Cancer Side Effects Flashcards
Which side effect of chemotherapy is a health professional likely to be most concerned about?
myelosuppression
Which side effects of chemotherapy are a patient likely to be most concerned about?
nausea
vomiting
hair loss
how is haematological toxicity caused ?
killed stem cells in the bone marrow affected the most by chemo and myelosuppression
downstream effect of…
thrombocytopenia
anemia
neutropenia
what is the most risky haematological toxicity?
neutropenia = risk of life
what are predisposing factors of developing neutropenia?
- mucosal damage =increase opportunity pathogens
- depth/duration of neutropenia
- loss of cell mediated and humoural immunity
why is depth/duration of neutropenia important?
larger the time under RBC count = larger time for risk of infection = larger risk
how is neutropenia managed/treated?
- G-CSF - stimulates stem cell proliferation
- prophylactic antibiotics/anti-fungals
- delayed/reduced dose chemo
- PT with neutropenia and fever = broad spectrum antibiotic
what would you do if your chemo pt has neutropenia and fever?
prompt broad spectrum antibiotic treatment
how is GI toxicity caused ?
GI tract worn away by the passage of food and require food replacement
what GI effects occur from cytotoxic drugs?
nausea n vomiting
diarrhoea
oral mucositis
how can nausea and vomiting be characterised?
acute - first 24hrs
delayed - after 24hrs
anticipatory - e.g. arrival to chemotherapy
how is nausea and vomiting managed?
5-HT3 receptor antagonists and NK1 antagonists - antiemtics
what are the classes of anti-emetics? and name examples
- dopamine antagonists - metoclopramide/domperidone
- 5-HT3 antagonists - ondansetron
- antihistamine - cyclizine
- NK1 antagonists - aprepitant
- anticholinergics - hyoscine hydrobromide
- corticosteroids - dexamethasone
what are the risk factors for nausea/vomiting?
young age
female
history of motion sickness
history of morning sickness
adjuvant therapy
how are chemo treatment scaled when it comes to nausea/vomiting?
- high emetogenic risk (>90%)- cisplatin based chemo/SCT
- moderate emetogenic risk (30-90%) - DA/FLAG
- low emetogenic risk (10-30%) - bortezomib
- minimal emetogenic risk (<10%) - bleomycin/vincristine
what treatment plans for low emetogenic risk ?
metoclopramide PRN (po/iV) prechemo and TTO
what treatment plans for moderate emetogenic risk ?
metoclopramide (po/IV) + dexamethasone 8mg pre-chemo then metoclopramide 10mg TDS 3/7 and dexamethasone 2mg TDS 3/7 TTO
what treatment plans for high emetogenic risk ?
what are the symptoms of oral mucositis?
pain
dry mouth
altered taste
ulcerations
leads to infections
what drugs are responsible for oral mucositis?
5-FU
MTX
anthracyclines
cytarabrine
how can oral mucositis be prevented?
good oral hygiene - using mouthwashes
how can oral mucositis be treated?
- antiseptic mouthwashes
- topical steroids
- sucralfate - for ulcers
- antacid and oxetacaine - local anaesthetic
- lidocaine gel - local anaesthetic
what drugs are responsible for diarrhoea?
5-FU
irinotecan
majority of nibs
how is diarrhoea treated?
loperamide 2 tabs every 2 hrs - max dose
codeine n octreotide if very severe
what drugs are responsible for skin toxicities?
anthracyclines
bleomycin
etoposide
what skin toxicities are people mainly concerned about?
alopecia but hair will regrow
what can treat alopecia?
scalp cooling is used to cause vasoconstriction of blood vessels to the area = less chemotherapeutic effect = less hair damage
name skin toxicities
alopecia
hand and foot syndrome/PPE
how is hand and foot syndrome/PPE treated?
dose interruption/reduction
chiropody
cushioned footwear
urea based emollients
decrease exposure to warm water
oral analgesia
pyridone -vit b
what drugs cause hand and foot syndrome/PPE?
5-DU
capecitabine
some nibs
what are symptoms of hand and foot syndrome/PPE?
tenderness
redness
tingling
peeling of the skin on the palms and soles
difficulty walking
what is tumour lysis syndrome?
chemo = large number of cells killed = release of urate from nucleic acid breakdown = urate deposit in kidneys = renal failure
how is tumour lysis syndrome prevented?
hydration and allopurinol/fexobustat
how does allopurinol prevent tumour lysis syndrome?
prevents formation of uric acid
how is tumour lysis syndrome treated?
rasburicase
allopurinol doesn’t work on already formed uric acid deposits
what drugs causes reproductive toxicities?
alkylating agents
what is offered to those at risk of reproductive toxicities?
young males - sperm banking prior to chemo
females - IVF/egg freezing/ ovarian tissue freezing
what does chemo do to women reproductive system?
amenorrhoea
menopausal symptoms
what drugs cause pulmonary toxicities?
bleomycin - fibrosis n chronic pneumonia
dose dependent
what drugs cause nephrotoxicity?
cisplatin
ifosfamide
MTX
what can nephrotoxicity cause?
renal failure
electrolyte disturbances
what must you do if you suspect nephrotoxicity?
dose reduction
good hydration
high dose MTX= alkalise urine to prevent
how do you alkalise urine?
sodium bic. and saline administration
why would you alkalise urine ?
when acidic urine build up causing nephrotoxicity due to high dose MTX forming MTX crystallisation
what drugs cause neurotoxicity?
cisplatin
oxaliplatin
vinca alkaloids - Vincristine
bortezomib
thalidomide
what can neurotoxicity cause?
- peripheral neuropathy - pins n needles
- autonomic neuropathy - constipation
what drugs cause cardiotoxicity?
anthracyclines - doxorubicin
5-FU
cyclophosphamide
what can cardiotoxicity cause?
arrhythmias = heart failure
describe the side effects of checkpoint inhibitors?
auto-immune effects on the immune system
appears within first weeks/months of treatment
potentially life threatening
affect the skin/GI tract
how are checkpoint inhibitor side effects managed?
corticosteroids
