Radiation Side Effect Management, Chemotherapy Agents and Targeted Cancer Therapies

What are the different skin reactions?

1. Erythema

2. Dry desquamation

3. Moist desquamation

What dose does erythema occur at?

2000 cGy

What dose does dry desquamation occur at?

3000 cGy

What dose dose moist desquamation occur at?

Over 4000 cGy

What general interventions are available for skin reactions?

1. Assess and monitor skin for changes

2. Moisturizing lotion

3. Avoid exposing treated area to heat, cold, deodorant, razor shaving, scented products

4. Wear loose clothing

What interventions can be provided for dry desquamation?

If dry desquamation has occurred and skin is tender, cortisone cream can be used

What interventions can be provided for moist desquamation?

Consult nurse and physician for prescriptions

Topical antibiotics can be used for open areas to prevent infections

What dose does alopecia occur at?

2000 cGy

What interventions are available for alopecia?

1. Protect scalp from heat, cold, wind

2. Avoid frequent shampooing

3. Avoid hair dryers, sprays, gels

4. Apply lotion to scalp

5. Explore body image issues (wigs)

What are mouth changes that can occur?

1. Mucositis

2. Xerostomia

3. Dysguesia

What are signs and symptoms of mucositis?

Red and swollen gums and mouth

Sores in mouth

Pain when eating, speaking, swallowing

What dose can mouth changes occur at?

2000 to 3000 cGy, xerostomia can be permanent at 3200 cGy

What interventions are available for mouth changes?

1. Soft, bland diet

2. Avoid alcohol, acidic and spicy foods

3. Practice gentle dental care

4. Use mouth rinses as directed by physician

What dose dose pharyngitis occur at? What intervention is available?

2000 to 3000 cGy

Assess for odynophagia and dietary changes

What dose does laryngitis occur at? What intervention is available?

4000 cGy

Optimize hydration

What dose does esophagitis occur at?

2000 to 3000 cGy

What interventions are available for esophagitis?

1. Modify diet to soft, non-spicy, and non-acidic food

2. Use topical anesthetics and analgesics as prescribed

3. Assess for cough

What dose does nausea and vomiting occur at?

1000 to 2000 cGy

What interventions are available for nausea and vomiting?

1. Patients should be prescribed anti-emetics prophylactically

2. Fluids to prevent dehydration

3. Low fat and low sugar diet

4. Eat small, frequent meals

What dose does enteritis occur at?

2000 to 5000 cGy

What dose does cystitis occur at?

3000 to 4000 cGy

What is skin pallor?

Paleness

Need to monitor low hemoglobin, WBC, platelets

What neurological changes require immediate referral to the radiation oncologist?

1. Headaches

2. Visual changes

3. Difficulty with blanace

4. Change in mood or behaviour

5. Changes in mental status

What are the side effects of anti-androgens?

Impotence and gynecomastia

What are the side effects of anti-estrogen (tamoxifen)?

Nausea and vomiting

Hot flashes

Changes in menustral pattern

Increase in bone pain

Hypercalcemia

Fluid rentention

What are the side effects of LHRH receptor blockers?

Impotence

Gynecomastia

Decreased libido

Increase in bone and tumour pain

Genital atrophy

What is considered to be significant and severe weight loss at:

a) 1 month

b) 3 month

c) 6 month

1 Month:

Significant: 5%

Severe: >5%

3 Months:

Significant: 7.5%

Severe: >7.5%

6 Months:

Significant: 10%

Severe: >10%

Describe the normal adult values for:

a) pulse

b) respirations

c) blood pressure

a) 60 to 100 beats per minute

b) 12 to 15 breaths per minute

c) 90 to 140 mmHg, 60 to 80 mmHg

What are major side effects of carboplatin?

Nausea and vomiting, bone marrow suppression, ototoxicity, neurotoxicity, hyperuricemia

What are major side effects of cisplatin?

Nausea and vomiting, myelosuppression, neurotoxicity, nephrotoxicity, hypokalemia, hypomagnesemia

What are major side effects of capecitabine?

Diarrhea, nausea and vomiting, mucositis, myelosuppression, neurotoxicity

*GI cancers

What are major side effects of gemcitabine?

Nausea and vomiting, myelosuppression, hair loss, rash, bruising, bleeding

What are major side effects of 5-FU?

Diarrhea, nausea and vomiting, oral and GI ulcers, vein hyperpigmentation, radiation recall

What is imatinib mesylate (Gleevec) used to treat?

Leukemia and GI cancers

What is Rituximab (rituxan) used to treat?

B-cell non-Hodgkin lymphoma, leukemia