Chemotherapy Side Effects

Question 1

Name some common Chemotherapy side effects.

Answer 1

Nausea and vomiting, mucositis, hypersensitivity, hair loss, rash, fatigue, myelosuppression, extravasation, constipation, diarrhoea

Question 2

What is Chemotherapy Induced Nausea and Vomiting (CINV) caused by?

Answer 2

It is caused by a serotonin release from enterochromaffin cells in the GI tract. This form of serotonin binds to 5-HT3 receptors causing nausea and vomiting, and also a release of Substance P from the Area postrema in the brain causes this also.

Question 3

What are the types of CINV?

Answer 3

Acute (within 24 hours), Delayed (after 24 hours), Breakthrough (CINV despite prophylaxis), Anticipatory (prior to chemo), Refractory (CINV despite appropriate measures)

Question 4

What are some complications of CINV?

Answer 4

Dehydration, nutritional deficiency, electrolyte disturbances, aspiration pneumonia, oesophageal tears, delayed chemotherapy, reduced quality of life

Question 5

What is mucositis?

Answer 5

A sore or ulcerated mouth/throat caused by sensitive mucosal cells in mouth.

Question 6

How does a patient prevent mucositis?

Answer 6

Maintaining good oral hygiene, rinse mouth regularly with salt water, avoid spicy/acidic food

Question 7

What can be given to treat mucositis?

Answer 7

Pain: local anaesthetic mouthwash or analgesics (paracetamol)
Infections: fungal (fluconazole or nystatin) or viral (aciclovir)

Question 8

What chemotherapy agents are most likely to cause diarrhoea?

Answer 8

5-FU, Capecitabine, Irinotecan

Question 9

What can be used to treat Chemotherapy Induced Diarrhoea?

Answer 9

Non-pharmacological: Oral hydration, dietary changes
Pharmacological: Loperamide 2mg

Question 10

What can potentially cause Chemotherapy Induced Constipation?

Answer 10

Cisplatin, Vinca alkaloids (Vincristine), Opioids for pain, Ondansetron for CINV, inactivity

Question 11

What can be used to treat Chemotherapy Induced Constipation?

Answer 11

Prevention: Fluids, high fibre foods, exercise
Treatment: Laxatives

Question 12

What is alopecia?

Answer 12

Loss of hair due to hair cells being affected by systemic chemotherapy

Question 13

What is myelosuppression?

Answer 13

A condition where the bone marrow doesn’t make enough of the key components of blood. There is a lack of red blood cells, white blood cells and platelets.

Question 14

What can occur as a result of myelosuppression?

Answer 14

Red blood cells: Anaemia, fatigue
White blood cells: Increased infection risk, neutropenia
Platelets: Thrombocytopenia, easy bruising, may bleed more easily

Question 15

What is febrile neutropenia?

Answer 15

Fever in patient with neutropenia. It is defined by a patient having a temp >38 degrees and an absolute neutrophil count <0.5 x10-9/L.

Question 16

What is used/done to prevent febrile neutropenia?

Answer 16

Good hygiene, avoiding sick people, consider prophylactic antibiotics, G-CSF prophylaxis, chemotherapy dose reductions

Question 17

What is GCSF prophylaxis?

Answer 17

GCSF will promote the production of neutrophils, can be given as Figrastim or Lenograstim SC injections for 5-7 days after chemotherapy

Question 18

What are the risk factors for febrile neutropenia?

Answer 18

Severe symptoms, hypotensive, COPD, Leukaemia treatment (Imatinib), dehydration, >60yrs old, inpatient

Question 19

What is used to treat neutropenic sepsis?

Answer 19

Low risk: oral antibiotics (Ciprofloxacin, Co-amoxiclav)
High risk: IV antibiotics (Tazocin, Vancomycin, Gentamicin), with 48 hour review

Question 20

What is a dermatological side effect of Capecitabine?

Answer 20

Hand-foot syndrome (Palmar-plantar erythema)

Question 21

What can be used to treat EGFR inhibitor skin reactions?

Answer 21

Mild: Topical antibiotic cream (Clindamycin)
Moderate: Add topical steroid (Hydrocortisone), add oral antibiotics (Doxycycline)
Severe: Dermatology referral, reduced chemo dose

Question 22

What is extravasation?

Answer 22

Where there are leakages from a vein into surrounding tissues causing inflammation, pain, necrosis and blistering of skin.

Question 23

What can be given for a hypersensitivity reaction in chemotherapy?

Answer 23

Oral Dexamethasone 20mg, Oral Chlorphenamine 4mg

Question 24

What are the toxicities associated with Methotrexate therapy?

Answer 24

Stomatitis (mouth ulcers)

Question 25

What are the toxicities associated with Bleomycin therapy?

Answer 25

Pulmonary Fibrosis (scarring lung disease)

Question 26

What are the toxicities associated with Doxorubicin?

Answer 26

Cardiac toxicity (left ventricular dysfunction due to free radicals from Doxorubicin metabolism affecting cardiomyocytes)

Question 27

What are the toxicities associated with Cisplatin?

Answer 27

Ototoxicity (reactive oxygen species in ear tissue) and Nephrotoxicity (oxidative stress to renal tubular cells)

Question 28

What are the toxicities associated with CyclophospHamide? (Think HC)

Answer 28

Haemorrhagic cystitis (inflamed bladder lining, starts bleeding)

Question 29

What are the toxicities associated with Vincristine/Vinblastine? (Think SPINE)

Answer 29

Peripheral neuropathy