विवरण
The management of side effects associated with chemotherapy and immunotherapy is a critical aspect of cancer care to ensure patients can tolerate and complete their treatment. Chemotherapy commonly causes side effects such as nausea, vomiting, fatigue, and myelosuppression (reduced blood cell counts). Antiemetic medications, supportive care, and growth factor support are often utilized to alleviate these symptoms. Regular monitoring of blood counts helps manage myelosuppression, and adjustments to treatment doses may be considered.
Immunotherapy, which aims to boost the body's immune response against cancer, can lead to immune-related adverse events (irAEs) affecting various organs. Common irAEs include skin rash, diarrhea, and endocrine dysfunction. Prompt recognition and management are essential to prevent severe complications. Corticosteroids are often used to suppress immune reactions, and in some cases, immunosuppressive agents may be necessary.
सारांश
- Chemotherapy and immunotherapy patients are frequently monitored by various medical professionals. Common side effects of chemotherapy include nausea, vomiting, myelosuppression, fatigue, oral mucositis, diarrhea or constipation, skin and nail changes, neuropathy, hair loss, and appetite changes.
- Nausea and vomiting can be acute, delayed, anticipatory, breakthrough, or refractory. Management involves anti-emetics like serotonin antagonists (granisetron, ondansetron, palonosetron), neurokinin-1 antagonists, steroids, and anti-psychotics.
- Myelosuppression can result in febrile neutropenia, defined by fever and low neutrophil counts. Treatment includes antibiotics and granulocyte colony-stimulating factor (G-CSF) injections (filgrastim, pegfilgrastim).
- Thrombocytopenia, or low platelet count, is managed with dose modification, thrombopoietic receptor agonists (romiplostim), and platelet transfusions. Anemia, characterized by low hemoglobin, is addressed by checking iron levels, occult blood, upper/lower GI endoscopy, red blood cell transfusion, iron supplements, or erythropoietic therapy (epoetin alpha).
- Oral mucositis, presenting as mouth sores, is managed by alcohol-free mouthwash, soft toothbrushes, avoiding irritant foods, and topical/oral antifungals. Diarrhea requires fluid intake, antidiarrheals (loperamide), avoiding certain foods, and bland diets. Constipation is treated with high-fiber diets, fluids, exercise, and laxatives.
- Skin and nail changes are managed with moisturizers, sun protection, and gloves. Hair loss can be addressed with haircuts, gentle shampoos, scalp protection, satin pillows, and scalp cooling. Neuropathy is managed with exercise, avoiding smoking and alcohol, gloves/socks in cold weather, and careful use of heat.
- Immunotherapy, a novel cancer treatment, upregulates the immune system, but it can lead to immune-related adverse events different from chemotherapy. Immune checkpoint inhibitors include PD-1/PD-L1 inhibitors (nivolumab, pembrolizumab, atezolizumab, durvalumab) and CTLA-4 inhibitors.
- Corticosteroids (prednisone, methylprednisolone) are the primary treatment, but should be tapered carefully, with monitoring for blood sugar and bone density. Prophylactic antifungal treatment and gastroprotection with proton pump inhibitors or H2 blockers may also be needed.
- Immune-related adverse events result from the immune system attacking healthy cells. These range from mild to life-threatening and can affect multiple organs, including inflammatory skin conditions. Mild cases are managed with topical steroids, while severe cases may require hospitalization and stopping immunotherapy.
- GI side effects like diarrhea and colitis are treated with antidiarrheals and mesalamine/cholestyramine. Severe colitis necessitates steroid therapy and stopping immunotherapy. Hepatitis, pneumonitis, and endocrine system dysfunction (hypoglycemia, thyroid hormone changes, hypophysitis, adrenal gland insufficiency) may occur. Musculoskeletal manifestations, affecting joints, tendons, ligaments, bones, and muscles, are also possible, with steroid injections as a treatment option. Less common side effects include brain or eye involvement and pancreatitis.
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