Cancer Side Effects

Question 1

Which side effect of chemotherapy is a health professional likely to be most concerned about?

Answer 1

myelosuppression

Question 2

Which side effects of chemotherapy are a patient likely to be most concerned about?

Answer 2

nausea
vomiting
hair loss

Question 3

how is haematological toxicity caused ?

Answer 3

killed stem cells in the bone marrow affected the most by chemo and myelosuppression

downstream effect of…
thrombocytopenia
anemia
neutropenia

Question 4

what is the most risky haematological toxicity?

Answer 4

neutropenia = risk of life

Question 5

what are predisposing factors of developing neutropenia?

Answer 5

• mucosal damage =increase opportunity pathogens
• depth/duration of neutropenia
• loss of cell mediated and humoural immunity

Question 6

why is depth/duration of neutropenia important?

Answer 6

larger the time under RBC count = larger time for risk of infection = larger risk

Question 7

how is neutropenia managed/treated?

Answer 7

1. G-CSF - stimulates stem cell proliferation
2. prophylactic antibiotics/anti-fungals
3. delayed/reduced dose chemo
4. PT with neutropenia and fever = broad spectrum antibiotic

Question 8

what would you do if your chemo pt has neutropenia and fever?

Answer 8

prompt broad spectrum antibiotic treatment

Question 9

how is GI toxicity caused ?

Answer 9

GI tract worn away by the passage of food and require food replacement

Question 10

what GI effects occur from cytotoxic drugs?

Answer 10

nausea n vomiting
diarrhoea
oral mucositis

Question 11

how can nausea and vomiting be characterised?

Answer 11

acute - first 24hrs
delayed - after 24hrs
anticipatory - e.g. arrival to chemotherapy

Question 12

how is nausea and vomiting managed?

Answer 12

5-HT3 receptor antagonists and NK1 antagonists - antiemtics

Question 13

what are the classes of anti-emetics? and name examples

Answer 13

1. dopamine antagonists - metoclopramide/domperidone
2. 5-HT3 antagonists - ondansetron
3. antihistamine - cyclizine
4. NK1 antagonists - aprepitant
5. anticholinergics - hyoscine hydrobromide
6. corticosteroids - dexamethasone

Question 14

what are the risk factors for nausea/vomiting?

Answer 14

young age
female
history of motion sickness
history of morning sickness
adjuvant therapy

Question 15

how are chemo treatment scaled when it comes to nausea/vomiting?

Answer 15

1. high emetogenic risk (>90%)- cisplatin based chemo/SCT
2. moderate emetogenic risk (30-90%) - DA/FLAG
3. low emetogenic risk (10-30%) - bortezomib
4. minimal emetogenic risk (<10%) - bleomycin/vincristine

Question 16

what treatment plans for low emetogenic risk ?

Answer 16

metoclopramide PRN (po/iV) prechemo and TTO

Question 17

what treatment plans for moderate emetogenic risk ?

Answer 17

metoclopramide (po/IV) + dexamethasone 8mg pre-chemo then metoclopramide 10mg TDS 3/7 and dexamethasone 2mg TDS 3/7 TTO

Question 18

what treatment plans for high emetogenic risk ?

Answer 18

Question 19

what are the symptoms of oral mucositis?

Answer 19

pain
dry mouth
altered taste
ulcerations

leads to infections

Question 20

what drugs are responsible for oral mucositis?

Answer 20

5-FU
MTX
anthracyclines
cytarabrine

Question 21

how can oral mucositis be prevented?

Answer 21

good oral hygiene - using mouthwashes

Question 22

how can oral mucositis be treated?

Answer 22

1. antiseptic mouthwashes
2. topical steroids
3. sucralfate - for ulcers
4. antacid and oxetacaine - local anaesthetic
5. lidocaine gel - local anaesthetic

Question 23

what drugs are responsible for diarrhoea?

Answer 23

5-FU
irinotecan
majority of nibs

Question 24

how is diarrhoea treated?

Answer 24

loperamide 2 tabs every 2 hrs - max dose
codeine n octreotide if very severe

Question 25

what drugs are responsible for skin toxicities?

Answer 25

anthracyclines bleomycin etoposide

Question 26

what skin toxicities are people mainly concerned about?

Answer 26

alopecia but hair will regrow

Question 27

what can treat alopecia?

Answer 27

scalp cooling is used to cause vasoconstriction of blood vessels to the area = less chemotherapeutic effect = less hair damage

Question 28

name skin toxicities

Answer 28

alopecia hand and foot syndrome/PPE

Question 29

how is hand and foot syndrome/PPE treated?

Answer 29

dose interruption/reduction chiropody cushioned footwear urea based emollients decrease exposure to warm water oral analgesia pyridone -vit b

Question 30

what drugs cause hand and foot syndrome/PPE?

Answer 30

5-DU capecitabine some nibs

Question 31

what are symptoms of hand and foot syndrome/PPE?

Answer 31

tenderness redness tingling peeling of the skin on the palms and soles difficulty walking

Question 32

what is tumour lysis syndrome?

Answer 32

chemo = large number of cells killed = release of urate from nucleic acid breakdown = urate deposit in kidneys = renal failure

Question 33

how is tumour lysis syndrome prevented?

Answer 33

hydration and allopurinol/fexobustat

Question 34

how does allopurinol prevent tumour lysis syndrome?

Answer 34

prevents formation of uric acid

Question 35

how is tumour lysis syndrome treated?

Answer 35

rasburicase allopurinol doesn't work on already formed uric acid deposits

Question 36

what drugs causes reproductive toxicities?

Answer 36

alkylating agents

Question 37

what is offered to those at risk of reproductive toxicities?

Answer 37

young males - sperm banking prior to chemo females - IVF/egg freezing/ ovarian tissue freezing

Question 38

what does chemo do to women reproductive system?

Answer 38

amenorrhoea menopausal symptoms

Question 39

what drugs cause pulmonary toxicities?

Answer 39

bleomycin - fibrosis n chronic pneumonia dose dependent

Question 40

what drugs cause nephrotoxicity?

Answer 40

cisplatin ifosfamide MTX

Question 41

what can nephrotoxicity cause?

Answer 41

renal failure electrolyte disturbances

Question 42

what must you do if you suspect nephrotoxicity?

Answer 42

dose reduction good hydration high dose MTX= alkalise urine to prevent

Question 43

how do you alkalise urine?

Answer 43

sodium bic. and saline administration

Question 44

why would you alkalise urine ?

Answer 44

when acidic urine build up causing nephrotoxicity due to high dose MTX forming MTX crystallisation

Question 45

what drugs cause neurotoxicity?

Answer 45

cisplatin oxaliplatin vinca alkaloids - Vincristine bortezomib thalidomide

Question 46

what can neurotoxicity cause?

Answer 46

1. peripheral neuropathy - pins n needles 2. autonomic neuropathy - constipation

Question 47

what drugs cause cardiotoxicity?

Answer 47

anthracyclines - doxorubicin 5-FU cyclophosphamide

Question 48

what can cardiotoxicity cause?

Answer 48

arrhythmias = heart failure

Question 49

describe the side effects of checkpoint inhibitors?

Answer 49

auto-immune effects on the immune system appears within first weeks/months of treatment potentially life threatening affect the skin/GI tract

Question 50

how are checkpoint inhibitor side effects managed?

Answer 50

corticosteroids