When first-line therapy is indicated for patients with HER2-positive GEA. supportive care is considered throughout the entire treatment process and not just for side effects from cancer therapyCancer and its treatment can have many physical, emotional, psychological, social and financial impacts for patients, families and friends. The focus of supportive care is to prevent or reduce symptoms and treatment side effects. Supportive care can also help patients to deal with and come to terms with the cancer and its effects on their eating and nutrition. Strong supportive care should complement cancer treatment and be ongoing throughout the cancer patient’s care.
When first-line therapy is indicated for patients with HER2-positive GEA (such as those with advanced or metastatic disease), therapy can be with HER2-targeted therapy, in combination with chemotherapy, and/or immunotherapy when appropriate. Thus, it is crucial that supportive care is considered throughout the entire treatment process and not just for side effects from cancer therapy. Treatment of the underlying cancer and related symptoms are an integral part of the overall treatment plan for any patient with GEA.
Understanding the Role of Supportive Care
Supportive care is provided throughout a cancer patient’s treatment. It aims to stop or reduce symptoms and side effects from treatment and to deal with nutritional and psychological problems that cancer and its treatment can cause. It is supplementary to the cancer treatment so that when circumstances change, the supportive care can be altered accordingly.
Symptoms such as fatigue, nausea, loss of appetite, difficulty swallowing and other digestive symptoms all affect patients with cancer in different ways and can have an impact on eating as well as energy levels for cancer itself and treatment. Early identification and assessment by the oncology team may help address symptoms that affect daily activities.
Disclose to oncologists any current health problems, current medications (including vitamins and supplements), any allergies and any previous treatments have received. This helps oncologists to assess any potential problems and to plan any monitoring or additional support may require.
Managing Treatment-Related Side Effects
Side effects caused by cancer treatment for HER2 positive GEA can vary based on the type of treatment as well as the combination of different treatments. There are side effects caused by chemotherapy and possible side effects of HER2 targeted therapies. For example, some of the HER2 targeted therapies can affect heart function.
Informing patients of symptoms that can be managed at home and those that require prompt medical assessment is crucial. While some symptoms such as persistent vomiting, diarrhea, or weakness can be managed with home care and monitoring for signs of dehydration (e.g., decreased urine output), patients must report to cancer treatment centers immediately with severe symptoms such as difficulty breathing or severe chest pain.
Preventative medicines, monitoring of patients and their disease and regular follow-up by healthcare professionals can help identify and manage treatment-related complications. Patients should be reminded not to stop taking their cancer medicines or change their treatment schedule without consulting their oncologist first.
Supporting Nutrition and Hydration
Nutrition for individuals with a gastroesophageal cancer diagnosis and treating with HER2 targeted therapy can be challenging. Many symptoms of cancer and its treatment can affect patients’ appetites and the way they feel about eating. Swallowing discomfort, nausea, early satiety or feeling full too quickly after eating and loss of appetite are symptoms that can make eating more challenging.
Regular assessments with a healthcare professional or an oncology dietitian can identify foods that patients with gastroesophageal cancer are able to eat. Nutritional recommendations should be individualized by a healthcare professional or oncology dietitian.
Ensuring Hydration: Follow fluid recommendations from healthcare team. Let healthcare team know right away about signs of dehydration (such as getting more dehydrated).
Also important is monitoring of weight loss and discussion of the patient’s food intake. Patients with cancer of gastroesophageal who are losing weight unintentionally may benefit from being placed on nutritional supplements. However, the patient must discuss the possible interactions of the cancer drugs with alternative or herbal products and vitamins with their healthcare team prior to using them.
Maintaining Physical Strength and Energy
Fatigue (feeling tiredness) is caused by cancer, and its treatment can also affect concentration, travel, work, and even relationships with family and friends. Fatigue is often caused by a combination of factors including the size and spread of cancer, the treatment given, anemia, poor appetite and weight loss, lack of nutrients, sleep disturbance, and presence of other medical conditions.
Fatigue and Activities – Energy and participation
Balance rest with activity. Gentle walk, stretching or other activities recommended by healthcare professionals. Patients should be encouraged to plan and manage their daily activities and seek help when needed to complete tasks.
The patient should be encouraged to plan activities to have sufficient rest. Patients should priorities activities, break long tasks into smaller ones and try to obtain help with tasks such as traveling or household work as needed. Management approaches for fatigue may be available depending on the underlying cause. First find out whether fatigue is caused by anemia, by cancer, by the treatment, by diet, by sleep or by some other disease. Then we can start to treat it.
Addressing Emotional and Psychological Well-Being
Many patients living with advanced cancer have concerns about their treatment and its potential results. They worry about caring for family members, the financial burden of their illness, and what the future holds for them. In many cases, this fear can cause patients to experience anxiety or sadness, leading to feelings of frustration. Some patients may even have trouble sleeping.
The patient should have the opportunity to express their fears and concerns about their illness, without worrying that they are not being “positive enough.” Family members and loved ones can be a great source of support for the person with cancer, especially in helping with daily tasks and showing that they care about the person without try to manage them.
Support from a psychologist, counselor, social worker or even a Cancer Support Group can also be very beneficial in teaching people to cope with their emotional and practical circumstances.
Support the patient’s caregiver too. It can be hard to find the energy to support another person. Give them time to rest and encourage others in the family to get involved too, so that no one person feels they are carrying the load.
Coordinating Monitoring and Follow-Up Care
Follow-up evaluations with the patient’s and/or their family’s oncology team are scheduled on a regular basis to assess the degree to which the cancer is responding to treatment as well as to manage any treatment-related side effects. The team will evaluate whether the current treatment strategy is still appropriate as well as make any recommendations for changes as indicated by the patient’s clinical course and findings.
Be prepared to inform the doctor about any changes in condition or symptoms between visits. Record all of medication as well as any changes. Use a list to organize and prioritize questions. For patients on First-Line HER2+ GEA treatment supportive care needs to be embedded within overall treatment plan and tailored accordingly by healthcare professionals.
Building a Patient-Centered Care Plan
Supportive care is given in conjunction with treatment and is provided by a range of people including patients, their families, other caregivers, and health professionals, including oncologists, nurses, dietitians and a wide range of other support personnel.
Everyone is different and, therefore, the supportive measures that are of value to the patient will vary depending on his/her individual situation. By ensuring on an ongoing basis that the patient and his/her family are well-informed and have the requisite support, the patient can make informed decisions with respect to his/her treatment and strive to attain the best possible quality of life while on treatment for his/her cancer.
Disclaimer: The information provided in this article is intended for educational purposes only and should not be interpreted as medical advice, a clinical guideline, or a recommendation for any specific treatment.