Chemotherapy

Question 1

Systemic

Answer 1

(oral, IV, SC, IM) with aim of maximal therapeutic cytotoxic effect whilst avoiding extreme
toxicity to normal healthy tissues

Question 2

Regional

Answer 2

(intrathecal, intraarterial) which is aimed at delivering cytotoxics directly into cavity in which
tumour is located or blood vessel supplying tumour therefore minimizing side effects

Question 3

Common Side Effects

Answer 3

• Extravasation of IV drugs – leakage of cytotoxic drug from vein into subcutaneous or subdermal
  tissue, which can lead to permanent tissue damage; refer to local guidelines for prevention and
  prompt management
• Nausea and vomiting – can cause distress and may lead to refusal of treatment so prophylaxis of
  nausea and vomiting is very important; drugs have varying emetogenic potential

- Bone marrow suppression (except vincristine and bleomycin) – commonly occurs 7-10 days after
administration, important to treat infection before or when starting cytotoxic, neutropenic sepsis is a
medical emergency (see warning signs below)

Question 4

Other SE

Answer 4

oral mucositis, diarrhoea, fatigue, organ toxicities (e.g. neurotoxicity with vinca
alkaloids so IV administration only, cardiotoxicity with anthracyclines), hyperuricaemia, urothelial
toxicity

Question 5

Warning Signs of Neutropenic Sepsis

Answer 5

• Feeling unwell and/or have two temperature readings of 37.5¡C or above
• Develop shivering episodes / flu-like symptoms
• Uncontrolled gum/nose bleeds or unusual bruising
• Diarrhoea and/or uncontrolled vomiting
• Develop mouth ulcers that stop patient from eating or drinking

Question 6

Actions Required

Answer 6

• Advise patient to attend their nearest A&E department if they develop signs of neutropenic
sepsis and not to take paracetamol without seeking advice (to avoid a dangerous delay in
starting antibiotics)
• Advise patient to report immediately to a doctor if any side-effects occur
• For a drug that causes severe or moderate emesis, antiemetics should always be prescribed
on a regular basis
• Advise patient to main good oral hygiene (rinsing mouth more frequently and effective brushing
of teeth with soft brush 2-3 times daily) to avoid mucositis