Benefits of chemo radiation
- Radiosensitiser: enhances DNA damage
- Radiation enhancer: enhances radiation effect
- Chemotherapeutic agents + XRT: doses need to be adjusted with concurrent XRT -> acceptable toxicities
Increases cancer cure rate
Replaces or delays need for surgery
Allows organ preservation
Complications of chemo
Nausea and vomiting
RT vomiting is less severe than chemo
Nausea and vomiting medication
injections, wafers (dissolves) helps as people usually can’t swallow things
5HT3 antagonist: ondansetron, granisetron -> constipation, headache/migraine, QT-prolongation
Corticosteroids: Dexamethasone -> infection, oedema, hypertension, hyperglycaemia delay wound healing, weight gain
Dopamine receptor antagonist - metoclopramide, prochlorperazine, tremor, slurred speech, akatisia, dystonia
Which mucousitis is more severe
- Radiation induced
- Longer duration and more severe
- Appears around 2 weeks of radiation and at its worse by the end of RT, may persist for up to 8 weeks
- Chemotherapy induced ones occur 2-3 weeks from chemo commencement
Considerations for mucositis
symptom control, nutritional intake
What leads to higher risks of mucositis
poor oral hygiene, gum disease, dry mouth, smoking, alcohol consumption
Symptoms of mucositis
mild soreness to severe, risk o bleeding and infection
Treatment for mucositis
Requires dietary modifications: soft foods
Candidiasis: anti fungal infection medication, lozenges
Topical anaesthetics
Systemic pain relief such as morphine - drowsiness, constipation, respiratory depression, dependence
Saliva substitute: for dry mouth, gland hypofunction, for topical use (spray), artificial lemon flavour
Sodium bicarbonate mouthwash: increase salivary pH -> improves symptoms of dry mouth, cheap and effective
Oesophagitis treatments
Antacids
- Neutralise HCL secreted
H2 antagonists
- In short supply
- Reduce gastric acid secretion - > reduce symptoms of reflux
Proton pump inhibitors
- Can increase risk of osteoporosis
- Stimulated and basal acid secretion
People need a script: depending on the dosage
Diarrhoea issues and treatment
- May lead to malnutrition, weight loss, electrolyte imbalance, real insufficiency and hospital admission
- To help with diarrhoea: oral rehydration -> 8-10 large glasses of clear liquids (not just water, sports drinks, clear juices or broth)
- Infection risk (neutropenia)
- Use gastro stop or lomotil: antisecretory agents -> activate opioid receptors in the gut wall, decreasing bowel motility and increasing fluid absorption
- Overusing it can cause constipation
- Lactobacillus-containing probiotics may be useful in preventing chemo and/or radiation therapy induced
Cystitis what is it and symptoms
- Inflammation of the bladder and urthera: common side effect for radiotherapy in pelvic region
- Generally acute onset
- Self-limiting symptoms <3 months following RT
- Symptoms include: painful urination, blood in urination, urgency, abdominal pain
How can we help with cystitis
ural, ibuprofens, paracetamol
Ural: to treat burning and painful symptoms, 1-2 sachets dissolved in cold water, may alter therapeutic effects of medication
Ibuprofen: analgesic, anti-pyretic and anti-inflammatory
Bleeding risk, readily available, if there is blood in urine and things like that, it may increase risks of bleeding
Paracetamol: negligible anti-inflammatory effects
Dermatitis treatments
Redness, swelling, skin peeling off
Use sorbelene creams
- Can occur weeks to months to years after RT, 6-9% of patients impacted
- Diagnosis is based on the appearance within the previous radiation therapy field
- Hydrocortisone cream
- After withdrawal of the drug, the reaction usually resolves within 1-2 weeks
- Aloe Vera gel: it depends on the product and which part of the plant, hence evidence is 50-50. Therefore, not the most reliant. Not a first line
- EGFR inhibitor induced rash -> can cause more rash
- Cannot use steroid creams for too long as it thins out skin
Drug induced radiation recall
an acute inflammatory reaction confine to an area of previous radiation exposure that is triggered by chemotherapeutic agents or other drugs
Other agents and radiation
- Immunotherapies: RT may cause issues and potentiate the effect of anti-PD-1 immunotherapy in NSCLC
- CDK 4/6 inhibitors: high grade haematological toxicity, neutropenia recurs -> 3rd degree burns
- Complementary and Alternative medicine (CAM) - anti-oxidants -> stop these a week before radiation, they play a role in managing the free radicals, making radiation less effective
How to ensure patient care
Interacting with patient: be professional and empathetic, safe use of medicine
Taking medications as directed, stigma to use medications, did not tell anyone
Consider cultural differences
When and where do patients get dermatitis
Common side effects of breast, head and neck and lung cancer
Can occur in anterior of neck, extremities, chest/breast, abdomen, face and scalp
What are some patient factors of dermatitis
Obesity, older age, gender (female), chronic sun exposure, smoking, breast implants/reconstruction
Pre-existing disorders: connective tissue disorders, radio sensitivity disorders
Antacids contraindications
Constipation -> if containing al and Ca
Diarrhoea -> if containing Mg
Monitor Ca, Al and Mg concentration -> accumulation and toxicity in renally impaired patients
H2 antagonists contraindications
Accumulation may occur in renal impairment patients -> may need dose adjustment
