorship

Supportive care and survivorship covers everything that keeps a patient well enough to receive treatment and well afterwards: anti-emetics, growth factors, scalp cooling, cardio-oncology, fertility preservation, geriatric assessment, palliative integration, exercise oncology, financial toxicity mitigation and survivorship monitoring, an area under-studied relative to its impact. It also houses the complementary approaches people ask about, from acupuncture, CBT for fatigue and music therapy to ginger, curcumin, melatonin, medicinal mushrooms, homeopathy and the so-called herbal cancer cures. Scalp cooling, cardio-oncology, exercise oncology, geriatric assessment, head and neck and thyroid cancer, and companies such as Cancer Commons link here.

• A changed face and voice: body image after head and neck cancer treatment: Head and neck cancer treatment changes the part of the body a person cannot cover, and the functions, speech and eating, that social life is built on. There is no pooled prevalence figure for body image distress in this group: the first systematic review of the factors behind it was still a published protocol in 2025, which makes this the clearest measurement gap in this part of the corpus.
• Active surveillance of papillary microcarcinoma: Active surveillance watches papillary thyroid cancers of 1 cm or less with ultrasound every 6 to 12 months instead of operating, because about 90% stay stable over a decade and delayed surgery works as well when needed. It is not suitable for tumours next to the windpipe or the voice nerve, and uptake outside Japan and Korea is still low.
• Acupuncture and acupressure for chemotherapy nausea: Stimulating the P6 point on the inner wrist, with needles, electrical stimulation or a pressure band, adds a small further reduction in chemotherapy vomiting on top of modern anti-sickness drugs. It is safe and cheap, and guidelines say it can be offered.
• Acupuncture for aromatase-inhibitor joint pain: Joint pain and stiffness are the main reason women stop aromatase-inhibitor tablets early. In a large randomised trial, twelve weeks of acupuncture reduced that pain more than sham needling or no treatment, and the benefit lasted after the sessions ended.
• Acupuncture for chemotherapy-induced neuropathy: Numb, tingling or painful hands and feet after taxanes, platinum or bortezomib have no proven preventive treatment. Small trials suggest acupuncture may ease the symptoms, but they are too small and inconsistent to be sure, so it is an option to try inside a trial or with careful tracking rather than an established treatment.
• Acupuncture for dry mouth after head and neck radiotherapy: Radiotherapy to the head and neck can permanently dry the mouth. A randomised trial in the United States and China found that acupuncture given during radiotherapy reduced dry mouth a year later compared with standard care, an effect that needs confirming.
• Acupuncture for hot flushes on endocrine therapy: Hot flushes on tamoxifen or aromatase inhibitors are common and hormone replacement is off the table. Acupuncture reduced flushes in several randomised trials, in one about as well as the drug gabapentin and with fewer side effects, though sham-controlled results are mixed.
• 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.
• Adolescents and young adults: a group with its own cancers, its own gap and its own needs: People diagnosed between 15 and 39 get different cancers from children and from older adults, and for years their survival improved more slowly than either. Since 2000 that has changed: five-year survival gains for this group have paralleled those of childhood cancers. The obstacles that remain are trial enrolment, access and insurance, and support that fits the age.
• After a transplant or cell therapy: what to ask for: The things worth asking a transplant team for, in one place: who follows you up and for how long, which screens are due at which year, what immunisations you need and when, and who to ring when something changes.

• Remestemcel-L (approved): Donor bone marrow stromal cells given to children whose acute graft-versus-host disease no longer responds to steroids, the first mesenchymal stromal cell therapy approved in the United States.
• Eltrombopag (established): Eltrombopag is a daily tablet that raises platelet counts by stimulating the bone marrow; it is approved for immune thrombocytopenia and severe aplastic anaemia, and haematologists also use it when low platelets complicate blood cancers and their treatment.
• Emapalumab (established): Emapalumab switches off interferon gamma, the signal behind the runaway immune activation of haemophagocytic lymphohistiocytosis (HLH), a condition that can also be triggered by lymphoma and by CAR-T therapy.
• Fostamatinib (established): Fostamatinib is a tablet that blocks the enzyme SYK so the spleen stops destroying antibody-coated platelets; it is approved for chronic immune thrombocytopenia and was first trialled as a lymphoma drug.
• Propranolol (Hemangeol) (established): Hemangeol is a liquid form of the blood-pressure drug propranolol approved to shrink infantile haemangiomas, the common benign blood-vessel tumours of babies, replacing steroids and surgery for most children who need treatment.
• Ravulizumab (established): Ravulizumab is an eight-weekly infusion that blocks the complement system; it treats paroxysmal nocturnal haemoglobinuria, a clonal bone marrow disorder managed by haematologists alongside aplastic anaemia and myelodysplasia.
• Romiplostim (established): Romiplostim is a weekly injection that tells the bone marrow to make more platelets; it is approved for immune thrombocytopenia and for radiation injury, and is being tested for the low platelets that chemotherapy causes.

• Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question · One operation, and still the only cure (historic)
• Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question · A blood marker with a blind spot and an oncogene in nearly every tumour (historic)
• Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question · Gemcitabine, and chemotherapy after surgery (historic)
• Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question · Combination chemotherapy for metastatic disease (historic)
• Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question · Genomes, subtypes and the inherited five percent (historic)
• Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question · Adjuvant modified FOLFIRINOX, and the neoadjuvant question (current)
• Recovery and rejuvenation roadmap: cure is not enough → survivorship gets a name → the cohorts that measured the cost → exercise proven as treatment → biological ageing measured and sold → repair, if anyone funds it · Cure arrives, and the bill with it (historic)
• Recovery and rejuvenation roadmap: cure is not enough → survivorship gets a name → the cohorts that measured the cost → exercise proven as treatment → biological ageing measured and sold → repair, if anyone funds it · Survivorship gets a name, a definition and an office (historic)
• Recovery and rejuvenation roadmap: cure is not enough → survivorship gets a name → the cohorts that measured the cost → exercise proven as treatment → biological ageing measured and sold → repair, if anyone funds it · The cohorts that measured the cost (historic)
• Recovery and rejuvenation roadmap: cure is not enough → survivorship gets a name → the cohorts that measured the cost → exercise proven as treatment → biological ageing measured and sold → repair, if anyone funds it · The care plan, and the trials that deflated it (historic)
• Recovery and rejuvenation roadmap: cure is not enough → survivorship gets a name → the cohorts that measured the cost → exercise proven as treatment → biological ageing measured and sold → repair, if anyone funds it · Exercise becomes a treatment (current)
• Recovery and rejuvenation roadmap: cure is not enough → survivorship gets a name → the cohorts that measured the cost → exercise proven as treatment → biological ageing measured and sold → repair, if anyone funds it · Biological ageing becomes measurable, and sellable (current)
• Supportive care and survivorship roadmap: making treatment bearable → proving it extends life → caring for tens of millions afterwards · Making chemotherapy deliverable (historic)
• Supportive care and survivorship roadmap: making treatment bearable → proving it extends life → caring for tens of millions afterwards · Counting the cost of cure (historic)
• Supportive care and survivorship roadmap: making treatment bearable → proving it extends life → caring for tens of millions afterwards · Supportive care that lengthens life (current)
• Supportive care and survivorship roadmap: making treatment bearable → proving it extends life → caring for tens of millions afterwards · Cheap fixes with strong evidence (current)
• Supportive care and survivorship roadmap: making treatment bearable → proving it extends life → caring for tens of millions afterwards · Cachexia gets a drug (emerging)
• Supportive care and survivorship roadmap: making treatment bearable → proving it extends life → caring for tens of millions afterwards · Survivorship as a system, not a leaflet (emerging)

• Study 3 (rolapitant, moderately emetogenic chemotherapy) (phase 3, n=1,369): Complete response in the delayed phase (no emesis and no rescue medication, more than 24 to 120 hours), cycle 1: 71% vs 62%
• XM22-03 (phase 3, n=202): Duration of severe neutropenia in cycle 1: 0.7 days vs 0.8 days
• MNTX 302 (phase 3, n=133): Laxation within 4 hours of the first dose: 48% vs 15%
• XM01-22 (phase 3, n=186): Complete haemoglobin response (increase of at least 2 g/dL without transfusion in the previous 4 weeks): 72.6% vs 25.3%
• CHALLENGE (CCTG CO.21) (phase 3, n=889): Disease-free survival at 5 years: 80.3% vs 73.9%, HR 0.72
• TRANSCEND (phase 3, n=120): Mean percent change in body-mass index at 52 weeks after dose escalation (pivotal cohort): -16.5% vs 3.3%

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.

• NCI: Side effects of cancer treatment: https://www.cancer.gov/about-cancer/treatment/side-effects
• NCI: Survivorship: https://www.cancer.gov/about-cancer/coping/survivorship