Table 4.

Resource allocations for treatment-related toxicity (A): organ-based toxicity management during treatment

	Basic	Limited	Enhanced	Maximal
Musculoskeletal Toxicities	Basic physical activity (eg, aerobic, ROM) Pain management, including morphine^a	PT focused on early lymphedema, shoulder mobility, and pain management Other drug therapy for pain^a	Other non-morphine opioids^a BMD assessment for at-risk patients Bone modifying agents
Gastrointestinal Toxicities	Oral/IV hydration and electrolyte replacement Drug therapy: antiemetics, antidiarrheal medications, stool softeners, laxatives Mucositis support, eg, ice chips Anxiety symptom management Consideration of parasitic and/or bacterial infection	Drug therapy: 5HT3 blockers, H2 antagonists, anti-acids, stimulant laxatives Mucositis support: topical agents Antianxiety drugs Consultation with certified dietitian	Drug therapy: NK-1 antagonists, PPIs Mucositis support: opioid analgesics for severe mucositis Individualized education by certified dietitian
Skin Toxicities, Chemotherapy Extravasation	Patient and family education^b	Topical agents (eg, steroid- or zinc- containing skin creams) DMSO Debridement surgery Coordinated patient care	Consultation with dermatology specialist Central line access/management	Dexrazoxane
Nervous System Toxicities	Pain management, including morphine^a Topical agents Patient and family education^b	PT: functional limitations Drug therapy for pain^a	Anesthetics for nerve blockage Consultation with neurology specialist for pain management and cognitive problems

Note: The table stratification scheme implies incrementally increasing resource allocation at the basic, limited, and enhanced levels. Maximal-level resources should not be targeted for implementation in LMICs, even though they may be used in some higher-income settings.

Abbreviations: BMD, bone mineral density; DMSO, dimethyl sulfoxide; 5HT3 blockers, 5-hydroxytryptamine blockers; NK-1, Neurokinin −1; PPIs, proton pump inhibitors; ROM, range of motion; PT, physiotherapy.

Pain management should follow the World Health Organization pain ladder recommendations. Morphine should be available and easily accessible at a basic level of resources.

Patient, family and/or partner education may be the primary intervention for some supportive care services.