Complications of chemotherapy Flashcards
What are the classic side effects of chemotherapy?
- Nausea
- Vomiting
- Fatigue
- Hair loss
- Diarrhoea and mucositis
- Infection and drop in white cell count
What is conventional chemotherapy?
An umbrella term for chemotherapy that consists of
- Traditional (older) chemotherapy drugs
- Lack of target specificity to cancer cells
- Targeting rapidly dividing cells
- With classic chemotherapy side effects
Why do chemotherapy side effects occur?
- Conventional chemotherapy targets rapidly dividing cells which lead to the destruction of hair follicles, stem cells and mucosal cells
- Leads to non specific toxicity through killing of normal body cells
Define acute vomiting
Expected vomiting after the first 24 hours after chemotherapy administration
Define delayed vomiting
Occurs more than 24 hours after chemotherapy administration and up to 6-7 days after chemo
Define anticipatory vomiting
Occurs prior to beginning of a new cycle of chemotherapy as it expected from anxiety or previous cycle response- most common after 3-4 cycles of chemo
Define breakthrough vomiting
Development of symptoms despite anti-emetic therapy that require treatment with additional pharmacological agent
Define refractory vomiting
Patients who have failed on both standard and rescue medication
What are the different grades of nausea?
Grade 1- Loss of appetite without alteration of eating habits
Grade 2- Oral intake decreased without significant weight loss, dehydration, malnutrition, IV fluids indicated for less than 24 hours
Grade 3- Inadequate oral caloric or fluid intake; IV fluids, tube feeding or TPN indicated for more than or equal to 24 hours
Grade 4- Life threatening consequences
Grade 5- DEATH
What are the different grades of vomiting
Grade 1- 1 episode in 24 hours
Grade 2- 2-5 in 24 hours; IV fluids indicated at less than 24 hours
Grade 3- More than or equal to 6 episodes in 24 hours; IV fluids or TPN indicated at more than or equal to 24 hours
Grade 4- Life threatening consequences
Grade 5- DEATH
What grade is cisplatin for nausea and vomiting
GRADE 3- all cause high rates for nausea and vomiting
Give examples of anti-emetics and the receptor site and action they have
- Metoclopramide- D2 antagonist, 5-HT3 antagonist, 5HT4 agonist
- Domperidone- D2 antagonist
- Hyoscine hydrobromide- Muscarinic antagonist
- Ondansertron- 5HT3 antagonist
What regimen in the lungs and GI has the highest rates for emetogenicity (sick)?
Lung:
Cis/pemetrexed: High
Cisplatin/Vinorelbine: High
Upper GI:
Cis/5FU: High
ECF: High
Gem/cis: High
Describe a typical anti-emetic regime used?
- Given pre and post chemotherapy
- Dexamethasone in low doses of 2mg or 4mg BD usually max 3 days pre and post chemo
- 5-HT3 antagonist like ondansetron or granisetron for 1-3 days as very constipating for pre and post chemo
- Dopamine antagonist given with 5-HT3 and dexamethasone post chemo such as domperidone or metoclopramide max 5 days PRN
How do you treat diarrhoea in cancer patients
Loperamide: can be taken at 2 hourly
Irinotecan: used in colorectal cancer treatments-
Atropine 300mg sc pre-irinotecan to minimuse cholinergic side effects like diarrhoea
How do you treat mucositis in patients?
- Early treatment to avoid issues with eating and drinking
- Mouthwashes with Difflam and chlorhexidine
- Good oral hygiene is necessary and soft toothbrush
How do you treat hair loss?
Prevented with scalp cooling
Very time consuming and not particularly comfortable (brain freeze)
How do you measure fatigue and what are the different levels?
Performance levels
0= normal activity level, no symptoms
1= normal activity leave, symptomatic
2= Bed less than half the day, assistance with daily activities, symptomatic
3= bed more than half a day, symptomatic
4= Bed written
What happens if a patient has anaemia on chemotherapy?
- May transfuse to increase haemoglobin levels
2. May have to delay next cycle or reduce doses
What is thrombocytopenia and neutropenia and what causes and how do you treat them?
Thrombocytopenia- bleeding and bruising
Neutropenia- infection prone
Causes: Bone marrow suppression- myelosuppression
Treatment:
FBC taken before each cycle of chemotherapy
Delays/dose reductions if not adequate
Patients counselled to be vigilant and report possible symptoms
Thermometers essential
What is tumour lysis syndrome, what can it lead to and how do you treat it
Associated with aggressive and large haematological cancers
High cell burden with chemotherapy leads to mass cell lysis
Uric acid and electrolytes released from cells as they breakdown
Leading to deranged U and E and acute kidney injury
Treatment: allopurinol or rasburicase to promote uric acid secretion
What is burkitts lymphoma
Patient losing up to 10kg in weight with first cycle of chemo due to breakdown of all cells
What are the specific side effects of platinum drugs
- Very emetogenic- high rate of nausea and vomiting
- Very ototoxic (hearing) and nephrotoxic (kidney)
- Requiring IV fluids before and after administration
how do you treat specific platinum side effects
Strong anti-emetics like aprepitant (NK1 inhibitor)
Use of IV fluids Mg and K to prevent electrolyte drop and extreme urine output of >100ml per hour to ensure it is excreted quickly
