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.
- Mucositis and diarrhoea can cause dehydration, malnutrition, infection and dose interruption; severity is measured by intake, stool frequency, bleeding and physiology.
- Peripheral neuropathy, fatigue, cognitive complaints, alopecia and fertility effects can be dose-limiting even when they are not immediately life-threatening.
- Renal, hepatic, cardiac, pulmonary and bladder injury are agent-specific and should not be hidden under the label of common chemotherapy effects.
- Supportive medicines have their own constipation, sedation, QT, glucose and interaction harms and require reconciliation.
- Every significant adverse event needs documentation, causality review and a clear decision to continue, delay, reduce, substitute or stop the next cycle.
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.
- Treat sepsis, bleeding, dehydration, thrombosis and organ failure in parallel with confirming treatment causality.
The patient is stable but symptoms threaten hydration, nutrition, function or adherence.
- Optimise regimen-matched antiemesis, mouth care, analgesia, bowel treatment, hydration and nutritional support with interaction review.
- Correct electrolytes and anaemia or platelet problems through the appropriate protocol, investigating infection and blood loss where relevant.
- Escalate persistent or atypical symptoms to imaging or organ specialists rather than repeatedly adding symptomatic medicine.
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.Obtain cultures without delaying the antibiotic, verify serious beta-lactam allergy, resuscitate shock and seek source control. Monitor renal, hepatic and haematological toxicity and avoid routine extra aminoglycoside or glycopeptide without an indication.
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.Review QT prolongation, bradyarrhythmia, electrolyte disturbance, constipation or obstruction and serotonergic combinations. Persistent vomiting requires hydration and assessment for infection, metabolic disturbance, intracranial disease or bowel obstruction.