Cancer Foundations
Match each patient scenario with the most appropriate term: Cure, Control, Palliation, Adjuvant Therapy, or Neoadjuvant Therapy.
Patient A: A patient receives systemic chemotherapy before surgery with the intent of shrinking the tumor and improving the ability to surgically remove it.
Patient B: A patient undergoes surgical removal of the primary tumor and then receives systemic chemotherapy to eliminate residual microscopic disease and reduce the risk of recurrence.
Patient C: A patient's treatment is intended to completely eradicate the cancer and achieve long-term disease-free survival.
Patient D: Treatment is primarily intended to relieve cancer-related symptoms and improve quality of life rather than eradicate the malignancy.
What drug class should be used for anticipatory CINV?
What are Benzodiazepines?
Your patient receives viscous lidocaine 2% for mucositis. Give the important counseling points for its use.
Swish & Spit
This medication will numb your entire mouth, ensure diet modifications are made
Avoid spicy foods
Increase risk for accidental trauma
A patient begins experiencing abdominal cramping and diarrhea while irinotecan is infusing.
What type of diarrhea is occurring, and what medication treats it?
What is early-onset irinotecan-induced diarrhea due to cholinergic syndrome; atropine 0.25–1 mg IV/SQ?
Differentiate neutropenia, severe neutropenia, and profound neutropenia based on the patient’s absolute neutrophil count (ANC).
Correct Answer:
A pathology report describes a tumor as poorly differentiated, locally invasive, and capable of spreading to distant tissues.
Based on these characteristics, is this tumor more consistent with a benign or malignant tumor, and what features support your answer?
What is malignant tumor?
Key characteristics include:
There are four major types of chemotherapy-induced nausea and vomiting discussed in class. Differentiate acute, delayed, anticipatory, and breakthrough CINV based on when or why they occur.
This agent causes mucositis/stomatitis in approximately 60% of patients when prophylaxis is not provided. Identify the offending agent AND the prophylactic medication.
Offending Agent: Everolimus
Prophylactic medication: Dexamethasone oral solution
A patient has severe chemotherapy-induced diarrhea that remains uncontrolled despite standard antidiarrheal therapy. What agent may be used for severe or refractory chemotherapy-induced diarrhea?
What is octreotide?
A patient with a nonmyeloid malignancy is receiving myelosuppressive chemotherapy with palliative intent. Her Hgb is 8.9 g/dL, and she has at least two additional months of chemotherapy planned.
The oncologist asks whether epoetin alfa is appropriate.
Before recommending the ESA, what additional laboratory assessment must be performed and corrected if abnormal, and why?
What are iron studies, including:
If iron is inadequate, iron replacement should be provided, because an ESA will not adequately correct the anemia if sufficient iron is unavailable for RBC/hemoglobin production.
Two major types of genes involved in cancer development are proto-oncogenes and tumor suppressor genes. What is the normal function of each, and what happens when each becomes altered?
A patient's regimen contains Daunorubicin and Oxaliplatin. How should the overall regimen be approached for CINV prophylaxis based on what we discussed in class?
What is highly emetogenic risk requiring a three- to four-drug prophylactic antiemetic regimen?
How can a patient prepare the bland rinse formulation
1 teaspoon of salt and 1 teaspoon of baking soda in 1 pint of water
A patient receiving chemotherapy develops constipation. The pharmacist recommends senna and polyethylene glycol (PEG). What type of laxative is each medication, and how does each help relieve constipation?
G-CSFs are used for which type of chemotherapy-induced myelosuppression: neutropenia, anemia, and/or thrombocytopenia?
Then:
What is neutropenia?
A patient's cancer is documented as:
T2 N1 M0
Using the TNM staging system, explain what T, N, and M represent and interpret what this patient's M0 tells you.
What is:
A patient appropriately received fosaprepitant + ondansetron + dexamethasone before chemotherapy. Several hours later, she develops significant nausea and vomiting.
What drugs could be used for breakthrough CINV
What is Phenothiazines (promethazine, prochlorperazine)?
What is Dopamine Antagonists (Chlorpromazine, Haloperidol, Metoclopramide)?
What is Cannabinoids (dronabinol)?
A patient develops uncomplicated, mild-to-moderate chemotherapy-induced oral mucositis. What are the treatment options that may be used to manage the patient's symptoms?
What are:
A patient calls the clinic 72 hours after irinotecan reporting severe diarrhea.
What type is this, and what treatment should be initiated (Include dosing)?
What is late-onset irinotecan-induced diarrhea treated with aggressive loperamide?
Dosing: 4 mg PO × 1, followed by 2 mg PO every 2 hours until a formed bowel movement. (more stringent than direction on over-the-counter box)
Chemotherapy-induced myelosuppression can result in neutropenia, thrombocytopenia, or anemia. What are the main treatment/supportive-care options for each?
The CAUTION acronym identifies seven warning signs that may indicate cancer. What does each letter in CAUTION stand for?
What is:
Change in bowel or bladder habits
A sore that does not heal
Unusual bleeding or discharge
Thickening or lump in the breast or elsewhere
Indigestion or difficulty swallowing
Obvious change in a wart or mole
Nagging cough or hoarseness
A patient is beginning highly emetogenic chemotherapy. First, name the FOUR antiemetic drug classes/agents that can make up the four-drug prophylactic regimen. Then provide ONE important counseling point for each agent.
Should every patient with chemotherapy-induced mucositis automatically receive an antifungal? If not, when should antifungal therapy be used, and name TWO agents discussed in class.
Answer: No. Antifungal therapy is used when there is evidence/suspicion of a fungal infection such as oral candidiasis (thrush). Treatment agents: nystatin oral suspension and clotrimazole troches
A patient receiving chemotherapy reports worsening constipation. She has poor oral intake and drinks very little fluid. A family member recommends that she significantly increase her fiber intake with a Psyllium.
As the pharmacist, would you recommend this strategy? Explain why or why not, and identify more appropriate pharmacologic options.
No. Bulk-forming/fiber agents (psyllium) should be used cautiously or avoided when a patient has inadequate fluid intake because they can increase stool bulk without sufficient hydration and potentially contribute to mechanical obstruction.
More appropriate options may include:
A patient with a nonmyeloid malignancy has chemotherapy-induced anemia. State the major criteria that must be met before an ESA should be used.
What is: