Supportive care

What is neutropenic sepsis?

Temperature above 38 degrees

with neutrophils below 0.5×10^-9 or lower

Define supportive care

Supportive care is the prevention and management of the adverse effects of cancer and its treatment.

What is first line treatment for neutropenic sepsis?

Immediate IV piperacillin tazobactam within one hour

Why are cancer patients at high infection risk?

Neutropenia mucosal injury immunosuppressive drugs and disease related immune dysfunction

What prophylaxis is used in prolonged neutropenia?

Aciclovir

posaconazol

levofloxacin

GCSF

What are main causes of anaemia in cancer?

• Chemotherapy

• marrow infiltration

• chronic disease

• renal impairment

• nutritional deficiency

When are RBC transfusions indicated?

Symptomatic anaemia or haemoglobin <70–80 g/L

When are Erythropoiesis‑stimulating agents ESAs used?

In palliative settings to reduce transfusion need

delete 1

delete 1

Which chemotherapy agents are highly emetogenic?

Cisplatin high dose cyclophosphamide and anthracycline plus cyclophosphamide

What is antiemetic regimen for highly emetogenic chemo?

5-HT3 antagonist + NK1 antagonist + dexamethasone ± olanzapine

What is mucositis?

Inflammation and ulceration of mucosal surfaces due to chemo or radiotherapy

How is mucositis managed?

• Oral hygiene

• saline rinses

• benzydamine

• analgesia

• nutritional support

• palifermin

• avoiding alcoholic mouth washes

What is tumour lysis syndrome?

Metabolic emergency which occurs when large number of cancer cells die and their intraceullar content is released into blood stream.

Leads to high potassium, phosphate, uric acid and low calcium and acute kidney injury

How is TLS prevented?

IV fluids allopurinol or rasburicase depending on risk

What are key features of CRS?

Fever hypotension and hypoxia after CAR T therapy

What is ICANS?

Immune effector Cell-Associated Neurotoxicity Syndrome, a CAR T neurotoxicity causing confusion aphasia or seizures

How is ICANS treated?

Steroids (not tocilizumab as doesn’t cross BBB)

What are common immune related adverse events?

• Colitis

• pneumonitis

• hepatitis

• thyroiditis

• rash

• adrenal insufficiency

How are moderate severe irAEs managed?

Hold immunotherapy and give high dose steroids, gradually re-titrate

What are early HSCT complications?

Neutropenia

mucositis

infection

Veno- occlusive disease (VOD)

acute GvHD

What are late Haematopoietic stem cell transplantation HSCT complications?

• Chronic GvHD

• endocrine dysfunction

• infertility

• secondary cancers

What causes cancer associated VTE?

• Hypercoagulability

• immobility

• chemotherapy

• central lines

How is cancer associated VTE treated?

LMWH or DOACs for at least six months

What are common causes of diarrhoea in cancer patients?

• Chemotherapy

• immunotherapy

• colitis

• infection

• GvHD

delete 2

delete 2