Support systems for the patient with cancer: future prospects

Bleeding and infection are the usual proximate causes of morbidity and mortality in patients with hematologic malignancy and many solid tumors. The most important cause of bleeding is thrombocytopenia. The use of immunologically matched platelets has rendered this complication less frequent. Host defenses against infection are often compromised unavoidably as a function of the primary disease and its therapy. However, it is important to note that many infections are caused by hospital-acquired organisms; a significant number of infections can be avoided with meticulous attention to possible breaches of the host barriers against invasion. Diagnosis and treatment of infection in the altered host are urgent and demanding, since the median survival with inappropriate therapy of bacterial sepsis is less than 3 days. Newer diagnostic techniques, such as the gallium scan, are helpful, as are antimicrobial combinations used empirically. Experimental approaches to the prevention of infection include antibacterial vaccines, the use of laminar air-flow isolation, and transplantation of bone marrow. Experimental approaches to the therapy of infection include leukocyte transfusion and the use of transfer factor. A discussion of supportive care must also include consideration of the psychosocial concomitants of the cancer process, particularly those factors in the doctor-patient relationship which promote anxiety in the physician to the end that his support of the patient is not effective.