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Rehabilitation, Palliative Care, and Integrative Medicine Interventions in Cancer

Rehabilitation Interventions in Patients With Cancer Introduction For patients with a broad range of serious life-threatening illness, loss of function and independence is a common struggle and a significant contributor to diminished quality of life. Among the factors that can contribute to loss of function are prolonged hospitalization, deconditioning, pain, fatigue, depression, malnutrition, organ failure, neurologic injury, and musculoskeletal problems. Patients with cancer can additionally experience…

Chronic and Interventional Pain Management in Patients With Cancer

Introduction Pain is one of the most common symptoms reported in cancer patients. This pain can be nociceptive (somatic or visceral) or neuropathic, or a combination of these. Chronic pain can arise secondary to the tumor burden itself or to cancer-related treatments, comprising radiation or chemotherapy that lead to radiation fibrosis and peripheral nerve damage, respectively. , This chapter will discuss the evaluation of patients with…

Acute Postsurgical Pain Management in Patients with Cancer

Introduction Postoperative pain management is an integral component of the perioperative management of patients requiring surgery. Perioperative management starts early, even before the patient is admitted to the hospital for surgical procedures. The perioperative care team's preoperative optimization of underlying comorbid diseases and associated medications ensures that optimal anesthesia and analgesic strategies are utilized. For example, patients with cardiac disease may have anticoagulants prescribed that need…

The Challenges of Novel Therapies in the Care of the Critically Ill Cancer Patient

The global incidence of both hematologic and solid organ cancers continues to rise. This is due in part to the aging population and changes in socioeconomic-associated cancer risk factors such as tobacco and alcohol intake, as well as improved diagnostics and screening programs. The latter have also contributed to a simultaneous improvement in survival, where earlier diagnosis leads to greater chance of primary surgical resection. The…

Intensive Care Considerations of the Cancer Patient

The Surgical Oncologic Patient Burden of Disease The International Agency for Research on Cancer reported that the incidence of cancer in 2018 was estimated at 18.1 million new cases and 9.6 million deaths. The cumulative risk for developing cancer is 22% in men and 18.3% for women; 12.7% of men and 8.7% of women will die from the disease. Cancer incidence is predicted to continue to…

Early Warning and Rapid Response Systems

Introduction Rapid response teams arose out of the realization that inpatients are at risk for serious adverse events that were usually preceded by physiologic signs of instability that were not always recognized by ward staff. , These teams have evolved over time since the concept appeared in the medical literature in the 1990s. These teams of responders vary in composition, but most have critical care experience…

Special Considerations in the Postoperative Care of the Cancer Patient

According to the National Cancer Institute, an estimated 1.7 million new cases of cancer were diagnosed in the United States in 2018, and more than 600,000 people died from the disease. In fact, cancer is the leading cause of death in the United States. Cancer mortality is higher among men than women, and when comparing groups based on race/ethnicity and sex, cancer mortality is highest in…

Delivering Perioperative Care for Older Patients Undergoing Cancer Surgery

Introduction The surgical population is aging at a faster rate than the general population. A significant proportion of this group will undergo cancer surgery; in 2030 it is estimated that more than 75% of cancer patients will be aged over 65 years. While there are clear benefits in terms of morbidity and mortality, older people undergoing cancer surgery remain at higher risk than younger patients of…

Frailty in the Perioperative Setting for Cancer Patients

Introduction The world’s population is aging at an unprecedented rate with the number of older people growing at a faster rate than all other age groups. By 2050, one in six people will be over the age of 65 (16%), accounting for 1.6 billion worldwide. The global population aged 80 years and over is expected to more than triple between 2015 and 2050, growing from 126.5…

Palliative Surgery in Cancer Patients

Introduction Palliative surgery is “… used with the primary intention of improving quality of life or relieving symptoms caused by advanced disease. Its effectiveness is judged by the presence and durability of patient-acknowledged symptom resolution.” Surgical treatment decisions for patients receiving palliative care are challenging. Often they have to be made within a short period of time, and the outcome expectations may vary significantly between the…

Perioperative Care of the Surgical Patient: Surgical Emergencies in Cancer

Background Oncologic surgical emergency may be defined as an acute, potentially life-threatening condition arising from cancer pathology, e.g., obstruction of hollow viscera, bleeding from the tumor, or its treatment such as cecal perforation in a neutropenic patient. Understanding the pathophysiology and prognosis of the surgical condition the patient presents with is therefore very important for appropriate management and improving outcomes. Broadly, cancer patients present with three…

Perioperative Care of the Surgical Patient: Reconstructive Surgery

Applied Surgical, Pathologic, and Physiologic Concepts General The resection of tumors may cause large aesthetically and functionally unacceptable defects. Similarly, adjuvant therapies may leave functional tissue impairment or chronic nonhealing wounds requiring excision and reconstruction. Reconstructive surgery aims to obliterate dead space, provide structural support for remaining tissues, ensure adequate wound closure and healing, and maintain an aesthetically acceptable appearance. Flap surgery has improved markedly over…

Perioperative Care of the Surgical Patient: Bone and Soft Tissue Tumors

Introduction Orthopedic oncology is one of the newest subspecialties in orthopedics that specializes in the management of musculoskeletal tumors, which are slowly increasing globally. The great variability of complexity and duration of oncologic orthopedic surgeries is such that there is no guide that can universalize the management for all patients. Surgery can range from short duration with limited bleeding to more demanding procedures such as sacrectomies…

Perioperative Care: Sarcoma and Melanoma

Perioperative Care: Sarcoma Introduction Sarcoma is an umbrella term for malignant neoplasms of mesenchymal origin. A wide variety of underlying cell types can become neoplastic, and so these cancers are best understood by division into histologic subtype and anatomic location. Sarcomas are rare cancers in adulthood, making up less than 1% of all adult malignancies. Approximately 10% are of bony origin and the remainder originate in…

Anesthesia and Surgery for Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

Introduction Cytoreductive surgery (CRS) was initially described in the 1930s for patients with locally advanced gynecologic cancers, especially those with local and peritoneal spread, in an attempt to reduce symptoms arising from tumor burden. The subsequent extensive debulking surgeries developed in the 1960s and 1970s demonstrated an improvement in patient survival in conjunction with postoperative chemotherapy and improved tumor response to adjuvant treatment. Seeding of tumor…

Anesthesiology and Perioperative Management of Patients Presenting for Surgical Excision of Endocrine Tumors

General Introduction Surgical excision of endocrine tumors ranges from relatively common thyroid cancer surgery to rare conditions such as removal of pheochromocytoma and hypophysectomy for pituitary adenoma. A comprehensive evaluation of the perioperative management of all endocrine tumors is beyond the scope of this chapter. Therefore this chapter focuses on the perioperative management of the following endocrine tumors: Thyroid tumors Pheochromocytoma Cushing’s disease Carcinoid syndrome Hypophysectomy…

Perioperative Care of the Surgical Cancer Patient: Gynecologic Cancers

Introduction According to the American Cancer Society (ACS), there will be >900,000 new all-cause cancer cases in American women by 2020, approximately a third of whom will die as a result. The most prevalent gynecologic cancers among women are ovarian cancer, endometrial cancer, cervical cancer, and vulval cancer. Cancer therapies are increasingly complex, and for solid tumors, surgical management remains the cornerstone of treatment. The perioperative…

Perioperative Care of the Surgical Patient: Genitourinary Cancers

Introduction Good perioperative planning, which begins at the time the decision is made to perform surgery and continues through the postoperative recovery phase after discharge, is crucial to achieving successful outcomes in urological cancer surgery. Improvements in surgical technology and technique paired with enhanced recovery and perioperative optimization programs have been shown to reduce patient morbidity and mortality following major urological surgery. Common urological malignancies and…

Perioperative Care of the Colorectal Cancer Patient

Introduction Colorectal cancer is the third most commonly diagnosed cancer worldwide with an estimated 1.8 million new cases in 2018, but ranks second in terms of mortality (after lung cancer) with an estimated 881,000 associated deaths per annum. Approximately 50% of all colorectal cancer patients die from metastatic disease, with around 20% found to have metastases at time of presentation. A higher incidence of colorectal cancer…

Intraoperative Care of the Surgical Patient: Upper Gastrointestinal Cancers

Introduction The upper gastrointestinal (GI) tract comprises the mouth, esophagus, stomach, and duodenum. The incidence of such cancers is rising, and improved operative safety and successes of neoadjuvant chemotherapy have increased the number of patients who are candidates for curative resection. Resection of tumors involving the upper GI tract carries high intraoperative risk, and due to shared anatomy, close concert between the anesthesiologist and surgeon. The…