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It is recommended that a multi-disciplinary team should manage patients with Lymphedema. Options of care include external compression, massage, elevation, exercise, psychosocial support, prompt treatment of infection and avoidance of factors which may aggravate it.Sterility, infertility and teratogenicityPrior to any planning for cancer treatment, a care team is strongly advised to discuss with the patient, with or without the family, the effects of the treatment of fertility, potential for sterility and teratogenicity. Options for sperm banking, ovarian relocation, and embryo preservation should be discussed.Oral: Xerostomia and painPatient should maintain a clean and well-hydrated mouth, avoiding any foods such as acidic citrus fruits and juices, hot and spicy products and rough-textured foods, if these cause discomfort. Both topical and systemic analgesics should be used for pain and oral antiseptics gargles for infections.Patient support groupsFormation of patient support groups should be encouraged. This forms an integral part of survivorship care. Spiritual and psychosocial counseling (see Chapter 40).
National Guidelines for Cancer Management Kenya218Blood and Blood Products TransfusionThis is indicated in patients with anaemia or thrombocytopaenia and other disorders of coagulation and haemostasis. In patients presenting with low haemoglobin and associated symptoms, it is recommended that blood and blood products transfusion is undertaken, appropriately guided by the clinical scenario. These include Hb<10gm/dl prior to chemotherapy or radiotherapy and symptomatic anaemias. Also, erythropoietin and parenteral iron replacement may be used as needed.Skin care: Wounds and radiation skin reactionsWound management should be structured around three core principles: treatment of the underlying tumour and management of co-morbid conditions; symptom management; and local wound management.Radiation skin reactions are a common side effect of radical radiotherapy. Reactions are evident one to four weeks after beginning treatment and can persist for several weeks post treatment. Patients should maintain good skin hygiene, applying aqueous cream and cytoprotective agent e.g. amifostine.RehabilitationRehabilitation should be considered and addressed prior to any cancer management plan. These include physiotherapy, speech and occupational therapy.Stoma careNurses or health care professionals trained in stoma care should be charged with assisting patients with management of stomas.Thrombo-embolism managementThe risk of thrombosis exists in cancer patients and should be taken into consideration. Prompt referral to a facility that can initiate immediate anticoagulation is key to the survival of patients with thrombosis.
National Guidelines for Cancer Management Kenya21942. Palliative Care Ali Z, Maara M, Njuguna E, Munyoro E, Makumi D , Mwangura F, Kumar V.