Module 5.2.2 (Management of adverse effects of chemotherapy) Flashcards
What are all the adverse effects of chemotherapy?
- Extravasation
- Nausea and Vomiting
- Myelosuppression
- Neutropenia
- Mucositis
- Alopecia
- Gonadal Toxicity
- GI Toxicity
- Cardiac Toxicity
- Renal Toxicity
- Neurological Toxicity
- Hand and foot syndrome
- Tumour Lysis Syndrome
- Immunotherapy Adverse Effects
What are examples of combination chmeptherapy?
- BEP (Bleomycin / Etoposide / Cisplatin)
- FEC (Fluorouracil / Epirubicin / Cyclophosphamide)
What does the following chemotherapy regimens mean;
A) Primary (conventional)
B) Neo-adjuvant
C) Concurrent/Concomitant
D) Adjuvant
E) Local/Regional
A)
- Chemotherapy is sole cancer treatment
- Used to decrease tumour size / prevent tumour growth / reduce symptoms
- Potentially curative
B)
- Given BEFORE surgery/radiotherapy
- Aim to decrease tumour size to enable complete resection / less invasive surgery / organ-sparing operations
- Improve effectiveness and tolerability of radiotherapy (limited field)
- Prevent cancer spread by eradication undetectable micrometastases
C)
- Given concurrently with radiotherapy / targeted therapy / hormonal therapy
- Aim to improve treatment outcomes Vs single agent
- Chemotherapy as ‘radiosensitiser
D)
- Given AFTER primary therapy (post-surgery, postradiotherapy)
- Patient ‘cured’ (no detectable cancer) prior to adjuvant chemotherapy
- Eradicate systemic micrometastatic disease to increase cure rate (i.e. decrease rate of relapse)
- Important for prompt initiation after primary therapy
- Outcomes measured in terms of rates of recurrence / survival
E)
- Local control
- May be part of a curative regimen Intrathecal / intra-arterial / intrapleural / intraperitoneal / topical / intravesicular / isolated limb-perfusion
How to counsel on oral chemotherapy?
- Indication
- When to start / stop treatment
- How to take tablets
- Warning Signs
- Safety –> storage and cytotoxic waste
- Emergency contact numbers
- Complementary Medicines
What are the warning signs and symptoms of oral chemotherapy?
- Temperature ≥ 38°C
- Chest pain
- Chills / Shivers / Shakes
- Unusual bleeding (including gum/nose bleeds)
- Pain / burning / blood in urine
- Vomiting (not responsive to nausea medication)
- Diarrhoea (four or more bowel movements than usual and/or night-time diarrhoea)
- Shortness of breath
What are the significant interactions of oral chemotherapy?
Many chemotherapy drugs are metabolised by CYP450 enzymes
Warfarin and Azole antifungals (e.g. fluconazole / voriconazole)
What are the local effects of IV chemotherapy?
- Pain at administration site
- Local allergic reaction
- Discolouration/hyperpigmentation of vein
- Cold sensation
- Chemical phlebitis
- Extravasation:
> The unintentional instillation or leakage of a drug or substance out of a blood vessel into surrounding tissue
> Consequences depend on nature of drug(s) being infused
How to treat extravasation?
- Stop injection/infusion immediately
- Aspirate extravasated fluid
- Elevate limb
- Follow extravasation kit guidelines
- Treatments include hot or cold compresses, DMSO, hyaluronidase (depending on type of chemotherapy extravasated)
What are some non-drug treatments for the treatment of nausea and vomiting?
- eat several small snacks and meals each day (rather than three large meals), and chew the food well
- peppermints or peppermint tea may help with nausea
- ginger may help with nausea, and to try ginger biscuits or ginger beer
- sip drinks slowly
- avoid drinking too much before a meal
- avoid alcohol and high volumes of coffee
- avoid fried foods and foods with a strong smell
What medications are use to treat/prevent cytotoxic induced nausea or vomiting?
Dopamine receptor antagonists
- Metoclopramide / Domperidone / Haloperidol / Prochlorperazine
5-HT3 receptor antagonists –> the best
- Ondansetron / Granisetron / Palonosetron
Corticosteroids
- Dexamethasone / Prednisolone / Methylprednisolone
Substance P Neurokinin1 receptor antagonist
- Aprepitant / Neupitant
Benzodiazepenes
- Lorazepam
Other
- Cyclizine / Levomepromazine / Olanzapine / Cannabinoids / Antihistamines
What are the common Anti-proliferative effects of chemotherapy
myelosuppression, mucositis, alopecia and gonadal damage
What to monitor patients for pre-treatment
full blood picture (FBP) pretreatment
- Effect of chemotherapy can suppress all blood cells formed in bone marrow
What is febrile neutropenia? How to treat?
- Temperature > 38.3°C or > 38°C on 2 occasions
- ANC (absolute neutropil count) < 0.5x109/L or 1.0x109/L and falling
Treatment
- Requires prompt initiation of empirical broad spectrum intravenous antibiotics (e.g. piperacillin/tazobactam 4.5g QID IV)
What is the Granulocyte Colony Stimulating Factor (GCSF)? What drugs are used?
Clue: for minimising neutropenia
Helps white blood cells recover–> decrease incidence of infection secondary to neutropenia in patients treated with myelosuppresive chemotherapy
- Filgrastim 5microg/kg subcutaneously daily during neutropenic period
- Pegfilgrastim (pegylated formulation) 6mg subcutaneously given 24 hours after chemotherapy
How to manage mucositis? What is used for treatment?
Management
Mouthcare
- Soft toothbrushing after meals / before bed
- Regular alcohol-free mouthwashes following brushing
- Avoid painful stimuli (smoking, alcohol, acidic foods, hot drinks, spicy food, effervescent drinks, excess salt)
Treatment
- Local anaesthetics (e.g. lidocaine mouthwash)
- Systemic analgesia
- Topical antifungals (e.g. nystatin)
Immunotherapy: type of cancer treatment that boosts the body’s natural defences to fight cancer. It uses substances made by the body or in a laboratory to improve or restore immune system function
What are the types of immunotherapy?
Monoclonal antibodies
Pembrolizumab / Nivolumab / Ipilimumab / Avelumab / Atezolizumab
Non-specific immunotherapies
Interferons / interleukins / haematopoietic growth factors
Cancer vaccines
Trigger body’s immune system to detect cancer cells e.g. Bacillus Calmette-Guérin (BCG) vaccine given intravesically to treat bladder cancer
