The patient is a 60-year-old man with colorectal cancer and liver metastases. Following discussion by the colorectal multi-disciplinary team, he is to be offered oxaliplatin and capecitabine chemotherapy. Common side effects include nausea and vomiting, diarrhoea, bone marrow depression, peripheral neuropathy, fatigue and hand-foot syndrome.
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1. What factors will have been considered by the MDT in proposing a course of chemotherapy?
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The likely outcomes of treatment
As the patient has liver metastasis, a surgical resection of the primary colorectal tumour is not likely to improve overall survival, and chemotherapy is more likely to increase duration and quality of life.
The patient’s ability to tolerate chemotherapy
This includes their general health, performance status and co-morbidities (e.g. capecitabine can cause cardiotoxicity, which may be more common in patients with a prior history of coronary artery disease).
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2. Prior to chemotherapy the patient has to give written consent stating they have been fully informed. What should patient information include?
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Correct answer:
Patients need to be able to consider the costs and benefits of treatment. To do this, they need to know the aim of treatment, how and when it is given and the full range of side effects. (For example, patients whose work or hobbies require a high level of dexterity need to know about the risk of peripheral neuropathy.)
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3. What factors are reviewed before each cycle of chemotherapy is prescribed?
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Is the treatment working and does it warrant continuing, the patients experience of side effects, has the patient recovered sufficiently to continue and are blood tests within acceptable limits (FBC, U&E and LFTs)
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4. What advice would you give about contraception during chemotherapy to this patient?
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Correct answer:
They should not try to father a child to prevent harm to a developing foetus. They must use a barrier method of contraception while on treatment to prevent passing chemotherapy on to their sexual partner in their body fluids.
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5. Eight days after their chemotherapy, the patient contacts the treatment centre saying they have had a temperature and feel generally unwell. What should happen next and why?
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Correct answer:
They could be neutropenic and more prone to infection and less able to fight it. Neutropenic patients can become seriously ill very quickly, so they need an urgent full blood count, and if unwell, they need immediate intravenous antibiotics and acute care interventions.
