Clinical Problems in Oncology: A Practical Guide to Management

Clinical Problems in Oncology: A Practical Guide to Management is an easy–to–use, compact reference with essential, practical information on managing oncological emergencies, as well as the side effects and complications of cancer and its treatment. Because patient responses can vary widely, depending on the type of treatment prescribed, this resource offers medical professionals the specific information they need to improve the evaluation and treatment of cancer patients at the point of care. The compact format includes a wide range of clinical information, from the dose of drugs that would typically be used, through guidance on the practical procedures that are frequently used to treat oncology patients. Some of the book’s highlights include: • Toxicity grading and management, including at–a–glance summaries of the most common toxicities associated with chemotherapy • Prescribing guidelines, including how to write up electrolyte replacement properly • Information on specialised oncology procedures (such as SIR spheres), and how to manage complications • Types of vascular access lines and how to check their position, access them and troubleshoot problems • Drug and dosing guidelines for patients being started on the Liverpool Care Pathway With an expert team of writers who have contributed materials in their areas of expertise, Clinical Problems in Oncology is an ideal reference for oncologists in training, oncologists in non–training positions, oncology registrars and general practitioners.

List of contributors, ix Preface, xi Acknowledgements xii List of abbreviations xiii 1 Introduction to clinical problems in oncology 1 Sing Yu Moorcraft General approach to the management of oncology patients 2 Performance status 6 Tumour markers 6 2 Oncological emergencies 13 Daniel L.Y. Lee Anaphylaxis and hypersensitivity reactions 13 Bleeding 16 Central airway obstruction and stridor 19 Extravasation 23 Febrile neutropenia 28 Hypercalcaemia 30 Non–neutropenic sepsis 34 Raised intracranial pressure and seizures 36 Spinal cord compression 41 Superior vena cava obstruction 45 Transfusion reactions 48 Tumour lysis syndrome 50 3 Side effects and complications of cancer and its treatment 53 Alexandra Pender, Sing Yu Moorcraft and Daniel L.Y. Lee Overview of toxicity management 54 Abnormal liver function tests 57 Alopecia 60 Anaemia 62 Anorexia and nutrition 66 Ascites 69 Bone metastases and osteoporosis 71 Bowel obstruction 75 Breathlessness 77 Chest pain and other cardiac complications 81 Confusion and decreased conscious level 86 Constipation 91 Dental disorders 93 Diarrhoea 95 Dysphagia 100 Fatigue 104 Fertility and pregnancy 106 Haematuria 113 Hearing loss 115 Hiccups 117 Hyperglycaemia and hypoglycaemia 119 Hypertension and hypotension 123 Lymphoedema 127 Mucositis 129 Nausea and vomiting 133 Neuropathy 138 Neutropenia 142 Proteinuria 145 Pruritus 146 Psychiatric disorders 149 Rash 154 Renal failure and hydronephrosis 163 Sexual dysfunction 166 Thrombocytopenia 170 Thromboembolism 173 Vaccinations and immunoglobulin 178 Visual symptoms 180 4 Introduction to radiotherapy 185 Emma Dugdale, Alexandra Gilbert and Robin Prestwich Introduction to radiotherapy 185 Methods of delivery of radiotherapy 186 5 Radiotherapy side effects and their management 193 Alexandra Gilbert, Emma Dugdale and Robin Prestwich Overview of radiotherapy toxicity 193 Overview of radical radiotherapy treatment and side effect management by anatomical treatment site 195 Brain 195 Head and neck 196 Breast 200 Thorax 200 Abdomen 204 Pelvis 205 Skin toxicities 211 Total body irradiation 214 6 Endocrine therapy, immunotherapy and targeted therapies 215 Samantha Turnbull Endocrine therapy 215 Immunotherapy 218 Targeted therapies 220 7 Electrolyte abnormalities 225 Sing Yu Moorcraft Hypocalcaemia 225 Hyperkalaemia and hypokalaemia 227 Hypermagnesaemia and hypomagnesaemia 231 Hypernatraemia and hyponatraemia 234 Hyperphosphataemia and hypophosphataemia 237 8 Palliative care and pain management 241 Karen Neoh Pain management 241 Overview of pain management 241 Opioid prescribing in palliative care 245 Opioid toxicity 251 Syringe pumps 252 End–of–life care 253 9 Oncology procedures and their complications 257 Juanita Lopez Ascitic drains (paracentesis) 257 Biliary drains and stents 259 Central venous access devices 261 Chemoembolisation 265 Chest drains and pleurodesis 266 Enteral feeding tubes 269 Nephrostomies and ureteric stents 270 Oesophageal stents and dilatation 272 Radioembolisation (SIR–spheres®) 273 Radiofrequency ablation (RFA) 275 10 Cancer drug development and funding 277 Sing Yu Moorcraft Clinical trials 277 Funding of cancer drugs 280 Personalised medicine 282 Appendices 287 Sing Yu Moorcraft and Daniel L.Y. Lee Chemotherapy regimes 287 Drug toxicities 287 Useful resources 296 Index 301

Edited by Sing Yu Moorcraft , MB BCh, MRCP, Clinical Research Fellow in Medical Oncology, The Royal Marsden NHS Foundation Trust, London, UK Daniel L.Y. Lee , MB BCh, MRCP, Specialist Registrar in Medical Oncology, St James’ Institute of Oncology, Leeds, UK David Cunningham , MD, FRCP, FMedSci, Consultant Medical Oncologist, The Royal Marsden NHS Foundation Trust, London, UK