Supportive Care During Cancer Chemotherapy

Question 1

How do you manage fever in a patient on chemotherapy?

Answer 1

Children with fever must be emergently evaluated for bacterial sepsis and other invasive infection. Give broad-spectrum antibiotics as soon as cultures are obtained.

Question 2

What prophylactic antibiotic is prescribed to patients undergoing chemotherapy?

Answer 2

Trimethoprim/sulfamethoxazole (Bactrim) is prescribed as prophylaxis against Pneumocystis pneumonia.

Question 3

Which vaccines are contraindicated for children receiving chemotherapy?

Answer 3

Live viral vaccines are contraindicated during treatment.

Question 4

What is tumor lysis syndrome?

Answer 4

Tumor lysis syndrome is a medical emergency and describes the metabolic complications of rapid cell lysis noted with the initiation of chemotherapy or with high cell turnover with certain tumors.

Question 5

Which (4) electrolyte abnormalities are characteristic of tumor lysis syndrome?

Answer 5

Hyperkalemia, hyperphosphatemia, hypocalcemia, and hyperuricemia.

Question 6

Which three malignancies have high cell turnover which predisposes to tumor lysis even before chemotherapy initiation?

Answer 6

Burkitt lymphoma, T-cell ALL, and AML with hyperleukocytosis.

Question 7

What therapies are used to prevent tumor lysis syndrome in at-risk patients?

Answer 7

Hyperhydration with fluids that do not contain potassium and administration of allopurinol, which prevents the formation of uric acid.

Question 8

Why must blood products be irradiated in patients undergoing chemotherapy?

Answer 8

Irradiation of blood products helps to prevent life-threatening graft-vs-host disease.