Oncology Supportive Care Quiz

Oncology Supportive Care

• Supportive care is an important part of cancer care, addressing physical, emotional, social, and financial effects of cancer.
• Palliative and supportive care can be given at any age, for any type and stage of cancer, at any time during cancer treatment.
• Research shows that palliative and supportive care improves quality of life by helping patients feel more satisfied with cancer treatment.

Side Effects of Cancer & Anticancer

• Chemotherapy-induced bone marrow suppression (CIBMS) affects blood cells made in the bone marrow.
• CIBMS hematological side effects include: Leucopenia (Febrile Neutropenia), Thrombocytopenia, and Anemia.
• Additional side effects include: Nausea and Vomiting, Infertility, Hair Fall, and Cancer Pain.

Chemotherapy-Induced Bone Marrow Suppression (CIBMS)

• Bone marrow contains stem cells that produce white blood cells, red blood cells, and platelets.
• Chemotherapy can harm the bone marrow, reducing the production of these blood cells.

Febrile Neutropenia

• Neutropenia: A low count of neutrophils (a type of white blood cell) in the blood.
• Febrile neutropenia: Neutropenia coupled with a high fever.
• Neutropenic patients are at high risk of serious infections, often with little or no outward symptoms.

White Blood Cells (Leukocytes)

• White blood cells (leukocytes) are part of the immune system, defending against diseases and foreign substances.
• Normal WBC count is 4.8-10.8 × 100 cells/mm³ with a circulating lifespan of 6–12 hours.
• A decreased WBC count is called leucopenia or granulocytopenia.
• Types of leukocytes include neutrophils, basophils, eosinophils, lymphocytes, monocytes and macrophages.

Neutrophils

• Neutrophils are the most abundant white blood cells and an essential part of the immune system.
• They have a rapid turnover rate, making their affected by cytotoxic chemotherapy.
• Neutrophils are segmented and banded, essential for calculating Absolute Neutrophil Count (ANC).
• Normal ANC is >1500 cells/mm³ (1500 – 7700 cells/mm³).

Pattern of ANC after Chemotherapy

• NADIR is the lowest ANC value after chemotherapy.
• NADIR usually occurs 10-14 days after chemotherapy with recovery within 3-4 weeks.

Thrombocytopenia

• Normal platelet count is 140,000 - 440,000 cells/mm³.
• Thrombocytopenia occurs when the platelet count drops below 100,000 cells/mm³.
• Bleeding risk significantly increases when platelets drop to 20,000 cells/mm³ or less.

Thrombocytopenia Management

• Many institutions do not transfuse platelets until the patient shows bleeding symptoms (ecchymosis, hemoptysis, hematemesis).
• Some institutions transfuse for a platelet count of 10,000 cells/mm³ or less, regardless of symptoms.
• Caution is required with antiplatelet therapy, monitoring closely and intervening as needed.

Oprelvekin (interleukin-11)

• Drug stimulates bone marrow to increase platelet production.
• Available in 5-mg vials as a powder, reconstituted with water, injected (within 3 hrs of mixing).
• Common side effects include edema, shortness of breath (SOB), tachycardia, and conjunctival redness.

Oprelvekin Administration

• Daily injections begin 6-24 hours after chemotherapy.
• Treatment continues until the platelet count exceeds 50,000 cells/mm³.
• Discontinue at least 2 days prior to the next cycle of chemotherapy.

Anemia & Fatigue

• Normal RBC count ranges from 4.6-6.2 × 10⁶ cells/mm³ with a 120-day lifespan.
• Anemia occurs when RBC mass, number, or hemoglobin concentration falls below normal levels (less than 13 g/dL in men and 12 g/dL in women).
• Symptoms include weakness, fatigue, irritability, tachycardia, palpitations, shortness of breath, chest pain, pallor, dizziness, and reduced mental acuity.
• Fatigue impacts 60-80% of cancer patients, measured using a numeric rating scale (0-10).

Causes of Fatigue & Anemia

• Unmanaged pain and other symptoms can exacerbate fatigue.
• Anemia is often a contributing factor with other mechanisms like cytokines.
• Causes of anemia include reduced RBC production due to anticancer therapy, decreased endogenous erythropoietin production, decreased vitamin B12, iron, or folic acid stores, and blood loss.

Anemia Types

• Anemia can manifest as microcytic (iron deficiency), macrocytic (vitamin B12 or folic acid deficiency), or related to chronic disease (including chemotherapy).

Colony Stimulating Factors (CSFs)

• Colony stimulating factors (CSFs) enhance the production and function of target cells.
• Examples include Granulocyte colony-stimulating factor (G-CSF): Filgrastim (Neupogen®) and Pegylated granulocyte colony-stimulating factor (G-CSF): Pegfilgrastim (Neulasta®).
• GM-CSF, Sargramostim (Leukine®).

CSFs in Oncology

• Pegfilgrastim is a long-acting CSF.
• CSF choice depends on the expected duration of neutropenia and the specific chemotherapy regimen.
• Studies show that CSFs reduce the frequency, severity, and duration of neutropenia.

CSF Adverse Effects & Contraindications

• Common adverse effects: bone pain and fever.
• Contraindications: bone marrow (BM) diseases and malignancies.
• CSF administration usually follows chemotherapy (24-72 hours).
• Treatment continues until post-nadir ANC is more than 2000-5000 cells/mm³.
• Discontinuing before nadir can cause 50% reduction in ANC.

CSF Use Restrictions

• CSF use is restricted for neutropenia, fever, risk factors of complications, including:
• ANC < 100/mm³.
• Sepsis syndrome, pneumonia, hypotension, multi-organ dysfunction, and invasive fungal infection.

CSF Management in Febrile Neutropenia

• Managing febrile neutropenia may involve reducing the next chemo dose or supporting with a CSF.
• The potential for cure influences the approach, either a dose reduction of chemotherapy or supporting with a CSF.

Secondary CSF Administration

• Postponed or reduced chemotherapy dosages might justify secondary CSF prophylaxis.
• Dose reduction of chemotherapy is often prioritized before considering CSFs, especially in palliative situations.

Primary CSF Prophylaxis

• CSFs are recommended for initial prevention of neutropenia in chemotherapy regimens with an anticipated risk of 20% or more of febrile neutropenia.