Management of Patients Receiving Chemotherapy

What is the purpose of colony-stimulating factors in neutropenia management?

They act on the bone marrow to enhance neutrophil production.

Name two colony-stimulating factor medications used for neutropenia.

Neupogen (filgrastim) and Neulasta (pegfilgrastim).

Why is hand hygiene important for someone with neutropenia?

To prevent infections because the patient’s immune system is compromised.

What type of diet is recommended for patients with neutropenia in the hospital?

A neutropenia diet, which includes cooked foods and excludes raw vegetables, undercooked fruits or eggs, and shellfish.

Can patients with neutropenia keep indoor plants or flowers?

No, they should avoid plants or flowers because they may harbor bacteria or mold.

What precautions should visitors take when visiting a patient with neutropenia?

Visitors should be healthy, without coughs or signs of infection, and patient exposure to sick individuals should be minimized.

Why should patients with neutropenia minimize visitors and family contact?

To reduce the risk of infection from people who may be sick.

How does chemotherapy affect the immune system?

Chemotherapy may fight cancer but gives the immune system a serious “time-out,” leaving patients immunocompromised and more vulnerable to infections.

Are chemotherapy medications selective in targeting cells?

No, they are not selective, which is why patients are considered immunocompromised.

Why should immunocompromised patients be cautious about common illnesses like a cold or cough?

Because even minor infections can progress quickly, potentially leading to serious complications like pneumonia.

What general health precautions should patients receiving chemotherapy take?

They should take extreme care of their health, maintain regular medical supervision, stay up to date with vaccinations, and follow preventive medication schedules.

How can chemotherapy patients reduce their risk of infection in public?

They should avoid crowds if possible, and if exposure is unavoidable, wear a mask to protect themselves.

Why is it important for chemotherapy patients to maintain preventive care?

Preventive care helps reduce infection risk and supports overall health while the immune system is weakened.

What is thrombocytopenia?

A condition characterized by decreases platelets in the blood

What is the normal platelet count in adults?

150,000 - 450,000/uL

At what platelet count is a patient considered to have thrombocytopenia?

When platelets fall below 150,000/µL.

What is the primary treatment for thrombocytopenia?

Platelet transfusion.

Why should patients with thrombocytopenia avoid aspirin or NSAIDs?

These medications increase the risk of bleeding.

What dental precautions should a patient with thrombocytopenia take?

Use a soft-bristled toothbrush to minimize gum bleeding.

What shaving precautions are recommended for thrombocytopenic patients?

Use electric razors only to reduce the risk of cuts and bleeding.

Why should intramuscular (IM) injections be avoided in thrombocytopenia?

They can cause internal bleeding or hematomas due to low platelet counts.

What happens when platelet counts drop below 20,000/µL?

Spontaneous bleeding can occur, potentially internally in the GI tract or brain.

How should patients be monitored for spontaneous bleeding?

Watch for changes in level of consciousness, as bleeding may occur without visible signs.

What is anemia?

A condition characterized by decreased hemoglobin levels in the blood.

What are common signs and symptoms of anemia?

Fatigue, low energy, and decreased activity tolerance. Patients may say, “I want to do everything but I don’t have the energy.”

What is the main cause of fatigue in anemia?

Decreased hemoglobin reduces oxygen delivery to tissues.

What are the primary treatments for anemia?

Packed red blood cell (RBC) transfusion, erythropoietin-stimulating agents, and iron supplementation.

What is the function of erythropoietin in the body?

It is a hormone secreted by the kidneys that stimulates the bone marrow to produce more red blood cells.

Why do some patients with anemia need erythropoietin supplementation?

Their bone marrow is suppressed, so supplemental erythropoietin stimulates RBC production.

Name two erythropoietin-stimulating agents used to treat anemia.

Epoietin-alfa (Epogen, Procrit) and darbepoietin-alfa (Aranesp).

What role does iron supplementation play in anemia treatment?

Iron supports hemoglobin production, which is necessary for healthy RBCs.

What are common gastrointestinal (GI) tract injuries caused by chemotherapy?

Stomatitis/mucositis, diarrhea, constipation, and nausea/vomiting.

What is stomatitis/mucositis?

Inflammation of the mucous membrane of the mouth.

Why does chemotherapy cause GI tract injuries?

Chemotherapy destroys rapidly growing cells in the GI tract, which can damage normal cells and lead to GI side effects.

Which chemotherapy-related GI side effect is associated with the destruction of normal GI cells?

Diarrhea.

How are oral ulcers from stomatitis typically managed?

With a medication called magic mouthwash.

Who prepares the magic mouthwash and how is it customized?

The pharmacist prepares it according to the proportions recommended by the oncologist.

What ingredients may be included in magic mouthwash?

Antacids, antihistamines, local anesthetics, nystatin, steroids, and sometimes antibiotics (as directed by the oncologist).

How should a patient use magic mouthwash?

Swish thoroughly in the mouth, keep it in as long as possible, then spit it out—do not swallow.

What medication is used to manage chemotherapy-related diarrhea?

Antidiarrheals.

What medication is recommended for constipation caused by chemotherapy?

Stool softeners.

How is nausea and vomiting managed during chemotherapy?

With antiemetics.

What is anticipatory nausea management in chemotherapy?

Giving antiemetics before chemotherapy begins to prevent nausea and reduce discomfort.

What is alopecia in chemotherapy patients?

Alopecia is hair loss caused by chemotherapy.

Is alopecia from chemotherapy permanent?

No, it is reversible—hair grows back once the medication clears from the body.

What type of reproductive toxicity can chemotherapy cause?

It can damage reproductive cells, leading to fertility issues.

What fertility preservation options are available for patients before chemotherapy?

Sperm banking or egg freezing.

When should sperm banking or egg freezing be done for chemotherapy patients?

Preferably before starting chemotherapy for the best results.

Why do cancer patients often experience severe pain?

Rapidly growing cancer cells invade and compress normal cells, causing extreme pain.

What type of medication is often required to manage cancer-related pain?

Narcotic (opioid) pain medications.

What are some non-pharmacological methods for pain management in chemotherapy patients?

Music therapy, distraction techniques, yoga, or other relaxing activities.

What strategies help manage fatigue in chemotherapy patients?

Frequent rest and maintaining adequate nutrition.

What causes Tumor Lysis Syndrome (TLS)?

Rapid death of cancer cells due to chemotherapy, leading to the release of intracellular contents into the bloodstream.

Which intracellular components are released during TLS?

Potassium, phosphorus, nucleic acids, and cytokines.

Why does potassium increase in TLS?

Potassium is normally an intracellular cation; when cells rupture, it is released into the bloodstream.

How does TLS affect phosphorus and calcium levels?

Phosphorus levels increase, which causes calcium levels to decrease.

What happens to uric acid levels in TLS and why?

Uric acid levels increase due to the breakdown of nucleic acids released from cancer cells.

What can excessive cytokine release during TLS lead to?

An inflammatory reaction that can result in multi-organ failure, especially affecting the kidneys.

What kidney complication can develop in TLS?

Acute kidney injury due to the buildup of uric acid and other substances.

In TLS, which lab value decreases while others increase?

Calcium decreases, while potassium, phosphorus, uric acid, and creatinine increase.

What is the first-line approach to manage uric acid levels in TLS?

Medications such as allopurinol or rasburicase.

Why is hydration important in TLS management?

IV or oral fluids help flush out excess electrolytes and uric acid, reducing kidney injury risk.

Which electrolyte imbalances must be corrected in TLS?

Hyperkalemia, hypocalcemia, and hyperphosphatemia.

When might dialysis be necessary for TLS patients?

If the patient develops acute kidney injury that cannot be managed with fluids and medications.