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MO2 > adverse effects and supportive care > Flashcards

adverse effects and supportive care Flashcards

1
Q

what should you inform the patient about their treatment?

A

– Purpose of treatment
– Treatment plan
– Contact numbers

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2
Q

what should you inform the patients about the side effects of their treatment?

A

– Short term / long term
– Specific information regarding oral treatment if relevant

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3
Q

what additional factors should you do to ensure you are meeting the needs of the patient during their treatment?

A
  • Explanation of tests
  • Promotion of family involvement
  • Opportunity to ask questions
  • Opportunity to discuss concerns
    – Emotional, practical, psychological, financial, spiritual
  • Importance of reporting new symptoms or concerns
  • Written and verbal information provided
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4
Q

what information should you give to the patient at the pre-assessment?

A
  • Personal information
  • Mandatory tests
  • Past medical history including
    – Any previous or current conditions
    – Previous surgery and/or radiotherapy
    – Pre-treatment performance status
    – Any presenting symptoms
  • Allergy status
  • Medication history including:
    – Current prescribed medication
    – Over the counter / herbal / illicit drug
    use
    – Recently stopped medication
    – Previous chemotherapy treatment
  • Any medicine management issues
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5
Q

what assessments should be done to the patient at the pre-assessment?

A
  • Psychological
  • Previous history of mental illness
  • Fears / anxieties
  • Social
  • Self care
  • Eating and drinking
  • Mobility
  • Bowel habits
  • Sleep patterns
  • Body image / sexual issues
  • Pain assessment
  • Quality of life
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6
Q

what are some stratigies to improve side effects?

A

– Supportive therapies - drugs to reduce side effects
– Newer drug design - reduced adverse effects and retained effficacy

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7
Q

why may cancer related fatigue happen?

A

Anaemia
– Wasting (cachexia)
– Tumour burden
– Sleep disturbance
– Pain
– Treatmen
psychological factors

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8
Q

what is myelosuppression?

A

Defined as the reduced production of:
– Erythrocytes (red blood cells)
– White cells (including neutrophils)
– Platelets

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9
Q

when does myelosuppression usually occur?

A

7-10 days after treatment
some drugs may cause delayed myselosuppression

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10
Q

how long does it take to recover from myelosuppresion?

A

20

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11
Q

how do you manage myelosuppression?

A
  • Blood counts monitored closely
    AT LEAST
    – Before treatment initiated
    – Before each cycle of chemotherapy
  • If blood counts low consider:
    – Dose reduction (in extreme cases)
    – Treatment delays
  • Depends upon disease and
    prognosis
    – Dose intensity vs treatment duration
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12
Q

what causes low erythrocytes and how do you treat it?

A

– Anaemia
– Treat with blood
transfusions depending
on severity / associated
symptoms

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13
Q

what causes a reduction in white blood cells? what is the risk here?

A

Reduction in WBC’s
– Neutropenia
* risk of infection

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14
Q

what is a reduction in white blood cells and platelets?

A

thrombocytopenia
- be aware of bruising and bleeds

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15
Q

what would you use to treat if neutropenia is high/prolonged?

A

– Antibiotics
– Antifungals
– Antivirals

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16
Q

what is neutropenic sepsis?

A

Neutropenia with elevated temperature +/- symptoms of infection

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17
Q

how is treatment for neutropenic sepsis determined?

A
  • Oral versus intravenous
  • Outpatient versus inpatient
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18
Q

what are the examples of some broad spec antibiotics ued for neutropenic sepsis?

A
  • Tazocin 48 hrs
  • Meropenem 48 hrs
  • Ceftazidime 48 hrs
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19
Q

what are the stages of chemo induced nausea and vomiting?

A
  • Acute - within 24 hours
  • Delayed - more than
    24 hours
  • Anticipatory
  • Breakthrough
  • Refractory
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20
Q

what is dependent on emetogenic potential of the regime?

A
  • Varies considerably between
    drugs and doses
    – High (eg. cisplatin, high dose
    cyclophosphamide)
    – Medium (carboplatin, low dose
    cyclophos, doxorubicin)
    – Low (taxanes, 5-fluorouracil,
    methotrexate)
    – Minimal (vincristine, bleomycin)
  • Antiemetic regime tailored
    accordingly
21
Q

what is the guidance for anorexia?

A

– important to make an effort to eat healthily and drink plenty of liquids
– try to maintain healthy weight
Healthy well balanced diet promoted
but at end of day- try not lose weight so eat what you want

22
Q

what is some advice for people who are anorexic?

A
  • Make and freeze meals in advance
  • Avoid ‘fad diets’
  • Weight should be monitored closely
  • Patient can also be offered referral to dietetics
  • Patients may need artificial feeding such as TPN or via PEG/JEG
23
Q

what is mucositis?

A

Oral mucosa vulnerable to chemotherapy due to rapid growth and cell turnover rate
* Inflammation of mouth leading to ulceration

24
Q

how do you manage mucositis?

A
  • Management strategy: primary prevention with good mouth care, mouthwashes and good nutrition
25
Q

how do you treat established mucositis?

A

– Topical analgesics or topical anaesthetics.
– Systemic pain control measures implemented if topical treatment
ineffective

26
Q

what is mucositis associated with?

A

antimetabolites and
anthracyclines

27
Q

what advice would you give to chemo patient with constipation?

A

– Consider patients normal bowel function
– Standard advice if patient prescribed constipating medication
* Maintain adequate fluid intake - 2 litres of fluid per day
* Maintain a healthy diet
* Gentle exercise
– Advise low threshold for starting treatment
* Docusate sodium (+/- senna)
* Macrogols
– Vigilance for signs of bowel obstruction or spinal cord compression

28
Q

what are the complications associated with diarrhoea?

A
  • Dehydration
  • Metabolic disturbances
  • Malnutrition
29
Q

what advice would you give to someone with diarrhoea?

A

– maintaining fluid intake - 2 litres
of fluid per day
– maintaining a healthy diet
– provided with loperamide prn
– seek advice if > 48 hours

30
Q

what is diarrhoea associated with irinotecan?

A
  • Within 24 hours likely to be a
    cholinergic reaction with associated
    symptoms
    – sweating
    – hyper salivation
    – visual disturbances
    – abdominal cramps
    – watery eyes
    – hypotension
31
Q

when must you report diarrhoea?

A
  • After 24 hours can treat with loperamide
  • Report if symptoms last > 24 hours despite loperamide
32
Q

what can peripheral neuropathy be associated with?

A

– Chemotherapy (some agents)
– Disease
– Complication of surgery / radiotherapy

33
Q

what are the symptoms of peripheral neuropathy?

A
  • Numbness, tingling (feeling of pins
    and needles) of hands and/or feet
  • Burning of hands and/or feet
  • Numbness around mouth
  • Constipation
  • Loss of sensation to touch
  • Loss of positional sense (knowing
    where a body part is without looking).
  • Weakness and leg cramping or any
    pain in hands and/or feet
  • Difficulty picking things up or
    buttoning clothes
34
Q

what may have to be done if a patient develops peripheral neuropathy?

A

may require dose reduction
may be reversible on stopping chemotherapy but sometimes may be permanent

35
Q

how does chemotherapy affect the skin and nails?

A

Hand-foot syndrome (palmar plantar erythrodysesthesia) associated with some
drugs

36
Q

what are the symptoms of hand-foot syndome?

A

Redness, swelling, tingling or burning, tenderness or sensitivity to touch,tightness of the skin, thick calluses and blisters on the palms and soles

37
Q

what is hand-foot syndrome caused by?

A
  • Capecitabine, 5-fluouracil, doxorubicin
38
Q

what advice is given to patients with hand foot syndrome?

A

– Avoid highly perfumed products
– Use moisturisers liberally (supplied by oncology)
– Avoid exposure to sun
– Keep nails short and clean - rub rather than itch

39
Q

how may alopecia be preventable with chemo?

A

cold cap- to stop the amount of blood flow to head

40
Q

what is tumour lysis syndrome?

A

Tumour lysis syndrome refers to a number of metabolicdisturbances that occur as the result of rapid cell lysis in patients

41
Q

who does tumour lysis syndrom most commonly occur in?

A

Most common in patients with leukaemia and lymphoma

42
Q

when does tumour lysis syndrome usually occur?

A

This may occur spontaneously, but more usually once treatment starts

43
Q

what can occur due to tumour lysis syndrome?

A
  • Potassium and phosphate are released from the dying cells
  • Uric acid is produced from the breakdown of nucleic acid
  • Hypocalcaemia occurs as a secondary response to
    hyperphosphataemia and renal failure
44
Q

how do you prevent and treat tumour lysis syndrome?

A
  • IV hydration
  • Management of hyperuricaemia
  • Start both prior to starting treatment
    by at least 12hrs if possible
45
Q

what are the long term effects ofcancer?

A

infertility and teratogenicity
second cancer
cardiovascular/ respiratory complications
psychological issues

46
Q

how may infertility caused by chemo affect women?

A

– Amenorrhoea which is usually reversible
* May induce early menopause in some women

47
Q

how may infertility caused by chemo affect men?

A

– Depression of spermatogenesis may lead to sterility
* Pre-treatment counselling, sperm storage
– Potential long term effects in children

48
Q

what are the side effects of hormone therapy?

A
  • Hormone therapy
  • Women – menopausal symptoms, hair thinning,
    osteoporosis, thrombosis
  • Men – muscle strength/tone reduced, erectile dysfunction,
    low libido, hair thinning
49
Q

what should you assess at the end of treatment?

A

Patient review
– Completed planned number of cycles
– Reason for any dose modifications required
* How has response to treatment been assessed?
* Rationale for termination of chemotherapy
* Discussion of any further treatment planned or
future options if appropriate
* Opportunity for patient to ask questions
* Opportunity for patient to discuss any concerns

MO2 (55 decks)

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