adverse effects and supportive care Flashcards
what should you inform the patient about their treatment?
– Purpose of treatment
– Treatment plan
– Contact numbers
what should you inform the patients about the side effects of their treatment?
– Short term / long term
– Specific information regarding oral treatment if relevant
what additional factors should you do to ensure you are meeting the needs of the patient during their treatment?
- 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
what information should you give to the patient at the pre-assessment?
- 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
what assessments should be done to the patient at the pre-assessment?
- 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
what are some stratigies to improve side effects?
– Supportive therapies - drugs to reduce side effects
– Newer drug design - reduced adverse effects and retained effficacy
why may cancer related fatigue happen?
Anaemia
– Wasting (cachexia)
– Tumour burden
– Sleep disturbance
– Pain
– Treatmen
psychological factors
what is myelosuppression?
Defined as the reduced production of:
– Erythrocytes (red blood cells)
– White cells (including neutrophils)
– Platelets
when does myelosuppression usually occur?
7-10 days after treatment
some drugs may cause delayed myselosuppression
how long does it take to recover from myelosuppresion?
20
how do you manage myelosuppression?
- 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
what causes low erythrocytes and how do you treat it?
– Anaemia
– Treat with blood
transfusions depending
on severity / associated
symptoms
what causes a reduction in white blood cells? what is the risk here?
Reduction in WBC’s
– Neutropenia
* risk of infection
what is a reduction in white blood cells and platelets?
thrombocytopenia
- be aware of bruising and bleeds
what would you use to treat if neutropenia is high/prolonged?
– Antibiotics
– Antifungals
– Antivirals
what is neutropenic sepsis?
Neutropenia with elevated temperature +/- symptoms of infection
how is treatment for neutropenic sepsis determined?
- Oral versus intravenous
- Outpatient versus inpatient
what are the examples of some broad spec antibiotics ued for neutropenic sepsis?
- Tazocin 48 hrs
- Meropenem 48 hrs
- Ceftazidime 48 hrs
what are the stages of chemo induced nausea and vomiting?
- Acute - within 24 hours
- Delayed - more than
24 hours - Anticipatory
- Breakthrough
- Refractory
what is dependent on emetogenic potential of the regime?
- 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
what is the guidance for anorexia?
– 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
what is some advice for people who are anorexic?
- 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
what is mucositis?
Oral mucosa vulnerable to chemotherapy due to rapid growth and cell turnover rate
* Inflammation of mouth leading to ulceration
how do you manage mucositis?
- Management strategy: primary prevention with good mouth care, mouthwashes and good nutrition
how do you treat established mucositis?
– Topical analgesics or topical anaesthetics.
– Systemic pain control measures implemented if topical treatment
ineffective
what is mucositis associated with?
antimetabolites and
anthracyclines
what advice would you give to chemo patient with constipation?
– 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
what are the complications associated with diarrhoea?
- Dehydration
- Metabolic disturbances
- Malnutrition
what advice would you give to someone with diarrhoea?
– maintaining fluid intake - 2 litres
of fluid per day
– maintaining a healthy diet
– provided with loperamide prn
– seek advice if > 48 hours
what is diarrhoea associated with irinotecan?
- Within 24 hours likely to be a
cholinergic reaction with associated
symptoms
– sweating
– hyper salivation
– visual disturbances
– abdominal cramps
– watery eyes
– hypotension
when must you report diarrhoea?
- After 24 hours can treat with loperamide
- Report if symptoms last > 24 hours despite loperamide
what can peripheral neuropathy be associated with?
– Chemotherapy (some agents)
– Disease
– Complication of surgery / radiotherapy
what are the symptoms of peripheral neuropathy?
- 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
what may have to be done if a patient develops peripheral neuropathy?
may require dose reduction
may be reversible on stopping chemotherapy but sometimes may be permanent
how does chemotherapy affect the skin and nails?
Hand-foot syndrome (palmar plantar erythrodysesthesia) associated with some
drugs
what are the symptoms of hand-foot syndome?
Redness, swelling, tingling or burning, tenderness or sensitivity to touch,tightness of the skin, thick calluses and blisters on the palms and soles
what is hand-foot syndrome caused by?
- Capecitabine, 5-fluouracil, doxorubicin
what advice is given to patients with hand foot syndrome?
– Avoid highly perfumed products
– Use moisturisers liberally (supplied by oncology)
– Avoid exposure to sun
– Keep nails short and clean - rub rather than itch
how may alopecia be preventable with chemo?
cold cap- to stop the amount of blood flow to head
what is tumour lysis syndrome?
Tumour lysis syndrome refers to a number of metabolicdisturbances that occur as the result of rapid cell lysis in patients
who does tumour lysis syndrom most commonly occur in?
Most common in patients with leukaemia and lymphoma
when does tumour lysis syndrome usually occur?
This may occur spontaneously, but more usually once treatment starts
what can occur due to tumour lysis syndrome?
- 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
how do you prevent and treat tumour lysis syndrome?
- IV hydration
- Management of hyperuricaemia
- Start both prior to starting treatment
by at least 12hrs if possible
what are the long term effects ofcancer?
infertility and teratogenicity
second cancer
cardiovascular/ respiratory complications
psychological issues
how may infertility caused by chemo affect women?
– Amenorrhoea which is usually reversible
* May induce early menopause in some women
how may infertility caused by chemo affect men?
– Depression of spermatogenesis may lead to sterility
* Pre-treatment counselling, sperm storage
– Potential long term effects in children
what are the side effects of hormone therapy?
- Hormone therapy
- Women – menopausal symptoms, hair thinning,
osteoporosis, thrombosis - Men – muscle strength/tone reduced, erectile dysfunction,
low libido, hair thinning
what should you assess at the end of treatment?
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
