adverse effects of cancer treatment

Question 1

potential factors for cancer related fatigue (CRC)

Answer 1

anaemia
wasting (cachexia)
tumour burden
sleep disturbance
pain
Tx - chemo, biologics, hormonal, radiotherapy
psychosocial factors

Question 2

How to improve cancer related fatigue?

Answer 2

light exercise
resting
diet, maintaing carbs

Question 3

What is myelosuppression?

Answer 3

reduced production of
- erythrocytes (RBCs)
- WBCs (incl neutrophils)
- platelets

Question 4

When does myelosppression most commonly occur?

Answer 4

7-10 days after Tx

Question 5

How long does it take to recover from myelosuppression?

Answer 5

20 days

Question 6

Sx and Tx from low erythrocytes in myelosppression

Answer 6

anaemia

treat with blood transfusions dpeending on severity/associated Sx

Question 7

What can reduced WBC cause in myelosppression?

Answer 7

neutropenia

risk of infection

Question 7

Sx of low platalets in myelosppression

Answer 7

bruising and bleeding

Question 8

management for myelosuppression

Answer 8

FBCs monitored before Tx initiated and before each chemo cycle

blood count low consider dose reducion in extreme cases or Tx delays

Question 9

prophylaxis Tx for myelosppression

Answer 9

growth factors like granulocytes eg. filgrastim

given with some regimens to reduce incidence of neutropenia

Question 10

What is filgrastim?

Answer 10

granulocyte G growth factor

reduces indidence of neutropenia

Question 11

What is neutropenic sepsis?

Answer 11

neutropenia with elevated temperature with/wo Sx of infection

medical emergency

broad spectrum ABX

Question 12

emperic broad spectrum ABX used in neutropenic sepsis

Answer 12

Tazocin

Meropenem

Ceftazidime

-> all for 48hrs

Question 13

What can be given if anaerobic cover is needed in neutropenic sepsis?

Answer 13

metronidazole

Question 14

How does chemotherapy cause N&V?

Answer 14

chemotherapy activates neurotransmitters

in chemoreceptor trigger zone AND GIT

vomiting centres in brain cause sickness

Question 15

What patients are more susceptible to N&V in chemotherapy?

Answer 15

female
U50
non-drinkers
anxious
previous motion sickness/morning sickness

Question 16

antiemetic used for anticipatory N&V

Answer 16

benzodiazepines

Question 17

antiemetic that targets histamine

Answer 17

cyclizine

Question 18

antiemetic that targets acetylcholine

Answer 18

hyoscine

Question 19

antiemetic that targets serotonin

Answer 19

ondansetron

Question 20

part of inner ear that can casue N&V in motion sickness or surgery

Answer 20

vestibular apparatus

Question 21

What is acute chemotherapy induced N&V (CINV)?

Answer 21

within 24hrs

Question 22

What is delayed CINV?

Answer 22

after more than 24hrs

Question 23

What does breakthrough N&V mean?

Answer 23

feeling sick despite being on antiemetics

Question 24

What does refractory N&V mean?

Answer 24

difficult to manage N&V tried multiple antiemetics

Question 25

chemo drugs with high N&V

Answer 25

cisplatin high dose cyclophosphamide

Question 26

chemo drugs with medium N&V

Answer 26

carboplatin doxuribicin low dose cyclophosphamide

Question 27

chemo drugs with low N&V

Answer 27

taxanes 5-FU methotrexate

Question 28

chemo drugs with minimal N&V

Answer 28

vincristine bleomycin

Question 29

How to prevent anorexia?

Answer 29

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

Question 30

What is mucositis?

Answer 30

inflammation of mouth leading to ulceration because oral mucosa vulnerable to chemo due to rapid growth and cell turnover rate

Question 31

prevention of mucositis

Answer 31

good mouth care mouthwashes good nutrition

Question 32

Tx of established mucositis

Answer 32

topical analgesics or topical anaesthetics syctemic pain control if topical ineffective

Question 33

Tx for constipation

Answer 33

docusate +- senna macrogols (osmotic)

Question 34

What to look out for with constipation?

Answer 34

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

Question 35

complications of diarrhoea

Answer 35

dehydration metabolic disturbance malnutrition

Question 36

Tx for diarrhoea

Answer 36

loperamide PRN fluids, diet seek advice if >48hrs

Question 37

diarrhoea associated with irinotecan

Answer 37

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

Question 38

Sx of peripeheral neuropathy

Answer 38

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

Question 39

name for hand and foot syndrome

Answer 39

palmar plantar erythrodysesthesia

Question 40

Sx of hand and food syndrome/palmar plantar erythrodysesthesia

Answer 40

redness swelling tingling/burning tenderness/sensitive to touch tightness of skin thick calluses/blisters on palms/soles

Question 41

drugs that can cause hand and foot syndrome/palmar plantar erythrodysesthesia

Answer 41

capecitabine 5-FU doxorubicin

Question 42

adivce for patients with palmar plantar erythrodysesthesia

Answer 42

avoid highly perfumed products use moisturisers liberally avoid sun exposure keep nals short/clean (rub don't itch)

Question 43

What Sx shuold be reported that could be palmar plantar erythrodysesthesia?

Answer 43

rashes itchiness

Question 44

preventative measures for hair loss/alopecia

Answer 44

cold cap -> reduces blood flow

Question 45

What is tumour lysis syndrome?

Answer 45

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

Question 46

In what patients is tumour lysis syndrome more common?

Answer 46

leukaemia and lymphoma

Question 47

tumour lysis Tx

Answer 47

IV hydration management of hyperuricaemia - allopurinol -> start both proir to Tx by at least 12hrs if possible

Question 48

LT effects of cancer Tx

Answer 48

infertility teratogenicity second cancer CV/resiratory problems psychosocial problems

Question 49

s/e of cetuximab (less serious)

Answer 49

rashes dry skin itching

Question 50

s/e of hormone therapy

Answer 50

women - menopausal Sx - hair thinning - osteoporosis - thrombosis men - muscle strength/tone reduced - erectile dysfunction - low libido - hair thinning