Table 3.

Supportive care resource allocations: organ-based (site-specific) metastatic disease management

	Basic	Limited	Enhanced	Maximal
Bone Metastases	Drug therapy: steroids, NSAIDS, opioids (eg, oral and parenteral morphine), co-analgesics Consider spinal cord compression and fractures	Radiotherapy Surgery Routine evaluation for spinal cord compression and fractures	Radioisotopes Bone-modifying agents	Radiofrequency ablation / cryoablation
Bowel Obstruction	Drug therapy: morphine (oral or parenteral), steroids, laxatives, antiemetics, anticholinergics NG-tube	Non-morphine opioids	Venting G-tube	Somatostatin analogues
Brain Metastases	Drug therapy: analgesics, steroids, anti-emetics, anticonvulsants	Whole brain radiotherapy	Stereotactic radiotherapy Surgery
Liver Metastases	Drug therapy: analgesics, steroids, anti-emetics, antihistamines		Biliary stents Percutaneous drainage Embolization	Liver resection
Lung Metastases	Drug therapy for breathlessness: opioids, anxiolytics and antipsychotics, steroids Thoracocentesis Oxygen therapy for hypoxemic patients	Pleurodesis: Thoracotomy, VATS Radiotherapy
Skin Metastases / Complications	Wound and skin assessment Drug therapy: Analgesics; Broad spectrum antibiotics Simple dressings and skin barriers Activated charcoal; metronidazole Teaching wound dressing to patients and family	Silver nitrate Radiotherapy Debridement surgery	More sophisticated dressing material Calcium alginate for hemostasis Stoma/wound therapy Air mattress, egg crate mattress	Plastic surgery Vacuum (negative pressure) wound therapy Mechanical bed

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-resource settings.

Abbreviations: G-tube, gastric tube; NSAIDS, non-steroidal anti-inflammatory drugs; NG, nasogastric; VATS, video-assisted thoracic surgery.