Wk 10: Adverse effects of cancer treatment Flashcards
During pre-assessment, what type of things are included during patient assessment?
- Psychological
- Fears
- Social
- Self care
- Eating + drinking
- Pain assessment
What are the common side effects associated w/ chemo?
- Fatigue
- Myelosuppression
- Nausea + vom
- Inc risk of infection
- Alopecia
- Diarrhoea/constipation
- Neuropathy
- Mucositis
What are the potential factors of cancer related fatigue?
- Anaemia
- Wasting
- Tumour burden
- Sleep disturbances
- Pain
- Treatment
What is myelosuppression?
- Red prod of erythrocytes, WBC + platelets
- Occurs: 7-10 days after treatment
- 20 days recovery
What are the risks of myelosuppression?
- Low erythrocytes: anaemia - treat w/ blood transfusion
- Red WBC: neutropenia
- Red platelets: thrombocytopenia
How is myelosuppression managed?
- Blood counts before treatment + before each cycle of chemo
- Low: red dose + delay treatment
What is given for the prophylaxis of myelosuppression?
High risk of neutropenia:
- Antibiotics
- Antifungal
- Antiviral
Growth factors:
- G-granulocytes (filgrastim)
- E-granulocytes (erythropoietin)
What is neutropenic sepsis?
Neutropenia w/ temp +/- symptoms of infection (medical emergency)
What is given to treat neutropenic sepsis?
Broad spectrum antibiotics:
- Tazocin 48hrs
- Meropenem 48hrs
- Ceftazidime 48hrs
- Anaerobic cover: metronidazole
What causes sickness in the body?
- Chemo activates NT
- Chemoreceptor trigger zone (brain) + GI tract
- Vomiting centre in brain = sickness
Which patients are more susceptible to nausea + vomiting?
- Female
- Under 50
- Non drinker
- Anxious
- Previous motion sickness/morning sickness
What is given for chemo triggering the chemoreceptor trigger zone?
- Dopamine: metoclopramide
- Serotonin: ondansetron
Whats is given for chemo, radiotherapy + surgery triggering the GI tract?
- Dopamine: metoclopramide
- Serotonin: ondansetron
- Cyclizine
- Hyoscine
What is given for anticipation nausea + vomiting?
Benzodiazepines
What are the types of N+V?
- Acute (w/in 24hrs)
- Delayed
- Anticipatory (fear/memory)
- Breakthrough (despite antiemetics)
- Refractory
What are the counselling points for a patient w/ anorexia + taste disturbances?
- Eat healthily + liquids
- Maintain healthy weight
- Make + freeze meals in advance
- Avoid fad diets
- Monitor weight
- Refer to dietetics
- May need artificial feeding (TPN) or via PEG/JEG
What is mucositis?
- Oral mucosa vulnerable to chemo due to rapid growth + cell turnover rate
- Inflammation of mouth = ulceration
- Inc risk of neutropenia
What is the management strategy of mucositis?
- Good mouth care
- Mouth wash
- Good nutrition
What is mucositis associated with?
Antimetabolites + anthracyclines
What is the treatment of established mucositis?
- Topical analgesics/anaesthetics
- Topical ineffective: Systemic pain control measures
What are the counselling points for a patient with constipation?
- Consider normal bowel function
- Maintain adequate fluid
- Healthy diet
- Gentle exercise
What is given for constipation?
- Docusate sodium
- Macrogol
What needs to be monitored if a patient has constipation?
Bowel obs or spinal cord compression
What are the complications of diarrhoea?
- Dehydration
- Metabolic disturbances
- Malnutrition
What is the counselling points for diarrhoea?
- Maintain fluid
- Healthy diet
- Loperamide prn
- Seek advice if > 48hrs
What are the symptoms of diarrhoea associated with irinotecan?
- > 24hrs = cholinergic
- Sweating
- Hyper salivation
- Visual disturbances
- Abdominal cramps
- Watery eyes
- Hypo
How do you treat a patient w/ diarrhoea associated with irinotecan?
- REPORT
- After 24hrs treat w/ loperamide
- Report if lasts > 24hrs despite loperamide
What is peripheral neuropathy associated with?
- Chemo
- Disease
- Complication of surgery/radiotherapy
What are important points of peripheral neuropathy?
- Initially mild, gradually worsens
- Dose red required
- Reversible + irreversible
What are the symptoms of peripheral neuropathy?
- Numbness, tingling of hands + feet
- Burning of hands + feet
- Numbness round mouth
- Constipation
- Loss of sensation + positional sense
- Leg cramps
- Difficulty picking things up
What are the symptoms of hand-foot syndrome?
Palm + sole:
- Redness
- Swelling
- Burning
- Tenderness
- Tight skin
- Blisters
What is hand-foot syndrome caused by?
- Capecitabine
- 5-fluouracil
- Doxorubicin
What are the counselling points for hand-foot syndrome?
- Avoid highly perfumed prods
- Moisturise
- Avoid sun exposure
- Short nails
- Report rashes + itchiness
What is a preventable measure of alopecia?
Cold cap
What is tumour lysis syndrome?
Metabolic disturbances that occurs as result of rapid cell lysis - common w/ leukaemia + lymphoma
How does tumour lysis syndrome occur?
- K + phosphate released from dying cells
- Nucleic acid breakdown = uric acid
- Hypocalcemia = secondary response to hyperphosphatemia + renal failure
What is the treatment/prevention for tumour lysis syndrome?
- IV hydration
- Manage hyperuricemia (allopurinol)
- Start 12hrs prior to treatment
What are the longer term effects in terms of infertility + teratogenicity?
- Avoid pregnancy esp 1st trimester
- Amenorrhoea
- Induce early menopause
- Sterility: depression of spermatogenesis (pre-counselling + sperm storage)
- LT effects in children
Give examples of long term effects
- 2nd cancer
- CV/respiratory
- Psychological issues
What are the side effects of cetuximab?
- Targets EGFR on normal skin cells
- Rashes, dry skin + itching
What are the side effects of hormone therapy in women?
- Menopausal symptoms
- Hair thinning
- Osteoporosis
- Thrombosis
What are the side effects of hormone therapy in men?
- Muscle strength reduction
- Erectile dysfunction
- Low libido
- Hair thinning
Which chemotherapy agents have the highest risk of causing cancer induced nausea + vomiting?
- Cisplatin
- High dose cyclophosphamide
Which chemotherapy agents have the mid risk of causing cancer induced nausea + vomiting?
- Carboplatin
- Low dose cyclophos
- Doxorubicin
Which chemotherapy agents have a low risk of causing cancer induced nausea + vomiting?
- Taxanes
- 5-fluorouracil
- Methotrexate
Which chemotherapy agents have the lowest risk of causing cancer induced nausea + vomiting?
- Vincristine
- Bleomycin
