Adverse effects of antineoplastic agents
EBM Guidelines
Jan 19, 2022 • Completely updated
Table of contents
- Essentials
- Nausea and other gastrointestinal symptoms evd
- Blood cytopenias evd
- Neutropenic infection
- Hair loss
- Adverse tissue and skin effects
- Adverse cardiovascular effects evd
- Adverse lung effects
- Adverse renal and urinary effects
- Adverse neurological and CNS effects
- Adverse effects on the fetus, pregnancy, fertility and hormone activity
- Other adverse effects
Extract
- Antineoplastic agents can be divided roughly into classic cytostatic/cytotoxic agents, hormonal agents, antibodies, drugs affecting signalling and other drugs. All have adverse effects. In most cases the therapeutic window is narrow.
- Antineoplastic agents may cause immediate, delayed or late adverse effects. Late effects may only appear until several years after the end of treatment.
- Antineoplastic agents cause adverse effects such as nausea, blood count changes, hair loss, neuropathy, damage to the myocardium, lungs, liver and kidneys, skin reactions, gastrointestinal effects and endocrinopathies.
- Before beginning antineoplastic treatment, blood tests, at least, should be performed. Depending on the drug combination, laboratory tests should be repeated regularly, usually at least before beginning each new cycle of treatment.
- The adverse effects of antineoplastic drugs may to some extent be controlled by adjusting the dose, by pausing treatment, and by giving supportive medication.
- Most antineoplastic drugs may cause miscarriages or fetal abnormalities, so birth control counselling and contraception must be taken care of. The most aggressive treatments may cause permanent or transient infertility and premature menopause.
- If antineoplastic medication is suspected of having adverse effects, it is important to check the patient’s medication list and to make sure that the causative drug is not given again until the matter has been investigated.
- It may be difficult to differentiate between an adverse drug effect, progression of the cancer being treated and other diseases.
- Due to the extensive range of pharmaceutical treatments and adverse effects, it is important to investigate the case carefully and to consult experts: to interview the patient and his/her relatives (patients often have with them material concerning their medication), to consult an appropriate drug database, the oncology unit in charge of the patient's cancer treatment or, during on-call hours, doctors on call at secondary or tertiary care hospitals.
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