Upon completion of the chapter, the reader will be able to:
Describe the impact of various supportive care interventions on the prognosis of patients with cancer.
Discuss the scientific basis for providing various supportive care interventions in the oncology patient population.
Identify patient-related and disease-related risk factors in defining a population for whom supportive care interventions would be of benefit.
Recognize typical presenting signs and symptoms of common complications and emergencies that require supportive care interventions.
Outline appropriate prevention and management strategies for various supportive care interventions.
Prepare a monitoring plan to evaluate the efficacy and toxicity of pharmacotherapy interventions for supportive care problems.
Patients with cancer are at risk for serious adverse events that result from their treatment, the cancer, or both. The management of these complications is generally referred to as supportive care (or symptom management). Examples of treatment-related complications include chemotherapy-induced nausea and vomiting (CINV), myelosuppression, febrile neutropenia (FN), hemorrhagic cystitis, mucositis, and tumor lysis syndrome (TLS). Tumor or cancer-related complications include superior vena cava (SVC) obstruction, spinal cord compression, hypercalcemia, and brain metastases. In some cases, these events can be life threatening. SVC obstruction, spinal cord compression, TLS, and hypercalcemia have traditionally been defined as oncologic emergencies. Treatment- and disease-related complications in the oncology population require rapid assessment and supportive care interventions. The onset of oncologic emergencies may herald the onset of an undiagnosed malignancy or progression or relapse of a preexisting malignancy. Optimal management of patients with various oncologic emergencies and complications requiring supportive care interventions can significantly decrease morbidity and mortality in patients with cancer. This chapter provides an overview of these issues. First, an overview of the management of common side effects of treatment is given. Later, a summary of common oncologic emergencies is presented.
CHEMOTHERAPY-INDUCED TOXICITIES: NAUSEA/VOMITING
Nausea and vomiting are among the most commonly feared toxicities by patients undergoing chemotherapy.1 KEY CONCEPT The optimal method of managing CINV is to provide adequate pharmacologic prophylaxis given a patient’s risk level for emesis. Insufficient control during the first cycle of chemotherapy leads to more difficulty in controlling emesis for subsequent cycles.2
EPIDEMIOLOGY AND ETIOLOGY
Although it is widely known that chemotherapy causes nausea and vomiting, the rate of emesis varies depending on individual patient risk factors and drug therapy regimen. Therefore, cancer treatments are stratified into varying risk levels: high, moderate, low, and minimal. Agents with a “high” emetic risk cause emesis in more than 90% of cases if not given any prophylaxis. The rates of emesis for “moderate,” “low,” and “minimal” are 30% to 90%, 10% to 30%, and less than 10%, respectively. Table 99–1 lists the individual agents and their risk category.3
Table 99–1Emetogenic Potential of Chemotherapy