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Questions and Answers
What is the primary purpose of palliative and supportive care in cancer treatment?
What is the primary purpose of palliative and supportive care in cancer treatment?
Which type of white blood cells are considered the most abundant in the immune system?
Which type of white blood cells are considered the most abundant in the immune system?
What does the term 'nadir' refer to in the context of chemotherapy administration?
What does the term 'nadir' refer to in the context of chemotherapy administration?
Which calculation is used to determine the Absolute Neutrophile Count (ANC)?
Which calculation is used to determine the Absolute Neutrophile Count (ANC)?
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Which of the following is NOT classified as a granulocyte?
Which of the following is NOT classified as a granulocyte?
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What blood cell count is considered normal for the Absolute Neutrophile Count (ANC)?
What blood cell count is considered normal for the Absolute Neutrophile Count (ANC)?
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How does leukopenia affect the body's ability to defend against disease?
How does leukopenia affect the body's ability to defend against disease?
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Which of the following conditions is a side effect associated with chemotherapy?
Which of the following conditions is a side effect associated with chemotherapy?
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What is the threshold platelet count below which thrombocytopenia is defined?
What is the threshold platelet count below which thrombocytopenia is defined?
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At what platelet count do risks of bleeding significantly increase?
At what platelet count do risks of bleeding significantly increase?
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What should be monitored closely when administering oprelvekin?
What should be monitored closely when administering oprelvekin?
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When is oprelvekin administration recommended to begin after chemotherapy?
When is oprelvekin administration recommended to begin after chemotherapy?
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Which of the following is NOT a common adverse event associated with oprelvekin?
Which of the following is NOT a common adverse event associated with oprelvekin?
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What hemoglobin concentration defines anemia in women?
What hemoglobin concentration defines anemia in women?
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What is the estimated percentage of cancer patients affected by fatigue?
What is the estimated percentage of cancer patients affected by fatigue?
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What is one of the mechanisms of fatigue that is independent of hemoglobin concentration?
What is one of the mechanisms of fatigue that is independent of hemoglobin concentration?
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What is the most common adverse effect of Colony Stimulating Factors (CSFs)?
What is the most common adverse effect of Colony Stimulating Factors (CSFs)?
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When should CSFs be initiated following chemotherapy?
When should CSFs be initiated following chemotherapy?
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In what situation should CSFs be primarily used for patients?
In what situation should CSFs be primarily used for patients?
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What is the recommended action during the next cycle of chemotherapy after a patient experiences febrile neutropenia?
What is the recommended action during the next cycle of chemotherapy after a patient experiences febrile neutropenia?
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What is considered secondary prophylaxis in the context of CSF administration?
What is considered secondary prophylaxis in the context of CSF administration?
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What platelet count range is considered normal?
What platelet count range is considered normal?
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What is the correct response if a patient’s ANC decreases by about 50% after CSF treatment is discontinued?
What is the correct response if a patient’s ANC decreases by about 50% after CSF treatment is discontinued?
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Which chemotherapy regimens are recommended for primary prophylaxis with CSFs?
Which chemotherapy regimens are recommended for primary prophylaxis with CSFs?
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What defines neutropenia based on ANC levels?
What defines neutropenia based on ANC levels?
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Which temperature condition is associated with febrile neutropenia?
Which temperature condition is associated with febrile neutropenia?
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What constitutes a high risk for febrile neutropenia?
What constitutes a high risk for febrile neutropenia?
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What is the most significant adverse effect of having an ANC below 500 cells/mm3?
What is the most significant adverse effect of having an ANC below 500 cells/mm3?
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How is management recommended for neutropenia without febrile symptoms?
How is management recommended for neutropenia without febrile symptoms?
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What ANC level is a patient required to have to receive chemotherapy?
What ANC level is a patient required to have to receive chemotherapy?
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What distinguishes low-risk febrile neutropenia characteristics?
What distinguishes low-risk febrile neutropenia characteristics?
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What role do Colony Stimulating Factors (CSFs) play in the treatment of neutropenia?
What role do Colony Stimulating Factors (CSFs) play in the treatment of neutropenia?
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Study Notes
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.
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Description
Test your knowledge on oncology supportive care, focusing on the importance of addressing physical, emotional, social, and financial effects of cancer. Understand the side effects of chemotherapy, particularly chemotherapy-induced bone marrow suppression, and how palliative care improves quality of life for patients with cancer.
