Toxicity when using chemotherapy

Chemotherapeutic drugs

Side effects and toxicity

By Sarah O'Shaughnessy

05

01

Urinary

Introduction

06

02

Cardiac

Gastrointestinal

07

03

Renal

Bone marrow

09

08

04

Conclusions

Hepatic

Dermatological

Explore the rest of the presentation to learn more about the most common side effects and how they can be managed - and don't forget to click on the interactive elements!

It is all about balance...

Chemotherapy drugs work by killing ALL rapidly dividing cells (no just neoplastic ones!) so it makes sense that most of their side effects are due to the death of other healthy and rapidly dividing cells in the body... This means that side effects due to tissue damage of the gastrointestinal tract and the bone marrow are most common. ...thus a balance needs to be struck between effective dosing and avoiding harmful side effects....

Introduction

Cytotoxic drugs can cause a range of side effects but these CAN be avoided and managed when chemotherapy is carefully p;rescribed...

Did you know?

Explore the rest of the presentation to learn more about the most common side effects and how they can be managed - and don't forget to click on the interactive elements!

It is all about balance...

Chemotherapy drugs work by killing ALL rapidly dividing cells (no just neoplastic ones!) so it makes sense that most of their side effects are due to the death of other healthy and rapidly dividing cells in the body... This means that side effects due to tissue damage of the gastrointestinal tract and the bone marrow are most common. ...thus a balance needs to be struck between effective dosing and avoiding harmful side effects....

Introduction

Cytotoxic drugs can cause a range of side effects but these CAN be avoided and managed when chemotherapy is carefully p;rescribed...

Did you know?

Gastrointestinal toxicity

The death of rapidly divding cells within the gastrointestinal tract can cause a range of clinical signs. Examples of common signs include vomiting, diarrhoea, nausea and stomatitis. Unfortunately, the loss of mucosal integrity within the gut increases the risk of bacterial translocation into the blood and sepsis.

Stomatitis?

Mangement

Examples

Bone marrow toxicity

As cells within the bone marrow are rapidly divididing, toxic effects relating to bone marrow injury are common. Can you work out what these would be? Click on the '?' to reveal the answer. Examples of drugs that can cause bone marrow toxicity are doxorubicin, vinblastine and cyclophosphamide

This is why routine haematology is conducted before a cytotoxic agent is given - this will inform whether the chempotherapy dose is delayed, reduced or if therapy needs to be stopped.

Dermatological toxicity

Many chemotherapeutic drugs are irritants and vescicants. This means that they cause tissue inflammation or even necrosis should they be administered inappropriately - for example should the drug extravasate during intravenous administration.

A video of a dog being administered chemotherapy - notice all of the precautions that staff are taking to avoid drug extravasation - click on 'management' to find out more.

Examples

Management

Urinary toxcity

Cyclophosphamide

Cyclophosphamide is a commonly used chemotherapeutic agent which can cause urinary toxicity - otherwise known as 'sterile haemorrhagic cystitis'.

Some cytotoxic drugs are associated with urinary toxicity. Clinical signs include stranguria, dysuria, pollakiuria, haematuria. Sadly, these signs can be sometimes be irreversible - again prevention is better than cure!

Management

Sadly there is no specific treatment. Early detection through regular urine dispsticks and sediment exams allows for early detection and avoidance. If blood is found the drug should be discontinued unless further investigation reveals a different cause e.g. urinary tract infection. Increasing water consumption and concurrent administration of furosemide may reduce the risk of developing urinary toxicity.

Cardiac

Acute vs chronic

Some chemotherapeutic drugs can cause acute and chronic cardiac toxicity. For example doxorubicin can cause tachyarrhythmias (acute) and cardiomyopathies which may lead to congestive heart failure (chronic).

Management

A video of a dog being administered doxorubicin - the medication is being given slowly to help avoid the development of arrhythmias.

Renal toxicity

Some cytotoxic drugs have the potential to cause proximal tubular necrosis leading irreversible loss of renal function - thic could lead to the development of acute and/or chronic kidney disease.

Mangement

Examples

Hepatotoxicity

Some chemotherapeutic can cause transient or irreversible loss of liver function.

Examples

Management

Take home messages

Treating patients with chemotherapy is challenging - always consider referral or seeking specialist advice.

Chemotherapeutic drugs can cause a wide range of side-effects.

These side effects could reduce the patient's quality of life.

However, almost all toxicities can be avoided through careful monitoring, dosing and patient management.

Thank you