Chemotherapy - Side Effects Flashcards
What are some immediate complications of chemo?
-Nausea + vomiting
-Myelosuppression
-Oral mucositis
-Diarrhoea / constipation
-Alopecia
-Neuro SEs eg peripheral neuropathy, ototoxicity
-GU SEs eg nephro-/bladder toxicity
-Arrhythmias
-Raised liver enzymes (transient)
-Tissue damage from extravasation, pigmentation, photosensitivity
-Myalgia, arthralgia, lethargy
What are some long-term complications of chemo?
-Second malignancies
-Reduced fertility
-Pulmonary fibrosis
-Cardiac fibrosis
-Psychological effects
What causes N+V in chemo patients?
-Nausea caused by direct stimulation of the vomiting centre, peripheral stimulation and anticipatory causes
-Ondansetron (5-HT antagonist) often given to treat
What causes myelosuppression in chemo patients and what are the effects?
-Kills haematopoietic progenitor cells causing leukopenia and thrombocytopenia 10-14 days after starting a cycle
-Neutrophil count of <0.5x10^9/1 poses significant infection risk
-Recovery seen after 3-4 weeks
What causes the GI side effects from chemo?
-GI epithelium is a rapidly dividing cell population so is sensitive to cytotoxic chemotherapy
-Oral mucositis reflects general damage to the GI epithelium
-Diarrhoea occurs due to colitis / small bowel mucosal inflammation
-Constipation is caused by dehydration due to reduced oral intake due to nausea, and adverse effects of other drugs eg opiates / 5HT antagonists
What causes alopecia in chemo patients?
-Rapidly dividing cell populations at hair follicles are targeted by chemo drugs
-Hair returns once chemo is discontinued
-Use of a cold cap can control it by reducing blood flow to the scalp
-Significant impact on psychological well-being
What causes the neurological effects of chemo?
-Peripheral neuropathies often recover over a few months but often not fully
-Autonomic neuropathy causing dysfunction
-Cochlear damage results in high tone hearing loss (eg cisplatin), damage is permanent
What causes the genitourinary effects of chemo?
-Platinum agents cause nephrotoxicity, good renal function is needed to reduce overall toxicity of drugs
-Haemorrhagic cystitis is caused by cyclophosphamide and isofamide (dose-dependent)
What causes the cardiac effects of chemo?
-Doxorubicin and paclitaxel can cause arrhythmias
-5-FU can cause coronary artery spasm –> ischaemia
What causes skin and soft tissue damage in chemo patients?
-Extravasation due to highly vesicant nature of some drugs
-Palmar plantar erythema is frequently seen with 5-FU and others, good response seen with emollients and drug withdrawal
-Photosensitivity (eg 5-FU)
-Skin and nail pigmentation often seen in combination with pulmonary fibrosis
What causes second malignancies in chemo patients?
-Some drugs cause sub-lethal DNA damage that cause genetic changes leading to malignancy
-Alkylating agents and procarbazine are the most carcinogenic
-High-dose chemo is also thought to increase the risk
What causes fertility changes in chemo patients?
-Most patients receiving high-dose chemo become infertile, and those receiving alkylating agents
-Sperm and egg storage might be offered to patients
What causes long-term pulmonary damage in chemo patients?
-Fibrosis induced by bleomycin and busulphan, and high dose alkylating agents
