5 patient referrals that could change cancer care

Cancer treatment isn’t just about chemo regimens and scan schedules—it’s about supporting patients through the entire experience.

In a recent Instagram Reel, medical oncologist Eleonora Teplinsky, MD, shared the five most common tests and referrals she orders for her patients throughout treatment.

From managing fatigue and neuropathy to monitoring heart and bone health, these supportive services can make an immediate difference in patient outcomes — and their outlooks.

Physical Therapy

Oncologists often reserve PT referrals for musculoskeletal injuries or post-op rehab, but Dr. Teplinsky challenges that limitation.

"So there's so, so many benefits, and it can just be such a great way to start to get back to movement," she adds.

Cancer-related fatigue, in particular, often lingers well into survivorship and is notoriously difficult to treat pharmacologically. Physical therapy can provide a structured reintroduction to movement, reduce deconditioning, and promote functional recovery.

What this means for your practice: Routinely refer PT when patients report persistent fatigue, balance issues, neuropathy, or post-surgical functional limitations—even if there's no acute injury. This can help prevent long-term disability and improve adherence to other parts of the survivorship plan.

Acupuncture

"A low-risk intervention that can really be beneficial" is how Dr. Teplinsky describes acupuncture for cancer patients. She explains that she uses this referral to help neuropathy, fatigue, sleep disturbances, pain, anxiety, and depression.

While not all patients benefit, there's evidence for acupuncture’s role in symptom control across cancer types—and especially for chemo-induced peripheral neuropathy (CIPN), where options are limited. ^{[] []}

What this means for your practice: Suggests patients try acupuncture earlier as part of an integrative care model—especially for those with multiple symptoms (such as, if they have both pain and sleep issues). It may reduce polypharmacy and improve quality of life with minimal downside.

Bone Density Scans

Systemic therapies—especially aromatase inhibitors and corticosteroids—are well-known contributors to bone loss.

Dr. Teplinsky said she orders DEXA scans in 95% of her patients and monitors at two-year intervals, adjusting frequency based on findings and treatment history. "It's so important to know what is happening with your bone density," said Dr. Teplinsky. "Do you have osteoporosis? What is your risk for fracture? If you've had any sort of systemic therapy for cancer, most likely you’ll benefit."

What this means for your practice: These tests can help you make more personalized recommendations. If you’re not already ordering baseline and follow-up DEXA scans for breast, prostate, or hematologic cancer patients on bone-impacting therapies, you’re likely missing silent osteoporosis. Bone health monitoring should be as routine as cardiac function in anthracycline-treated patients.

Sleep Assessment

Sleep apnea is underdiagnosed, especially in patients with cancer, where symptoms like fatigue and headaches are often dismissed as chemo fallout.

What this means for your practice: If your patients report persistent fatigue, morning headaches, or mood issues—consider whether they could be experiencing sleep apnea. Even without an apnea diagnosis, a referral for cognitive behavioral therapy may significantly improve sleep quality and therefore overall recovery.

Cardiology

Finally, Dr. Teplinsky stresses the importance of proactive cardio-oncology referrals.

Getting a baseline cardiology evaluation can help stratify risk and catch early changes before they escalate into symptomatic dysfunction. She also flags mild hypertension as a reason to involve cardiology earlier.

"We often refer patients to cardiology when something is going wrong," she explains. "Maybe they're having a lot of palpitations or their echocardiogram shows an abnormality. But in some patients, it can be really helpful to refer proactively, especially patients [who] have received cancer treatments that impact their heart."

What this means for your practice: Consider building cardio-oncology into your survivorship plan, especially for patients on cardiotoxic agents or those with preexisting cardiovascular risk. A baseline consult can improve long-term outcomes and reduce emergency interventions.

The Larger Message for Oncologists

Dr. Teplinsky’s real call to action? Reframe survivorship care as multidisciplinary and preventive. These types of referrals are often sidelined until problems become severe—but offering them earlier can mean fewer complications, better outcomes, and a stronger therapeutic alliance.

"There are so many other services and resources and incredible medical providers that I refer to to help take care of my patients," she said. "But I wanted to highlight these five because I just don't think we think about them as much."