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Supportive Care in Oncology

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by

Dana Manning

on 1 March 2016

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Transcript of Supportive Care in Oncology

Supportive Care in Oncology
Objectives:
Examine common supportive care topics for oncology care, including:
Mucositis
Spinal Cord Compression / SVCS
Complications of brain metastases
Complications of bone metastases / hypercalcemia
Urologic Complications
Tumor Lysis Syndrome
Extravasation
Neutropenia
Up to 75% of patients may develop
Associated with taxanes, anthracyclines, platinum agents, methotrexate, fluoropyrimidines

Mucositis
Pharmacist Intervention
Encourage good oral hygiene
Bland oral rinses/toothpastes (no EtOH, Cinnamon, Mint)
Oral antimicrobials when routine hygiene is not possible
Topical anesthetics

Palifermin (Kepivance®)
Keratinocyte Growth Factor
60 mcg/kg/day, 3 days before and 3 days after
Separate from Chemo by 24 hours each side

Arise from tumors putting pressure on other structures
Spinal Cord Compression / SCVS
Typically from fast-growing tumors (lymphoma, SCLC)
Pain control is important
Dexamehasone plays a cornerstone role: reduce edema, inhibit inflammation,
Surgery, radiation, and cytotoxic chemotherapy may shrink tumors quickly
Associated with Lung, Breast, melanoma, GI, and hematologic cancers
Brain Metastases
Pharmacological therapy centers on Dexamethasone to treat cerebreal edema and Anticonvulsant therapy (30-40% may experience seizure activity, phenytoin is commonly used)
Dexamethasone is usually given: 10mg IV loading dose followed by 4mg Po or IV q6h
Mannitol (1-2 g/kg IV bolus) can be used to prevent cerebral herniation
10-30% of patients, most common with breast, lung, prostate cancers
Bone Mets / Hypercalcemia
Lesions may be osteolytic, tumors may also be caused by secretion of humoral factors (PTH related protein)
Normal Ca++ is 8.5-10.5 (remember to correct for low albumin)
Treatment
Other Therapy
Increase fluid intake
Ambulate
D/C Calcium supplementation

Hydration and Diuresis are good for Sx relief, but antiresorptive therapy should also be initiated

Calcitonin is the DOC for emergency hypercalcemia becau
se it is rapid!
Classification
Mild: 10.5-11.9 mg/dl

Moderate: 12-13.9 mg/dl

Severe: >14 mg/dl
Pharmacologic causes:

Cyclophosphamide
Ifosfamide
Chronic low doses
High doses
Urologic Complications
Non-pharmacologic causes:

Pelvic irradiation
CMV
Viral infection (herpes, adenovirus)
Prevention and treatment
Stop/substitute drug
HYDRATION!
Bladder irrigation with catheterization
Hyperhydration: 3 L/m2/day with furosemide
Pain management
Mesna: binds to acrolein
Oral mesna only 50% bioavailable
Half life is 1.2 hours - must be dosed frequently and beyond chemo dosing
Risk
Vesicants and Irritants
Extravasation
Anthracyclines
Vinca alkaloids
Taxanes
Platinum agents
Cyclophosphamide
Etoposide
Irinotecan/topotecan
fluorouracil
gemcitabine
Neutropenia and Anemia
Neutropenia is a major dose-limiting toxicity of chemotherapy
Colony Stimulating Factors
G-CSF (granulocyte): filgrastim, pegfilgrastim
GM-CSF (Granulocyte-monocyte): Sargramostim
High risk: >20%
Intermediate risk 10-20%
Low risk <10%
ANC < 500 cells/uL or <1000 cells/uL with a predicted decrease to <500 cells/uL
Tumor Lysis Syndrome
Question
What are the typical components of "magic mouthwash"?
Question
Why aren't PO Bisphosphonates used to treat hypercalcemia?
Question
What would be the Mesna dose for a patient receiving one dose of 2.5 g/m2/d of ifosfamide over 4 hours, IV? They are 5'7" and weigh 180 lbs.
Question
Explain the mechanism by which insulin and calcium reduce hyperkalemia.
Question
What is the proposed mechanism for topical DMSO use in extravasation treatment?

What about cold? Hot?
Question
What is the main side effect of colony stimulating factors?
Question
What is the mechanism of action of mannitol in reducing cerebral edema?
Full transcript