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Although interferon- is generally tolerated in the standard doses listed in Table 39 11, it has significant toxicity with the higher doses required to treat CML and malignant melanoma and is more toxic in elderly patients Even standard doses may be intolerable to some patients Fever and chills are initial side effects but are infrequent after continued treatment These symptoms may be ameliorated or prevented by premedication with acetaminophen and bedtime dosing However, anorexia, fatigue, and weight loss can be cumulative and with time may become severe These symptoms may be dose or treatment limiting Thirty percent or more of patients are intolerant of interferon therapy even at low doses In some patients, central nervous system symptoms develop, usually manifested as confusion or somnolence Interferon causes a reduction in blood counts, but this is usually not clinically important and is part of the desired effect in the treatment of CML Interferon-induced side effects are sometimes confused with the symptoms of progressive cancer but usually clear within 1 2 weeks following cessation of interferon therapy
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Brizel DM et al Phase III randomized trial of amifostine as a radioprotector in head and neck cancer J Clin Oncol 2000 Oct 1;18(19):3339 45 [PMID: 11013273] Chu E et al (editors) Physicians Cancer Chemotherapy Drug Manual 2005 Jones & Bartlett, 2005 Kremer LC et al Frequency and risk factors of subclinical cardiotoxicity after anthracycline therapy in children: a systematic review Ann Oncol 2002 Jun;13(6):819 29 [PMID: 12123328]
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G Cisplatin Nephrotoxicity and Neurotoxicity
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Cisplatin is effective in the treatment of testicular, bladder, and ovarian cancer as well as in several other types of tumor Nausea and vomiting are common, but nephrotoxicity and neurotoxicity are more serious Vigorous hydration with or
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GENERAL WELL-BEING, PERFORMANCE STATUS, & SUPPORTIVE CARE
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The functional status of the cancer patient at diagnosis (or at the start of treatment) is a major prognostic factor and determinant of outcome with or without tumor-directed
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therapy It is therefore important to assess functional status as well as tumor burden and symptoms before deciding on possible anticancer therapy Functional status or performance status evaluates the patient s ability to perform activities of daily living and is clearly related to tumor burden, tumor site, and the patient s underlying physical condition Two scales are commonly used to measure performance status The ECOG scale is a five-point system that is simple and easy to apply to clinical practice The ECOG scoring system ranges from 0 to 4 as follows: 0, entirely asymptomatic; 1, symptomatic but fully ambulatory; 2, symptomatic and in bed less than 50% of the day; 3, symptomatic and in bed more than 50% of the day but not bedridden; and 4, bedridden The Karnofsky scale ranges from 100% (asymptomatic and fully functional) through 0% (dead) in steps of 10% For example, a Karnofsky performance status of 40% implies a patient who is disabled and requires special care and assistance This patient would be unable to work but would be able to live at home with special assistance These two systems are often the basis for clinical decisions despite their obvious lack of precision They are also useful in assessing the impact of therapy and disease progression
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Kattlove H et al Ongoing care of patients after primary treatment for their cancer CA Cancer J Clin 2003 May Jun;53 (3):172 96 [PMID: 12809410] Malin JL et al Results of the National Initiative for Cancer Care Quality: how can we improve the quality of cancer care in the United States J Clin Oncol 2006 Feb 1;24(4):626 34 [PMID: 16401682] Stasi R et al Cancer-related fatigue: evolving concepts in evaluation and treatment Cancer 2003 Nov 1;98(9):1786 801 [PMID: 14584059]
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CMDT 2008
1 Spinal Cord Compression
Spinal cord compression by tumor mass is manifested by back pain, progressive weakness, and sensory loss (usually in the lower extremities) Less commonly, spinal cord disease may present as chest or abdominal pain or as signs of nerve root compression due to the epidural location of the tumor Bowel and bladder dysfunction are late findings Spinal cord compression may occur as a complication of metastatic solid tumor, lymphoma, or myeloma Back pain at the level of the spinal cord lesion occurs in over 80% of cases and may be aggravated by lying down, weight-bearing, sneezing, or coughing Because back pain may precede the development of neurologic symptoms or signs, it is important to investigate this complaint thoroughly in any patient with cancer If neurologic deficits are present at diagnosis, they are usually irreversible, though treatment immediately after symptoms develop may result in partial recovery Neurologic impairment can progress rapidly Treatment of early lesions may completely avoid significant compromise Although patients who present with paralysis may not recover function, they should still be treated for pain relief and to limit the extent of progression In addition, patients may respond to systemic therapy depending on the specific tumor type The diagnosis of spinal cord compression is made by MRI scan with contrast With this noninvasive and sensitive test, it is possible to obtain detailed views of the area in question as well as sagittal images of the entire spinal cord and vertebral canal With the increasing availability of MRI scanning to evaluate bony lesions of the spine, true spinal cord compression has become increasingly uncommon as radiation is used earlier in the course of disease for local control A detailed examination is important for detection and treatment of multiple lesions Bone radiographs and bone scans are useful for detecting vertebral metastases, but they do not aid in assessing spinal cord compromise
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