Management of Cancer Side Effects and Pain

Question 1

Cardiotoxicity

Answer 1

Monitor ejection fraction w/ MUGA scan

Doxorubicin is the main drug that causes

-Usually chronic - cumulative chemo dosing or large dose radiation causes

Give Dexrazoxane (Zinecard) - cardioprotective, prevent free radical formation

Question 2

Skin/Cutaneous Response

Answer 2

Radiation dermatitis - superficial burn

Monitor, avoid heat, avoid vasodilation

Acral erythema (hand-foot syndrome)

• Painful palms/soles with erythema, desquamation, ulceration
• Caused by 5-FU, capecitabine, doxorubicin
• Hold ice during infusion to prevent; +/- pyridoxine

Question 3

Diarrhea

Answer 3

GI mucosa very sensitive to cytotoxic drugs - causes bowel wall to slough off

Common, especially w/ antimetabolites

Tx: Loperamide, diphenoxylate (opioid)

Question 4

Hemorrhagic Cystitis

Answer 4

Cyclophosphamides, ifosfamide, high dose methotrexate

Keep patient hydrated

Continuously flush bladder - catheter or diuretics

Question 5

Mucositis/Stomatitis/Esophagitis

Answer 5

Direct effect of drug or radiation to the oral mucosa

Lymphoma, leukemia, head and neck cancer

Sx: xerostomia, thrush/candidiasis, mucositis - painful

Mucositis has a grading scale from WHO

Question 6

Nausea/Vomiting

Answer 6

Vagus nerve stimulation with serotonin, CTZ medulla stimulated, or anticipatory

Alkylating agents

r/o other causes

Give an antiemetic

If chemo-induced: 5-HT3 agent + Dexamethasone most effective

-Palonosetron (Aloxi) is the preferred agent

Question 7

Nephrotoxicity

Answer 7

Direct or indirect (metabolite) damage

Cisplatin, high dose Methotrexate

Tx: adequate fluid intake

Question 8

Neurotoxicity

Answer 8

Direct effect, metabolite encephalopathy, or intracranial hemorrhage from coagulopathy or myelosuppression

Get w/ high dose chemo, drugs crossing BBB

Sx: tinnitus, peripheral neuropathy, motor loss, paresthesias

Colon cancer treatment causes neuropathy of hands & feet which will improve w/ cessation of treatment but may never fully resolve

Question 9

Pulmonary Toxicity

Answer 9

Bleomycin, Busulfan, radiotherapy

Toxic damage to alveoli -> pneumonitis and permanent pulmonary fibrosis

Tx: DC therapy, high dose steroids

-Monitor w/ PFTs

Question 10

Myelosuppression

Answer 10

Leukemia

Taxanes

Alkylating agents

Antimetabolites

Etoposide

Nitrosoureas