adverse effects and supportive care Flashcards by Niamh Walsh

what should you inform the patient about their treatment?

– Purpose of treatment
– Treatment plan
– Contact numbers

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

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

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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

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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

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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

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what are some stratigies to improve side effects?

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

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why may cancer related fatigue happen?

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

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what is myelosuppression?

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

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when does myelosuppression usually occur?

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

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how long does it take to recover from myelosuppresion?

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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

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what causes low erythrocytes and how do you treat it?

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

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

Reduction in WBC’s
– Neutropenia
* risk of infection

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what is a reduction in white blood cells and platelets?

thrombocytopenia
- be aware of bruising and bleeds

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

– Antibiotics
– Antifungals
– Antivirals

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what is neutropenic sepsis?

Neutropenia with elevated temperature +/- symptoms of infection

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how is treatment for neutropenic sepsis determined?

Oral versus intravenous
Outpatient versus inpatient

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

Tazocin 48 hrs
Meropenem 48 hrs
Ceftazidime 48 hrs

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what are the stages of chemo induced nausea and vomiting?

Acute - within 24 hours
Delayed - more than
24 hours
Anticipatory
Breakthrough
Refractory

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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