Complications of chemotherapy Flashcards
Other cells affected
- Hair follicles
- Stem cells
- Mucosal cells
Common side-effects of chemotherapy
- Nausea + vomiting
- Diarrhoea
- Mucositis
- Hair loss
- Fatigue
- Immunosuppression (infection)
- Fertility problems
Why does N + V occur?
- The body sees medicine as foreign.
- Activates chemoreceptor trigger zone.
- Sets of warning signals in brain and digestive system.
- Activation of vomiting centre.
Types of N + V
- Acute
- Delayed
- Anticipatory
- Breakthrough
- Refractory
Acute N + V
Occurs during the first 24 hours after chemo
Delayed
- Occurs more than 24 hours after chemo
- May continue for up to 6-7 days after.
Anticipatory
- N + V that occurs prior to beginning a new cycle of chemo.
- Common after 3-4 cycles after chemo.
- Badly controlled acute or delayed symptoms.
- May be a learned response:
- Following N + V induced on a previous cycle
- Anxiety response
Breakthrough
- Development of N + V despite standard anti-emetic therapy.
- Requires treatment with an additional pharmacological agent.
Refractory
- Failed treatment of both standard and rescue medicine.
Cisplatin
- Grade 3 N+ V, if no anti-emetic administered.
- N = Inadequate caloric intake, IV fluid, tube feedings, TPN indicated> 24 hours.
- V = 6+ episodes in 24 hours
- Use moderate/high risk regime + APREPITANT
Drug regime for Low risk N + V
- E.g. single agent fluorouracil regimes.
- Monotherapy with dopamine antagonist (metoclopramide OR domperidone).
- First dose pre-chemo, then regularly for 5-7 days (or PRN).
Moderate/high risk N +V drug regime
e.g. Cis/5FU
Pre-chemo:
- Dexamethasone + 5HT-3 antagonist (ondansetron and granisetron)
Post-chemo:
- Dexamethasone + 5HT-3 antagonist + dopamine antagonist
- 5-7 days after
Diarrhoea
- Incidence varies between cyckes
- Loperamide (just in case).
Mucositis
- Occurs when cancer treatments breakdown epithelial cells lining the GI tract.
- Early treatment is required to minimise eating/drinking issues.
- Mouthwashes
- Difflam
- Chlorhexidine
- Good oral hygiene
- Soft-bristled toothbrush
- Avoid cutting gums
Hair loss
Extent of hair loss varies between different drugs.
- Scalp cooling (cold-caps)
- Time-consuming and not particularly comfortable.
Fatigue
- Results from the stress of chemo or N + V
- Performace status monitored between cycles.
- Poor PS = delay or stop chemo
Performace status
0 = no symptoms, average activity level.
1 = symptomatic, can carry out normal daily activities.
2 = Symptomatic, bed less than half the day, some assistance required.
3 = Symptomatic, bed more than half the day.
4 = Bedridden
Haematological side-effects
- Myelosuppression
- Thrombocytopenia
- Neutropenia
Monitoring for haematological side-effects
- FBC before each cycle - delays/dose reduction if inadequate.
- WCC = 3+
- Neutrophils = 1-1.5+
- Platelets = 100+
- Counsel patients to be vigilant and report possible symptoms
- Transfusion if very low Hb (anaemia)
Myelosuppression
- Decreased bone marrow activity
- Fewer RBCs, WBCs and platelets.
Myelosuppression - management
- Transfusions
- Growth factors
- Time between cycles
- Isolation in sterile environment
WBC normal range (x10*9/L)
4-11
Platelets normal range (x10*9/L)
150-400
Neutrophils normal range (x10*9/L)
2-7.5
Tumour lysis syndrome
- Tumour cells release their contents into the bloodstream spontaneously or in response to therapy.
- Associated with aggresive/large haematological cancers (high cell burden)
Tumour lysis syndrome - process
- Chemotherapy causes mass cell lysis.
- Uric acid (and electrolytes) released from cells as they break down.
- Deranged U+Es = acute kidney injury.
Tumour lysis syndrome - treatment
- Prevention is curcial
- Allopurinol or rasburicase
- Promote excretion of uric acid.
Subfertility
- Spermbanking
- IVF
Cardiomyopathy
- ECG monitoring
- Cardiac glycosides
Hepatotoxicity
Liver function tests (pre and post)
Nephrotoxicity / Haemorrhagic cystitis
Hydration and forced diuresis (for ifosfamide and cyclophosphamide)
Patient education
- Balnced info on side-effects and benefits of treatment.
- Adress:
- What are the side effects?
- How likely are they to happen to me?
- What should I do if they occur?
Aims of treatment
- Reduce discomfort
- Reduce morbidity and mortality
- Increase tolerable dose threshold
