0430 - Chemo and its Complications

Question 1

Define Chemotherapy

Answer 1

A systemically administered, drug-based anti-cancer treatment. The term generally refers to cytotoxic chemotherapy - destroying rapidly growing cancer cells.

Question 2

What is the difference between acute and late chemotherapy toxicity?

Answer 2

Acute toxicity is common and generally self-limited and reversible.
Chronic/late toxicity is less common, and often requires more complex management/poses a higher risk.

Question 3

What are some common acute toxicities associated with chemotherapy?

Answer 3

Alopecia
Nausea/vomiting
Oral toxicity
Enterotoxicity
Bone marrow toxicity
Amennorhoea
Cognitive impairment/brain fog

Question 4

What are some possible late toxicities associated with chemotherapy?

Answer 4

Infertility
Early menopause/low androgen levels in men
Myelosuppression
Vascular disease
Peripheral neuropathy
Renal impairment
Cognitive impairment

Question 5

Give a brief overview of chemotherapy induced nausea and vomiting

Answer 5

Very common and feared complication
3 distinct entities - acute (24h), delayed (>24hr) and anticipatory (psychological) emesis.
Can be well-controlled (e.g. with ondansetron) - aim is to control form first cycle of treatment.

Question 6

Give a brief overview of chemotherapy-induced oral mucositis

Answer 6

Disruption, inflammation, or ulceration of oral mucosa that peaks 7 days post-treatment and heals in 10-14 days.
Broad spectrum of presentation - erythema to ulceration which can allow secondary infection.
Condition is self-limiting and treatment is supportive.
If severe, may need to stop ongoing chemotherapy.

Question 7

Give a brief overview of chemotherapy-induced GI toxicity

Answer 7

Ranges from diarrhoea/constipation to C. Diff-associated colitis
Treatment is supportive, with antibiotics for infection if required.

Question 8

Give a brief overview of Neutropenic fever

Answer 8

Patients on chemo should be assumed neutropenic until proven otherwise
Defined as Neutrophils 38.3 or >38 on two occasions.
Signs of infection may be subtle, and will increase as Pt recovers neutrophils
Treat with broad spectrum empirical antibiotics and monitor closely.
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