Blue Book: Chemotherapy Adverse effects

Question 1

Name immediate complications of chemotherapy

Answer 1

Nausea/vomiting
Myelosuppresion
GI disturbance: diarrhea/consipation/oral mucositis.
Alopecia
Neurological: peripheral neuropathies. autonomic neuropathy.
Genitourinary: nephrotoxicity, bladder toxicity
Cardiac: arrythmias
Hepatic: transient rise ion liver enzymes.
Skin: extravasation, Palmer plantar erythema, photosensitivity, pigmentation.
Other: Myalgia, arthralgia, allergic reaction, lethargy, changes in hearing, changes to taste, ‘chemo-brain’: inability to concentrate

Long term: fertility, future cancers

Question 2

What drugs can be given to reduce nausea and vominting?

Answer 2

It is better to prevent nausea and vomting. Steroid (dexamethasone) are given to all patients undergoing chemotherapy.

The depending on the chemotherapy treatment other anti-emetics such as ondansetron or metoclopramide may be given.

Question 3

Why does myelosuppression occur?

What happens to the red and white blood cells during myelosuppression. Generally when does this occur and how long does recovery normally take?

Answer 3

Chemotherapy causes bone marrow suppression by killing haematopoietic progenitor cells.

Leucopenia (especially neutropenia) and thrombocytopenia (low red blood cells). This occurs after 10-14 days from the beginning of each cycle. Recovery normally occurs after 3-4 weeks.

Question 4

What neutrophil count is associated with a high risk of infection?

Answer 4

0.5X109/1

Question 5

Why does oral mucositis occur?

What can be given as a treatment?

What can be a complication of severe oral mucositis?

Answer 5

Damage to the rapidly dividing gastrointestinal epithelium.

Antibacterial mouthwash: Chlorhexidine or Benzydamine hydrochloride/

Inability to eat and consequent weight loss. Dose of drug should be decreased.

Question 6

Why does dirrhorea occur and how can it be managed?

Answer 6

Due to colitis or small bowel mucosal inflammation. Give Loperamide.

Question 7

What causes constipation in chemotherapy patients?

When can paralytic ileus occur?

Answer 7

• Dehydration due to reduced oral intake due to nausea.
• Adverse effects of medication such as opiate analgesics or 5-HT antagonists.

Paralytic ileus can occur due to the autonomic neuropathy after platinum agents or vinca alkaloids.

Question 8

What neurological deficits maybe long term?

Answer 8

Peripheral neuropathies, particularly with cisplatin, taxanes and vinca alkaloids.

Ototoxicity, associated with cisplatin.

Question 9

What is extravasation?

Answer 9

chemotherapy leakage around the vein which can damage the tissues.

Question 10

What are the long term complications of chemotherapy?

Answer 10

• Second malignancies: chemotherapy drugs cause sub-lethal DNA damage.
• Fertility: most chemotherapy drugs reduce fertility, alkylating agents leave the patient infertile or high dose.
• Pulmonary: Long term complications from pulmonary fibrpsis or pneumonitis.

Question 11

How does chemotherapy affect fertility in females?

Answer 11

• Temporarily or permanently stop you overies from producing eggs.
• causing peroids to become irregular or stop (temporary infertility). Once chemotherapy stops it can take 2 months for peroids to start again. Younger women have a better chance of recovering periods and fertility.
• If they do not come back you will experience menopause: hot flushes, vaginal dryness, anxiety, mood swings, reduced sex drive. Early menopause is before 45.

Question 12

What is the risk of early menopause? How can this be prevented?

Answer 12

Osteoporosis. Give hormone replacement therapy (HRT)

Question 13

Give 4causes of myelosuppression in cancer.

Answer 13

1. Treatment related: myelosuppressive chemotherapy.
2. Bone marrow infilatration: Malignant infiltration can produce pancytopenia. More common in haematological cancers and certain solid eg breast, lung and prostate.
3. Para-neoplastic syndromes: can result in pancytopenia or single haematopoietic lineages.
4. Blood loss from a tumour can cause anaemia, usally iron deficient. Anaemia cause by repeated chemo is often macrocytic.

Question 14

If prolonged or excessive degrees of suppression occur what investigations should take place?

Answer 14

Blood film
Measurements of haematinics: folate, B12, iron
Bone marrow aspirate

Question 15

When should anaemia be treated? How can it be treated?

Answer 15

Hb less than 10g/dl
Blood transfusion
Recombinant erythropoietin (preventative)

Question 16

What are the clinical signs of thrombocytopenia?

Answer 16

Petechial haemorrhage, spontaneous nosebleeds, corneal haemorrhage, haematuria.

Question 17

What platelet count is at risk of spontaneous bleeding eg cerebral haemorrhage?

What platelet count range should be supported by a transfusion, especially if infected?

Answer 17

Below 10 x 10.9/L

10 x 10.9/L to 20 x 10.9/L

Question 18

What is neutropenic sepsis?

Answer 18

Neutropenic sepsis is a medical emergency requiring immediate urgent broad spectrum antibiotics. (Tazocin: piperacillin and tazobactam)

Question 19

How may the patients present?

What should you immediately do?

Answer 19

1. er. Any prexic patient following cytotoxic chemotherapy requires immediate review (within 1 hour) to assess neutropenia. If the total white count is less than 1 X 109/L in patient management with antib’s

2 Feel non-specifically unwell.

Carefully look for potential sites of infection (however rectal and vaginal examinations should not be done). Extensive blood culture, urine, sputum, throat and a chest x ray.

Question 20

When should the antibiotics be changed?

Answer 20

Failure to respond after 48 hours to second line broad spectrum antibiotics.

Identification of causative organism.

Persistent fever, consider additional antifungal or antiviral agents. Atypical infections such as pneumocystis pneumonia (PCP), fungal or viral infections may occur.

Question 21

How to prevent neutropenic sepsis?

Answer 21

• In some patients such as COPD prophylactic antibiotics can be given.
• Dose modification.
• Colony stimulating factors:.