Synopsis
Assess common cytotoxic adverse effects without missing sepsis or organ emergencies, grade severity from the patient's baseline, provide regimen-specific supportive care, and modify later treatment safely.
- Treatment toxicity is predicted by regimen, dose, cycle day, organ reserve and previous reaction; obtain the exact SACT record rather than relying on the drug class alone.
- Myelosuppression causes infection, bleeding and symptomatic anaemia, but clinical deterioration is treated before a laboratory nadir is confirmed.
- Nausea and vomiting need emetogenic-risk prophylaxis plus rescue treatment; refractory symptoms prompt assessment for obstruction, metabolic disturbance, brain disease and infection.
Key red flags
Recent chemotherapy with fever, rigors or unexplained deterioration requires immediate cultures and the first empirical intravenous antibiotic, targeted within 1 hour of acute presentation, without waiting for neutropenia to be confirmed.
Investigation priorities
Detect neutropenia, thrombocytopenia and anaemia after treatment.
Management branches
A chemotherapy-treated patient contacts the service with new symptoms.
- Obtain regimen, cycle day, temperature and ABCDE red flags and direct fever or deterioration to immediate acute assessment.
- Use the 24-hour oncology line and do not rely on a normal home temperature after antipyretic use or early presentation.
The patient is stable but symptoms threaten hydration, nutrition, function or adherence.
Key medicines
Piperacillin/tazobactam for suspected neutropenic sepsisAdminister 4.5 g intravenously as the first adult dose immediately; ongoing licensed febrile-neutropenia dosing is 4.5 g every 6 hours, adjusted for renal function and then for local resistance, allergy, cultures and clinical response.
Ondansetron (5-HT3 antiemetic example)For moderately emetogenic chemotherapy, a licensed adult oral schedule is 8 mg 1–2 hours before treatment followed by 8 mg 12 hours later, then 8 mg twice daily for up to 5 days. Highly emetogenic regimens need protocol-defined combination prophylaxis; moderate or severe hepatic impairment limits the total daily dose to 8 mg.