GI symptoms

Question 1

Types of chemotherapy-induced nausea & vomiting

Answer 1

Acute (start within 1-2 hours; resolve in 24 hours)
Delayed (start in 48-72 hours, resolve in 1-3 days)
Breakthrough
Anticipatory
Refractory

Question 2

Patient-specific risk factors for CINV

Answer 2

Young age (<50)
Female
Low prior alcohol intake (<1/day)
Previous CINV
Motion sickness
Previous emesis in pregnancy
Anxiety

Question 3

NCCN recommendation for high emetogenic risk chemo

Answer 3

Acute phase:
NK1
5HT3
DEXA
+/- OLA

Delayed phase:
NK1 (if Emend; 2-3)
DEX (2-4)
+/- OLA (2-4)

Question 4

NCCN recommendation for moderate emetogenic risk chemo

Answer 4

Acute phase:
5HT3
DEXA

Delayed phase:
DEXA (2-3)

Question 5

NCCN recommendation for low emetogenic risk chemo

Answer 5

Acute phase only:
5HT3 or DEXA or DOPA

Question 6

Non-pharmacological measures for CINV

Answer 6

• Small, frequent meals
• Avoid greasy/spicy/very sweet/salt food
• Sip small amounts of water ad avoid large amounts at once
• Avoid caffeine
• Avoid lying flat for 2 hours after eating

Question 7

Causative agents for chemotherapy-induced diarrhea

Answer 7

Cisplatin/oxaliplatin
Cyclophosphamide
Cytarabine
5-FU/Capecitabine
Gemcitabine
Methotrexate
Doxorubicin/daunorubicin
Texans
Irinotecan/topotecan
Targeted therapy

Question 8

Patient-specific risk factors for chemotherapy-induced diarrhea

Answer 8

• > 65 y.o.
• Female
• ECOG performance status at least 2
• Bowel inflammation or malabsorption
• Bowel malignancy
• Biliary obstruction

Question 9

CTCAE grading for chemotherapy-induced diarrhea

Answer 9

1: increase of <4 stools/day
2: increase of 4-6 stools/day & limiting ADL
3: Increase of 7 and above stools/day & limiting self-care; hospitalisation needed
4: Life-threatening & urgent intervention needed

Question 10

Uncomplicated CID

Answer 10

Grade 1-2
No complicating symptoms

Question 11

Complicated CID

Answer 11

Grade 3-4 or
Grade 1-2 plus any one of:
- Cramps
- >Grade 2 N/V
- Decreased performance status
- Fever, sepsis
- Neutropenia
- Frank bleeding
- Dehydration

Question 12

Patient-specific risk factors for mucositis

Answer 12

• Autoimmune conditions
• DM
• Female (for 5FU)
• Caucasians > African Americans
• Genetic predisposition (metabolising enzyme deficiency)
• Folic acid / B12 deficiency
• Smoking and alcohol
• Xerostomia and infections

Question 13

Treatment-related risk factors for mucositis

Answer 13

• Chemotherapy
• Radiation