It is recommended that a multi disciplinary team

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 teratogenicity
Prior to any planning for cancer treatment, a care team is strongly advised to discuss
with the patient, with or without the family, the e ff ects 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 pain
Patient 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 groups
Formation of patient support groups should be encouraged. This forms an integral part of
survivorship care.
Spiritual and psychosocial counseling (see Chapter 40).

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Blood and Blood Products Transfusion
This 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 reactions
Wound 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 e ff ect 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.
Rehabilitation
Rehabilitation should be considered and addressed prior to any cancer management plan.
These include physiotherapy, speech and occupational therapy.
Stoma care
Nurses or health care professionals trained in stoma care should be charged with assisting
patients with management of stomas.
Thrombo-embolism management
The 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.

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42. Palliative Care
Ali Z, Maara M, Njuguna E, Munyoro E, Makumi D , Mwangura F, Kumar V.