Chemotherapy Complications

Basics

Description

Side effects and complications are experienced by patients on widely used chemotherapeutic agents

Epidemiology

Incidence And Prevalence Estimates

  • 4 million emergency department (ED) visits are related to patients with cancer in the United States
  • Different complications of chemotherapy occur in varying frequencies
  • More frequent side effects include neutropenic fever, anemia, mucositis/esophagitis, diarrhea, and tumor lysis syndrome
  • Febrile neutropenia occurs in up to 50% of patients with solid tumors and over 80% of patients with hematologic cancers on chemotherapy or following stem cell transplant

Etiology

Common side effects and complications of many chemotherapy classes include:

  • Gastrointestinal (GI): Nausea and vomiting, diarrhea, weight loss, mucositis
  • Myelosuppression: Anemia, neutropenia (including neutropenic fever), thrombocytopenia
  • Dermatologic: Alopecia
  • Tumor lysis syndrome
  • Metabolic: Electrolyte abnormalities (hypercalcemia, hyper/hypokalemia, etc.)
  • Cardiac: Cardiomyopathy, arrhythmias
  • Infection
  • Urinary: Hemorrhagic cystitis
  • When patients become neutropenic, they are at increased risk for infection, which can result in hospitalizations and delay or alterations to chemotherapy treatment. In addition, neutropenia and febrile neutropenia can be life-threatening
  • Tumor lysis syndrome occurs when cells release their contents into the circulation at a more rapid rate than the body can metabolize or excrete, which classically results in hyperkalemia, hyperphosphatemia, and hyperuricemia. Most commonly, tumor lysis syndrome occurs with lymphomas, leukemias, and rapidly growing tumors, most often about 7 d after chemotherapy induction
  • Only a few of these complications require ED treatment, depending on the severity of symptoms and presentation

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