adverse effects of cancer treatment Flashcards
potential factors for cancer related fatigue (CRC)
anaemia
wasting (cachexia)
tumour burden
sleep disturbance
pain
Tx - chemo, biologics, hormonal, radiotherapy
psychosocial factors
How to improve cancer related fatigue?
light exercise
resting
diet, maintaing carbs
What is myelosuppression?
reduced production of
- erythrocytes (RBCs)
- WBCs (incl neutrophils)
- platelets
When does myelosppression most commonly occur?
7-10 days after Tx
How long does it take to recover from myelosuppression?
20 days
Sx and Tx from low erythrocytes in myelosppression
anaemia
treat with blood transfusions dpeending on severity/associated Sx
What can reduced WBC cause in myelosppression?
neutropenia
risk of infection
Sx of low platalets in myelosppression
bruising and bleeding
management for myelosuppression
FBCs monitored before Tx initiated and before each chemo cycle
blood count low consider dose reducion in extreme cases or Tx delays
prophylaxis Tx for myelosppression
growth factors like granulocytes eg. filgrastim
given with some regimens to reduce incidence of neutropenia
What is filgrastim?
granulocyte G growth factor
reduces indidence of neutropenia
What is neutropenic sepsis?
neutropenia with elevated temperature with/wo Sx of infection
medical emergency
broad spectrum ABX
emperic broad spectrum ABX used in neutropenic sepsis
Tazocin
Meropenem
Ceftazidime
-> all for 48hrs
What can be given if anaerobic cover is needed in neutropenic sepsis?
metronidazole
How does chemotherapy cause N&V?
chemotherapy activates neurotransmitters
in chemoreceptor trigger zone AND GIT
vomiting centres in brain cause sickness
What patients are more susceptible to N&V in chemotherapy?
female
U50
non-drinkers
anxious
previous motion sickness/morning sickness
antiemetic used for anticipatory N&V
benzodiazepines
antiemetic that targets histamine
cyclizine
antiemetic that targets acetylcholine
hyoscine
antiemetic that targets serotonin
ondansetron
part of inner ear that can casue N&V in motion sickness or surgery
vestibular apparatus
What is acute chemotherapy induced N&V (CINV)?
within 24hrs
What is delayed CINV?
after more than 24hrs
What does breakthrough N&V mean?
feeling sick despite being on antiemetics
What does refractory N&V mean?
difficult to manage N&V
tried multiple antiemetics
chemo drugs with high N&V
cisplatin
high dose cyclophosphamide
chemo drugs with medium N&V
carboplatin
doxuribicin
low dose cyclophosphamide
chemo drugs with low N&V
taxanes
5-FU
methotrexate
chemo drugs with minimal N&V
vincristine
bleomycin
How to prevent anorexia?
maintain healthy weight
eat healthy and drink plenty of fluids
make and freeze meals in advance
avoid diets
referral to dietitics
may need feeding - TPN/PEG/JEG
What is mucositis?
inflammation of mouth leading to ulceration
because oral mucosa vulnerable to chemo due to rapid growth and cell turnover rate
prevention of mucositis
good mouth care
mouthwashes
good nutrition
Tx of established mucositis
topical analgesics or topical anaesthetics
syctemic pain control if topical ineffective
Tx for constipation
docusate +- senna
macrogols (osmotic)
What to look out for with constipation?
bowel obstruction or spinal cord compression
- abdominal pain, really sick, vomit undigested food
- consipation, unable to pass urine, incontinence, weakness in legs/arms, loss of use of legs
complications of diarrhoea
dehydration
metabolic disturbance
malnutrition
Tx for diarrhoea
loperamide PRN
fluids, diet
seek advice if >48hrs
diarrhoea associated with irinotecan
within 24hrs likely to be chilineric reaction with asosciated Sx
- sweating
- hyper salivation
- visual disturbances
- abdominal cramps
- watery eyes
- hypotension
MUST REPORT
after 24hrs can Tx with loperamide
report if Sx >24hrs with loperamide
Sx of peripeheral neuropathy
numbness, tingling of hands/feet
burning hands/feet
nymbness around mouth
loss of sensation to touch
loss of positional sense (where body part is)
weakness and leg cramping
difficulty picking things up
name for hand and foot syndrome
palmar plantar erythrodysesthesia
Sx of hand and food syndrome/palmar plantar erythrodysesthesia
redness
swelling
tingling/burning
tenderness/sensitive to touch
tightness of skin
thick calluses/blisters on palms/soles
drugs that can cause hand and foot syndrome/palmar plantar erythrodysesthesia
capecitabine
5-FU
doxorubicin
adivce for patients with palmar plantar erythrodysesthesia
avoid highly perfumed products
use moisturisers liberally
avoid sun exposure
keep nals short/clean (rub don’t itch)
What Sx shuold be reported that could be palmar plantar erythrodysesthesia?
rashes
itchiness
preventative measures for hair loss/alopecia
cold cap
-> reduces blood flow
What is tumour lysis syndrome?
metabolic disturbances that occur as a result of rapid cell lysis
K and phosphate are released from dying cells
uric acid is produced from the breakdown of nucleic acid
hypocalcaemia occurs as a secondary response to hyperphosphataemia and renal failure
In what patients is tumour lysis syndrome more common?
leukaemia and lymphoma
tumour lysis Tx
IV hydration
management of hyperuricaemia - allopurinol
-> start both proir to Tx by at least 12hrs if possible
LT effects of cancer Tx
infertility
teratogenicity
second cancer
CV/resiratory problems
psychosocial problems
s/e of cetuximab (less serious)
rashes
dry skin
itching
s/e of hormone therapy
women
- menopausal Sx
- hair thinning
- osteoporosis
- thrombosis
men
- muscle strength/tone reduced
- erectile dysfunction
- low libido
- hair thinning
