Complications
A common adverse effect of many chemotherapeutic agents, and occurs as a result of direct damage to precursor cells in the bone marrow.
Physicians should instruct the patient to report any episodes of fever during the period of neutropenia. If fever occurs, empiric antibiotic therapy should be initiated based upon local microbiologic guidelines.
Certain classes of chemotherapeutic agents induce nausea in a majority of patients (e.g., platinum compounds and taxanes).
Nausea and vomiting tend to be short-lived, and can be minimized or controlled with prophylactic antiemetic agents, specifically from the 5-HT3 antagonist and neurokinin-1 (NK-1) receptor antagonist classes. Corticosteroids are particularly effective in controlling delayed-onset nausea and anticipatory nausea.
Erythropoiesis-stimulating agents (ESAs) have been associated with increased mortality in patients with cancer.[63][64] Practice guidelines recommend consideration of ESAs in patients with chemotherapy-associated anemia whose cancer treatment is not curative in intent, and whose hemoglobin has declined to <10 g/dL.[65] Red blood cell transfusion may be an option, depending on the severity of the anemia or clinical circumstances (e.g, when rapid correction of anemia is required). Patients with chemotherapy-associated anemia whose treatment is curative in intent should not receive ESAs.[65]
Certain classes of chemotherapeutic agents (e.g., platinum compounds and taxanes) can cause significant neurotoxicity: either peripheral neuropathy, or hearing loss in the case of platinum drugs.
The symptoms can be transient, but physicians should be cautioned against repeat exposure to offending agents, as effects can become permanent and debilitating. These agents are often used with palliative intent in adenocarcinoma of unknown primary site, so avoidance of treatment-induced adverse effects is of paramount importance.
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