General S/S
This term refers to the time period 7-12 days after chemotherapy when blood counts are at their lowest, usually lasting for 5-7 days.
What is the nadir?
58% of female oncology patients find this treatment side effect to be the most devastating.
What is alopecia?
This symptom characterized by unilateral ascending edema, hyperkeratosis, and localized heaviness is often caused by lymphadenectomy.
What is lymphedema?
This ancillary care provider should be consulted as early as possible when anorexia is identified.
Who is the dietician?
This intervention is best practice for preventing or minimizing the development of chemotherapy-induced peripheral neuropathy.
What is cryotherapy?
Cold booties and gloves applied with high-risk treatment, especially taxanes and platinum-based agents.
This radiation side effect occurs regardless of the targeted treatment site and progressively worsens over time.
What is fatigue?
A moderate maculopapular rash r/t checkpoint inhibitor treatment typically indicates this.
What is a strong desired effect in the body?
A patient presenting with new dyspnea, angina, and tachypnea who reports a localized tenderness in her right lower leg that started a few days ago should be worked up for this potential side effect of cancer and cancer treatment.
What is PE and DVT?
This is the first line of treatment for diarrhea.
What is loperamide (imodium)?
Compression of the ureters by a tumor is an example of this type of renal injury.
What is postrenal obstruction?
This chemotherapy side effect is responsible for the most dose adjustments and delays.
What is myelosuppression?
In addition to assessing the hands and feet of a patient with hand foot syndrome, this assessment should also be included.
What is interference with ADLs?
Patients with left ventricular dysfunction should be educated on these topics to help manage their symptoms and prompt early interventions. (Remember the mnemonic.)
Heart SMART: symptoms to watch for/ report, medications, activity, regular weight monitoring, and “toss the salt shaker”
Also weight loss, smoking cessation, decreased alcohol intake, stress reduction.
Magic mouthwash, avoiding spicy foods, avoiding hot foods, and palifermin can all help reduce discomfort from this chemotherapy and RT side effect.
What is mucositis?
Patients receiving radiation to the brain should be taught to immediately report worsening headaches, vision/ hearing changes, altered mental status, and/or balance changes which could indicate this condition warranting urgent intervention.
What is encephalopathy?
Case Study!
You call Ms. Ng, a 52yo female who underwent ovarian tumor debulking surgery one week ago, to discuss chemotherapy scheduling. During this call, she asks if it’s normal for her incision to feel hot while the rest of her feels really cold. What questions would you like to ask her and why?
These s/s could indicate a post-op infection.
Need to ask about additional infectious s/s: fever (and antipyretic usage), shivering, high or racing heart rate, incision pus/ oozing/ heat/ redness/ worsening pain, etc. Can she send a pic of the incision?
Consult with provider. They may be comfortable prescribing abx based on telephone assessment + MyChart photo or may prefer to see patient if they can come to clinic that day. After hours, patients are instructed to go to urgent care or ED.
A patient receiving concurrent cetuximab and radiation therapy to treat advanced head and neck cancer should be closely monitored for this dermatologic side effect.
What is severe radiation dermatitis?
Case Study!
Mr. Nowak is a 68yo male who completed thoracic RT and combination cisplatin and etoposide chemotherapy for SCLC (small cell lung cancer) 3 months ago. When he arrives in the clinic for follow up, you notice he can’t seem to catch his breath after walking to the clinic room, and he also has a frequent dry cough. His SPO2 is 87% on room air, and his temperature is 100.1℉. These are new findings compared with his previous assessment.
What complication of treatment do you suspect may be to blame?
Pulmonary toxicity r/t RT and chemotherapy.
A patient taking regular opioids, ondansetron, and IV iron would be at higher risk for this GI side effect.
What is constipation?
This chemotherapy agent is most commonly known to directly cause nephrotoxicity.
What is Cisplatin?
Case Study!
Anne is a 63yo female calling the oncologist’s office reporting “fast heart beating she can feel in her chest and excessive tiredness”. You see she received cycle 3 of gemcitabine + cisplatin chemotherapy for cholangiocarcinoma 9 days prior, and her last blood draw from 3 days ago showed ANC .9, Hgb 8.6, and Plt 62. What questions would you like to ask her and why?
She has likely reached or is close to nadir, so counts would be even lower.
Palpitations and fatigue point toward anemia being the main concern. Need to assess for s/s of active bleeding. Can also screen for infectious s/s.
Anticipate she needs CBC re-checked; may need G-CSF if not already given and possibly transfusion.
Case Study!
Mr. Khan is receiving Atezolizumab (a PDL-1 inhibitor) for NSCLC (non-small cell lung cancer) and reports a new rash all over his trunk. You notice a warm, reddish maculopapular rash. He reports it is particularly itchy and irritating.
What is one supportive treatment you might anticipate starting with, and what is one item of patient education would you like to provide to protect it from worsening?
Start with emollient creams, oral antihistamines, doxycycline, and/or topical steroids before moving to corticosteroids or delaying/ reducing atezolizumab dose.
Patient education includes completely avoiding direct sunlight (use of barriers), gentle soap/ creams only, pat skin dry, no temperature extremes, wear loose & non-irritating clothing, report fever or infectious s/s.
Case Study!
Ms. O’Leary is a 77 yo female breast cancer patient presenting for cycle 4 of maintenance trastuzumab after completing TCH chemotherapy (paclitaxel, carboplatin, and herceptin aka trastuzumab). She has a 40-pack year smoking history, and her last MUGA showed an LVEF of 50%. The treatment plan indicates she does not need another MUGA/ ECHO for 3 more weeks. What red flags would you look for in your assessment?
DOE and fluid retention.
H/o smoking, trastuzumab, h/o low LVEF, and older age all increase the risk for LVD. Other s/s include tachycardia, palpitations, chest pain, JVD, fatigue, and non-productive cough.
If you suspect worsening LVD, you should check with the provider before treating. They may want to check LVEF prior to the next dose, or they may continue to treat as trastuzumab-induced LVD is largely reversible. Anthracycline or RT-induced LVD is much harder to reverse.
Case Study!
You are the infusion nurse treating Ms. Ricci who is actively receiving cyclophosphamide (cytoxan) for breast cancer treatment. About half way through the infusion she approaches the nurses’ station on her way back from the bathroom and reports painful urination and blood in her urine. How would you respond to this development?
He can take the compazine now and start the zofran 48-72 hours after he received his aloxi dose yesterday. He should also call back if he is unable to keep meds, food, and hydration down or if the nausea does not improve.
Mr. Boden recently underwent a TURPS procedure and is experiencing frequent urinary incontinence. What goals would you like your patient education to address?
Minimizing toileting barriers, maintaining skin integrity, and monitoring for UTI s/s.