Oncology: Chemo

Overview of Chemotherapy and Radiation Side Effects

  • Discusses common side effects of chemotherapy (chemo) and radiation treatments.

Myelosuppression

  • Myelosuppression is the first and most dangerous side effect of chemo and radiation.
  • It is particularly evident with intravenous (IV) chemo and radiation targeting:
    • Pelvis
    • Thoracic lumbar vertebrae
    • Sternum
  • The affected bones are major sites for blood cell production.
Aplastic Anemia
  • Aplastic anemia often occurs in patients receiving cancer treatment.
  • Characterized by low blood cell count, particularly
    • Platelets
    • White blood cells
    • Red blood cells
  • Symptoms peak 7 to 10 days post-treatment when blood cell counts are at their lowest.
  • Neutropenic patients (those with low neutrophils) must avoid public places due to a weakened immune system.
Nursing Considerations for Neutropenic Patients
  • A neutropenic patient having a fever, e.g., a temperature of 100°F, is concerning and warrants immediate medical evaluation.
  • The administration of supportive treatments may involve:
    • Granulocyte colony-stimulating factor (G-CSF)
    • Granulocyte macrophage colony-stimulating factor (GM-CSF)
    • Erythropoietin (synthetic version) for red blood cells
    • Nuvega (interleukin-11) for platelet production
Nutrition and Diet in Aplastic Anemia
  • Refer to pages 403-406 of the current nutrition textbook for dietary guidelines for immunocompromised patients.
  • Patients with neutropenia should refrain from eating:
    • Fresh fruits and flowers
    • Raw vegetables due to the risk of bacteria
  • Recommended food options include:
    • Frozen fruits and vegetables

Thrombocytopenia

  • Thrombocytopenia may accompany aplastic anemia, especially in early cancer stages.
  • Widespread clotting can occur even before diagnosis, leading to unusual clot formations.

Fatigue in Cancer Patients

  • Extreme fatigue is common due to:
    • Increased metabolism from chemo
    • Anemia
    • Neutropenia
    • Stress and depression
  • Walking can help alleviate fatigue, as illustrated by a patient gradually increasing her walking distance.

Gastrointestinal Side Effects

Nausea and Vomiting
  • Patients commonly experience:
    • Nausea and vomiting during and after chemotherapy.
    • Anticipatory nausea before treatment.
  • Zofran has been effective in managing chemotherapy-induced nausea; it was designed for patients who need to remain alert.
  • Many patients prefer Zofran due to its sedative-free relief compared to older medications.
Diarrhea
  • Radiation in the pelvic region may lead to persistent diarrhea, impacting patients' quality of life.
Stomatitis and Oral Care
  • Patients may develop:
    • Dry mouth
    • Difficulty swallowing
    • Loss of taste (often a metallic taste)
  • Suggestions for coping:
    • Saliva substitutes
    • Using various spices to enhance flavor, especially hot sauces.
  • Severe cases require intensive oral care and hydration due to mucosal damage.
Anorexia
  • Reasons for reduced appetite include:
    • Nausea
    • Stress
    • Depression
  • Monitoring intake is crucial, ensuring patients receive the necessary nutrition.

Skin and Hair Effects

Alopecia
  • Hair loss is a major side effect due to targeted chemotherapy on rapidly dividing cells (e.g., hair follicles).
  • Scalp cooling caps are an emerging method to mitigate hair loss by reducing blood flow to hair follicles during treatment.
    • Studies show improved hair retention during therapy with cooling caps.
    • Costs for availability are a concern for many.
Hand-foot Syndrome
  • Patients may experience dryness and irritation in palms and soles, with significant discomfort.

Pulmonary Effects

  • Patients receiving radiation to the chest may develop:
    • Inflammation of the trachea or lung lining
    • Pulmonary fibrosis, leading to stiffening of lung tissue.

Cardiovascular Effects

  • Radiation in the chest can affect heart function leading to:
    • Left ventricular dysfunction
    • Cardiotoxicity from specific chemotherapy drugs.

Neurological and Cognitive Effects

  • Brain radiation can lead to:
    • Personality changes and cognitive impairments (often termed "chemo brain")
    • Difficulty concentrating and memory retention.
  • Case study mentioned of patient experiencing acute personality changes during radiation therapy.

Treatment and Monitoring

  • Monoclonal antibodies and biologic therapies are discussed for immunotherapy.
  • Colony-stimulating factors may induce severe bone pain post-administration, requiring pain management strategies.
Stem Cell Therapy
  • Hematopoietic stem cells are vital for patients undergoing high-dose chemotherapy:
    • Involves stem cell harvesting and administration post-myeloablative therapy.
    • Risks include engraftment failure and graft versus host disease (GVHD).

Metabolic Emergencies

  • The syndrome of inappropriate antidiuretic hormone (SIADH) can occur.
  • Hypercalcemia due to bone metastasis leads to elevated calcium levels in the blood.
    • Symptoms and management are echoed from previous chapters on electrolyte imbalances.

Infiltrative Emergencies

  • Tumor lysis syndrome arises as a rapid cellular breakdown from effective chemotherapy or radiation, causing:
    • Elevated uric acid and potassium levels,
    • Risks of gout and cardiac complications from hyperkalemia.

Conclusion

  • The complexities of cancer treatment and management highlight the need for holistic approaches towards care and nutrition.
  • Psychological support and ongoing education are crucial for both patients and families during treatment processes.