Oncology Supportive Care Quiz
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Questions and Answers

Why do oncology patients often have a central venous access device?

  • Because many chemotherapy drugs are vesicants. (correct)
  • To reduce the risk of infection during chemotherapy.
  • To provide a permanent route for blood transfusions.
  • To allow for easier monitoring of blood pressure.

What characterizes febrile neutropenia in a patient?

  • The development of skin abscesses.
  • A high white blood cell count with fever.
  • The presence of visible signs of infection.
  • Neutropenia alongside a fever as the only sign of infection. (correct)

What is the primary concern regarding infection in febrile neutropenia patients?

  • The absence of neutrophils hinders the inflammatory response. (correct)
  • Gram-positive bacteria are the most common cause.
  • They often show clear symptoms of infection.
  • Infections are typically localized to a single area.

Which type of bacteria has the highest risk of causing sepsis in febrile neutropenia?

<p>Gram-negative bacteria. (C)</p> Signup and view all the answers

What is often required if a patient's clinical condition does not improve after starting initial empiric antibiotics?

<p>Modification of the antibiotic regimen. (C)</p> Signup and view all the answers

What defines a low-risk febrile neutropenia patient?

<p>Expected ANC &lt; 500 cells/mm for ≤ 7 days with no comorbidities (C)</p> Signup and view all the answers

Which antibiotic is considered appropriate for high-risk febrile neutropenia treatment?

<p>Ceftazidime (A)</p> Signup and view all the answers

At what hemoglobin level should ESA therapy be initiated in chemotherapy-induced anemia?

<p>When Hgb is &lt; 10 g/dL (B)</p> Signup and view all the answers

Which of the following ESAs is considered a longer-acting agent?

<p>Darbepoetin alfa (A)</p> Signup and view all the answers

What is a significant risk associated with the use of ESAs in cancer patients?

<p>Shortened survival and increased tumor progression (C)</p> Signup and view all the answers

What must be true before initiating ESA therapy for a cancer patient?

<p>There should be at least two months of planned chemotherapy (D)</p> Signup and view all the answers

Which of the following statements about myelosuppression is accurate?

<p>It is a possible consequence of chemotherapy. (A)</p> Signup and view all the answers

Which statement is true regarding the treatment for anemia?

<p>Anemia can spontaneously resolve without any treatment. (D)</p> Signup and view all the answers

What is the primary cause of myelosuppression in oncology patients undergoing traditional chemotherapy?

<p>Bone marrow suppression (D)</p> Signup and view all the answers

What is referred to as the nadir in the context of myelosuppression?

<p>The lowest point of WBC and platelet counts (A)</p> Signup and view all the answers

When should chemotherapy generally be administered to a patient considering their blood cell counts?

<p>When WBCs are greater than 3000 cells/mm3 (D)</p> Signup and view all the answers

What does the term 'absolute neutrophil count' (ANC) represent in the context of neutropenia?

<p>The calculated number of neutrophils per microliter (D)</p> Signup and view all the answers

What is the normal platelet count range in cells/mm3?

<p>150,000 - 450,000 (D)</p> Signup and view all the answers

Which of the following statements about the recovery of white blood cells and platelets post-chemotherapy is correct?

<p>They require approximately 3-4 weeks for recovery. (C)</p> Signup and view all the answers

At what platelet count is the risk for spontaneous bleeding significantly increased?

<p>&lt; 10,000 cells/mm3 (A)</p> Signup and view all the answers

What percentage of segmented and band neutrophils would indicate an ANC of 675 cells/mm3 if a patient's WBC is 4500 cells/mm3?

<p>10% segmented and 5% band neutrophils (C)</p> Signup and view all the answers

When should platelet transfusions be indicated for a patient?

<p>When platelet count is below 30,000 cells/mm3 without bleeding (A), When platelet count is below 10,000 cells/mm3 (D)</p> Signup and view all the answers

Which complication is typically associated with myelosuppression from chemotherapy?

<p>Anemia due to low red blood cell count (C)</p> Signup and view all the answers

What is the role of transfusions in the management of severe cases of myelosuppression?

<p>To provide packed red blood cells for anemia (D)</p> Signup and view all the answers

What best represents the ANC for a patient with the following WBC counts: segmented neutrophils 60%, band neutrophils 10%, total WBC 600 cells/mm3?

<p>420 cells/mm3 (A)</p> Signup and view all the answers

What would be the most appropriate course of action for a patient with neutropenia?

<p>Monitor closely for signs of infection (A), Initiate a colony-stimulating factor (CSF) (B)</p> Signup and view all the answers

Which factors increase the risk of chemotherapy-induced nausea and vomiting (CINV)?

<p>History of motion sickness (C)</p> Signup and view all the answers

What is a patient-related risk factor for increased nausea and vomiting during chemotherapy?

<p>Anxiety and depression (D)</p> Signup and view all the answers

What medication class should be avoided in patients who are thrombocytopenic?

<p>Non-steroidal anti-inflammatory drugs (NSAIDs) (D)</p> Signup and view all the answers

What is the emetogenic potential classification for a drug that has a 25% chance of causing vomiting without prophylaxis?

<p>Low emetogenic potential (A)</p> Signup and view all the answers

How many days should patients be protected from nausea/vomiting when receiving highly emetogenic regimens?

<p>3 days (D)</p> Signup and view all the answers

What term describes emesis that requires additional rescue medications even when prophylactic treatment has been administered?

<p>Breakthrough emesis (D)</p> Signup and view all the answers

Which of the following is true regarding patients receiving chemotherapy with minimal emetogenic potential?

<p>They do not require any antiemetic prophylaxis. (D)</p> Signup and view all the answers

Which approach is recommended for treating breakthrough nausea and vomiting?

<p>Give an antiemetic with a different mechanism of action. (C)</p> Signup and view all the answers

What is a key principle for managing CINV during chemotherapy with moderately emetogenic agents?

<p>Prophylactic antiemetics should be administered prior to treatment. (A)</p> Signup and view all the answers

Which is true regarding the administration of antiemetics for CINV?

<p>Patient characteristics influence the choice between oral and IV antiemetics. (A)</p> Signup and view all the answers

During which chemotherapy cycles should patients expect to experience refractory emesis?

<p>When prophylaxis has failed in previous cycles (A)</p> Signup and view all the answers

Which class of medication is primarily used for preventing and treating chemotherapy-induced nausea and vomiting (CINV)?

<p>5-HT3 antagonists (C)</p> Signup and view all the answers

Which medication is commonly associated with the risk of tardive dyskinesia when used for an extended duration?

<p>Metoclopramide (B)</p> Signup and view all the answers

Which of the following medications is classified as a NK1 antagonist for CINV treatment?

<p>Aprepitant (C)</p> Signup and view all the answers

In the management of refractory or delayed CINV, which cannabinoids are indicated?

<p>Dronabinol and Nabilone (D)</p> Signup and view all the answers

Which of the following constitutes an appropriate antiemetic regimen for a patient undergoing cisplatin-based therapy?

<p>Aprepitant, palonosetron, and dexamethasone (B)</p> Signup and view all the answers

What common side effect is associated with the use of benzodiazepines in CINV treatment?

<p>Sedation (C)</p> Signup and view all the answers

Which medication is frequently used as an adjunct alongside antiemetics, specifically lorazepam?

<p>Dexamethasone (D)</p> Signup and view all the answers

What is a significant side effect of both dronabinol and nabilone when used for CINV?

<p>Hypotension (A)</p> Signup and view all the answers

Flashcards

Myelosuppression

A decrease in bone marrow activity, leading to lower levels of red blood cells (RBCs), white blood cells (WBCs), and platelets.

Neutropenia

A low neutrophil count, a type of leukopenia, assessed by the absolute neutrophil count (ANC).

Absolute Neutrophil Count (ANC)

A calculation determining the number of neutrophils in the blood, used to measure neutropenia severity; calculated by: ANC = WBC × percentage granulocytes or neutrophils.

Nadir

The lowest point of white blood cell and platelet counts after chemotherapy.

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RBC nadir

The lowest point of red blood cell count after chemotherapy, occurring later than WBCs and platelets (several months later).

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Chemotherapy Recovery

The period after chemotherapy when WBCs and platelets recover; 3-4 weeks.

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Chemotherapy Dosage

The next dose of chemotherapy is given when WBCs and platelets reach safe levels (WBC > 3000 cells/mm3, ANC > 1000, and platelets > 100,000).

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Myelosuppression Toxicity

The most common dose-limiting side effect of chemotherapy, a problem for many chemotherapy regimens.

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Central Venous Access Device

A central line is a medical device placed into a large vein, often used for chemotherapy delivery.

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Febrile Neutropenia

A medical emergency where a neutropenic patient has a fever, often a sign of severe infection.

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Neutropenia

A condition with low neutrophil counts, making the body vulnerable to infections.

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Empiric Antibiotics

Antibiotics given immediately to treat a suspected infection, before lab results are back.

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Gram-negative Bacteria

A type of bacteria that's particularly dangerous in febrile neutropenia, highly risk for sepsis.

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Febrile Neutropenia Low-Risk ANC

Expected Absolute Neutrophil Count (ANC) less than 500 cells/mm³ for up to 7 days, without comorbidities.

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Febrile Neutropenia High-Risk ANC

Expected ANC less than or equal to 100 cells/mm³ for more than 7 days, or presence of comorbidities, or renal/hepatic impairment(CrCl < 30 ml/min or LFTs > 5x ULN).

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Anemia Assessment

Evaluation of hemoglobin (Hgb) levels to determine the presence and severity of anemia.

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Anemia Treatment Options

Anemia can resolve spontaneously, or require a red blood cell (RBC) transfusion, or rarely, an erythropoiesis-stimulating agent (ESA).

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Erythropoiesis-Stimulating Agents (ESAs)

Drugs that stimulate red blood cell production, like epoetin alfa, epoetin alfa-epbx, and darbepoetin alfa.

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ESA Use Restrictions

ESAs should only be used for palliation in non-myeloid malignancies with chemotherapy-induced anemia and have a minimum of two additional months of planned chemotherapy. Initiate therapy when Hgb < 10 g/dL, use lowest possible dose.

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Normal Hemoglobin Levels (Females)

12 - 16 g/dL.

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Normal Hemoglobin Levels (Males)

13.5 - 18 g/dL

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Platelet count

The number of platelets (thrombocytes) in the blood, normally between 150,000 and 450,000/mm3.

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Thrombocytopenia

A condition characterized by abnormally low platelet counts, increasing the risk of bleeding.

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Platelet transfusion

Transfusion of platelets to raise the platelet count, used when the count is unsafe.

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ANC (Absolute Neutrophil Count)

Calculated to measure neutrophils; neutrophils are a type of white blood cell.

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Neutropenia

Low neutrophil count, increasing the risk of infection.

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CINV (Chemotherapy-Induced Nausea & Vomiting)

Nausea and vomiting that can be triggered by chemotherapy.

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Risk factors for CINV

Factors like female gender, age < 50, anxiety, dehydration, or prior nausea/vomiting history.

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Iron levels for ESA effectiveness

Serum ferritin, transferrin saturation (TSAT), and total iron-binding capacity (TIBC) must be sufficient for ESAs to work properly in treating anemia.

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High Emetogenic Potential

Chemotherapy with a greater than 90% chance of causing vomiting without antiemetic treatment.

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Breakthrough Emesis

Vomiting that happens despite being given antiemetic treatment.

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Refractory Emesis

Vomiting that keeps happening even when antiemetic treatments are used.

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CINV Prophylaxis

Antiemetic treatment given to prevent nausea and vomiting from chemotherapy.

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CINV

Chemotherapy-induced nausea and vomiting

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Emetogenic Potential Levels

Categories of chemotherapy based on their likelihood of causing vomiting: high, moderate, low, and minimal.

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Prophylactic antiemetics

Antiemetics given before a treatment with high or moderate chance to cause vomiting

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Duration of risk for nausea/vomiting

Duration of risk for nausea/vomiting, 3 to 2 days depending on the emetogenicity of the treatment

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Antiemetic regimen

A planned combination of medications to prevent nausea and vomiting, especially after chemotherapy treatments.

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5-HT3 receptor antagonists

A class of drugs that block serotonin receptors to reduce nausea.

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NK1 receptor antagonist

A class of drugs that block NK1 receptors to reduce nausea, often used together with other antiemetics.

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Corticosteroids

Medications that reduce inflammation and can help prevent and treat nausea, often used with chemotherapy.

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Dopamine antagonists

Drugs that block dopamine receptors, sometimes involved in the treatment of nausea, especially related to chemotherapy.

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Cannabinoids

Drugs derived from the cannabis plant; used in preventing or treating intractable nausea, especially in chemotherapy patients.

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Cisplatin and vinorelbine

Chemotherapy drugs used in lung cancer treatment; known to cause significant nausea.

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Appropriate antiemetic regimen for cisplatin/vinorelbine

Combination of antiemetics (Aprepitant, palonosetron, and dexamethasone) for most likely prevention of acute nausea in cisplatin/vinorelbine regimens.

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Study Notes

Oncology Supportive Care

  • Oncology supportive care is a field focused on managing side effects of cancer treatment.

Myelosuppression

  • Myelosuppression is a common side effect of chemotherapy.
  • It reduces bone marrow activity, resulting in lower counts of red blood cells (RBCs), white blood cells (WBCs), and platelets.
  • Bone marrow suppression is the most common dose-limiting toxicity associated with traditional cytotoxic chemotherapy.
  • Nadir is the lowest point WBCs and platelets reach, usually 7-14 days after chemo.
  • RBC nadir is much later (several months) due to RBC lifespan (120 days).
  • WBCs and platelets generally recover 3-4 weeks post-treatment.
  • The next chemo dose is given when WBC count is >3000 cells/mm³ or ANC >1000 cells/mm³ and platelet count is >100,000 cells/mm³.
  • Recovery time varies, and some cases may require transfusions if necessary.
  • Neutropenia (low neutrophils), a type of leukopenia (low WBCs), is assessed by the absolute neutrophil count (ANC).
  • Higher ANC, lower risk of infection.
  • ANC calculation: WBC x (percentage segmented neutrophils + percentage band neutrophils)

Neutropenia

  • Neutropenia is defined as an ANC ≤500 cells/mm³ or a count of ≤1000 cells/mm³, with a predicted decrease to less than 500 cells/mm³ during the next 48 hours.
  • Risk of infection increases with lower ANC.
  • Growth Colony Stimulating Factors (G-CSFs) stimulate WBC production and can prevent or reduce infection risk, not necessarily treat.
  • Patients with >20% chance of developing febrile neutropenia should receive a G-CSF.

Anemia

  • Hemoglobin (Hgb) levels assess anemia.
  • Normal Hgb levels are 12-16 g/dL for females and 13.5-18 g/dL for males.
  • Anemia can resolve without treatment, be treated with RBC transfusion, or erythropoiesis-stimulating agent (ESA).
  • Avoid ESAs for patients receiving curative chemo; ESAs may shorten survival or increase tumor progression. In order to use ESAs appropriately, two months of planned additional chemo is required prior to starting ESA's AND Hgb must be less than 10g/dL. Iron levels should also be evaluated for effectiveness of treatment.

Thrombocytopenia

  • Low platelets (thrombocytes) can cause spontaneous, uncontrolled bleeding.
  • Normal range is 150,000-450,000/mm³.
  • Platelet transfusion indicated when counts <10,000 cells/mm³ (or <30,000 if active bleeding).
  • Avoid IM injections, NSAIDs, while platelet count is low.

Chemotherapy-Induced Nausea and Vomiting (CINV)

  • Patient factors increasing risk: Female gender, age < 50, anxiety/depression, history of motion sickness or CINV with prior chemo, dehydration
  • Agent related factors:
    • High emetogenic potential: >90% vomiting chance
    • Moderate: 30-90%
    • Low: 10-30%
    • Minimal: <10%
  • CINV types: Acute (day 1, emesis peaks 5-6 hours after chemo); Delayed (days 2-5, peak emesis 48-72 hours after chemo)
  • Breakthrough emesis: Occurs despite prophylaxis or needs rescue meds.
  • Refractory emesis: Emesis during treatment cycles when prophylaxis or rescue failed in previous cycles.

Managing CINV

  • Prophylactic antiemetics: administered before moderately or highly emetogenic chemo or radiation.
  • Patients with low emetogenic chemo should get a single dose
  • Patients with minimal emetic risk don't need prophylaxis.
  • Antiemetics scheduled for delayed nausea and vomiting.
  • Patients need protection throughout the full period of risk.

General Principles

  • Oral and IV antiemetics are equally effective, but choice depends on patient factors like taking oral meds, form availability, and cost.
  • Patients undergoing chemo should have antiemetics available to treat breakthrough N/V.
  • If breakthrough CINV occurs, use a different antiemetic with a different mechanism.

Anti-emetic Regimen Examples

  • These are examples from the slides, not a comprehensive list
    • High emetic risk: NK1-RA + 5HT3-RA + Olanzapine + Dexamethasone
    • Moderate emetic risk: NK1-RA + 5HT3-RA + Dexamethasone
    • Low emetic risk: 5HT3-RA + Dexamethasone
  • Specific drugs and dosages covered in the medication sections

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Description

Test your knowledge on oncology supportive care, focusing particularly on myelosuppression and its impact during chemotherapy. This quiz covers important concepts such as nadir, recovery times, and the management of side effects related to cancer treatments.

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