SIDE EFFECT AND SYMPTOM

MANAGEMENT

FATMA ALDOSERI

CHEMOTHERAPY UNIT

Monoclonal antibodies

FLU-LIKE SYMPTOMS

FLU-LIKE SYMPTOMS

• Take a lukewarm bath. Also, you can use cold or ice packs on your body

for comfort.

• Rest when you feel achy and tired, however, there should be a balance

between rest and exercise.

• Rest in a quiet, dimly lit room. Perhaps, relaxing music would help soothe

your headache.

• Take medication to control symptoms of fever as recommended.

Flu-like symptoms develop most often after the first treatment and usually

occur immediately.

FATIGUE

• Difficulty sleeping

• symptoms such as shortness of breath or

feelings of a “racing” heart as these are

symptoms of anemia

• Pain

• Emotional distress, anxiety or depression

• General lack of energy.

• Tiredness.

FATIGUE

• Aim to sleep at least eight hours each night

• Take time to rest or take a short nap (no longer than one hour) during the day

• Eat a nutritious diet

• Drink at least 8 glasses of water or fluid a day, unless instructed otherwise by

your doctor

• Follow a modest exercise plan, as advice by the health care.

• Try meditation, guided imagery, prayer or other strategies to help you relax and

decrease stress

Management

Grade Symptoms Management

1 Papules or pustules, covering less than 10% of body

surface area, which may or may not be associated

with symptoms of pruritus or tenderness

No treatment or Topical hydrocortisone and/or

clindamycin Continue targeted therapy at the

current dose

2 Papules or pustules, covering 10–30% of body

surface area, which may or may not be associated

with symptoms of pruritus or tenderness Limited

impact on daily living

Topical hydrocortisone and/or clindamycin +

oral antibiotic from the tetracycline group

Continue targeted therapy at the current dose

Skin rash

Grade Symptoms Management

3 Papules or pustules, covering more than 30% of body

surface area, which may or may not be associated

with symptoms of pruritus or tenderness Limits self-

care activities of daily living Associated with local

super infection.

Local treatment + oral antibiotic from the

tetracycline group + methylprednisolone orally

targeted therapy dose interruption until

regression of the toxicity to grade 1

4 Papules or pustules, covering any percentage of body

surface area, which may or may not be associated

with symptoms of pruritus or tenderness, and which

are associated with extensive super infection, with

intravenous antibiotics indicated Life-threatening

consequences

5 Death

Skin rash

Diarrhea

Diarrhea

Grade Symptoms Management

1 Increase of fewer than 4 stools per day Adjust diet Loperamide at the beginning 4

mg orally, then 2 mg every 2–4 hours after

12 hours without diarrhoea Continue

Targeted therapy

2 Increase of 4–6 stools per day over baseline

3 Increase of 7 or more stools per day over

baseline;

Hospitalization and parenteral hydration is

recommended , limits self-care activities of

daily living ,targeted therapy should be

interrupted until regression of the side

effects to grade 1

4 Life-threatening consequences Urgent

intervention indicated

5 Death

Hepatotoxicity

Parameter Grade 1 Grade 2 Grade 3 Grade 4

ALT ↑ > UNL — 3.0 × UNL > 3.0–5.0 × UNL > 5.0–20.0 × UNL > 20.0 × UNL

AST ↑ > UNL — 3.0 × UNL > 3.0–5.0 × UNL > 5.0–20.0 × UNL > 20.0 × UNL

Bilirubin ↑ > UNL — 1.5 × UNL > 1.5–3.0 × UNL > 3.0–10.0 × UNL > 10.0 × UNL

Management

• A pre-existing dysfunction of the liver increases the risk of targeted therapy induced

hepatotoxicity.

• It is not recommended to start the therapy in persons with severe liver function disorders.

• The majority of cases of liver dysfunctions are asymptomatic and do not require managing.

• If the level of aminotransferases reaches CTCAE grade 3, after ruling out all other causes of

liver dysfunction, it is effective to temporarily discontinue. The treatment may be re-started

once the toxicity decreases to grade 1 or completely resolves.

• A reoccurring grade 3 or higher hepatotoxicity is an indication for dose modification

according to the drug characteristic.

Hepatotoxicity

Grade Symptoms Management

1 characterized only by radiologic • The treatment must be stopped regardless

of the ILD severity

• methylprednisolone at the daily dose of 1

g intravenously over three days

• Prednisolone at the dose of 60 mg/day

orally with a gradual dose reduction of 10

mg per week.

2 clinical symptoms, with or without limitation of

the unassisted functioning are present, and the

oxygen therapy is necessary. 3

4 Life-threatening consequences Urgent

intervention indicated

5 Death

Interstitial lung diseases

• Some targeted therapies may cause

a patient’s blood pressure to rise.

Unfortunately, there is not much

that can be done to prevent this.

• monitor blood pressure closely for

patients taking a drug with this

type of side effect.

• Some patients may require

medicine to help bring their blood

pressure back down to a safe level

while they are using a targeted

therapy.

High Blood Pressure

• This may lead to a patient experiencing

problems with bruising and bleeding.

• may also cause blood clotting in the patient’s

legs and lungs, as well as heart attacks and

strokes.

• Patients experiencing chest pain, sudden

shortness of breath, vision problems,

weakness, seizures or difficulty talking, must

seek immediate emergency help. These

symptoms caused by blood clots.

• (closely monitor them for any possible side

effects).

Blood Clotting

• burning sensation in the mouth

• redness in the mouth (a sign of inflammation)

• unusual sensitivity to hot and cold foods

• pain and discomfort in the mouth

• unusual mouth dryness

• sores or ulcers in the mouth

• difficulty swallowing

• dry, cracked or blistered tongue

• raw feeling in the throat

• bleeding from the lips, gums or inside the mouth

• white spots or swelling in the mouth

Mouth and Throat Mucositis

Symptoms

Mouth and Throat Mucositis

• Practice good oral hygiene

full dental check-up and cleaning

Clean teeth and mouth after every meal and at bedtime

• Maintain good nutrition

Drink plenty of fluids

eating smaller, more frequent meals

Eat soft, moist, bland foods

• Use pain medicine

• Gels and ointments

• Special mouthwashes and rinses

• Special toothpastes

• Numbing lozenges

• Treat bleeding

• Treat infections ( Bacterial , Fugal , Viral )

Treatment

Biotherapy treatment

Anemia

• Fatigued

• Weak

• Short of breath

• Increase in heart rate

• Dizzy

• Headaches

• Chest Pain

• Pale skin

symptoms

Treatments for anemia including blood

transfusions or medications that encourage the

growth of red blood cells and hemoglobin,

which supplies the body with oxygen.

Treatment for anemia is determined by the

cause and extent of the condition.

CONSTIPATION

• Drink 8 to 12 glasses of water or fluid each

day.

• Warm drinks and prune juice may also be

helpful.

• Stay active. Try to get a moderate amount of

exercise every day.

• using fiber supplements, laxatives or stool

softeners Suppositories and enemas ( doctors

order )

• Consider adding fiber to the diet.

Management

Hair loss

• Avoid hair products that contain harsh chemicals (permanents,

dyes, and relaxers), hairdryers and curling irons, hair bands and

clips, and braiding your hair or pulling it back tightly.

• Use a mild shampoo, pat your hair dry, and brush with a soft

hairbrush.

• Avoid any products that suggest they prevent hair loss from

cancer treatment.

• Find new ways to feel good after hair loss with hats, scarves, and

other accessories.

• Talk to your health about resources and programs that are

available to you.

Infections

• The most effective way to avoid infection is washing

hands frequently and thoroughly with soap and warm

water

• Avoid people who are sick or who have just received

a live vaccine for 10-14 days.

• Stay away from large crowds.

• Wash fruits and vegetables well before eating.

• Avoid touching or eating raw or undercooked meat,

chicken, eggs and seafood.

TO PREVENT INFECTION

Allergic reactions The types of reactions can depending on how you receive your drug.

• Infusions are performed through I/V where the drug is delivered through a needle in your vein at an infusion center. Allergic reactions with a biologic infusion may result in shortness of breath, chills, redness, itchiness, itchy eyes, or itchy lips.

• If your medication is given through an injection, you may see a reaction at the injection site where they needle puncture is. Symptoms of injection site reactions are redness, itchiness, warm and tender to touch, and the possibility of a full body rash.

Less common Central nervous system reaction symptoms that can occur are sudden vision problems or any new numbness or tingling.

Cardiac issues might include exacerbation or a sudden onset of heart failure. If you have sudden swelling of the ankles, shortness of breath, or swelling of the hands let your provider know immediately. Your provider will take a look at the medications and see what could be the cause, some medications can aggravate things like COPD and make them worse while on the medication.

Lupus-like syndrome is another immune disorder that can occur when taking these medications. If a rash starts across your face and arms that gets worse when exposed to the sun, and you have new joint and body pain this could be a sign of Lupus-like syndrome. Please let you provider know if you develop any of these symptoms.

Vaccination therapy

Local reaction

(redness or swelling around injection site)

• Place a cold damp cloth (cold compress) over the affected

area to give relief.

• Paracetamol (not aspirin) may be used to ease the discomfort.

(small lump may appear at the injection site)

No treatment is usually required and it will disappear in a few

weeks.

Mild temperature or fever

• Monitor the temperature regularly (a fever is above 38.5 °C).

• Paracetamol (not aspirin) may be used to help reduce the temperature.

• Extra fluids are recommended (for example, water, milk).

• Keep cool by not overdressing.

• Sponge down with lukewarm water.

• Cold baths or showers are not recommended

Irritability decreased appetite sleepiness

These symptoms are common in children and usually

disappear over 24 to 48 hours. It does not usually require

any specific treatment.

Anyone experiencing light-headedness before or after

vaccination is advised to lie down until symptoms subside.

Fainting

Hermon therapy

In women Menopausal symptoms

vaginal dryness, hot flushes, sweating and a lowered sex drive.

• A water based, over the counter vaginal lubricant like K-Y

Jelly can help make sex more comfortable.

• Try taking slow, deep breaths when a flash starts.

• Use a fan in your home or workplace.

• Try to notice what triggers your hot flashes and avoid those

things. Possible triggers to consider include spicy foods,

alcohol, caffeine, stress, or being in a hot place.

Management

In men

• Breast tenderness is a particular problem with high dose

bicalutamide (Casodex). The breast tissue can become painful

ands swollen

• Taking the drug tamoxifen can help to reduce breast tenderness in

about 6 out of 10 men taking bicalutamide.

• Small dose of radiotherapy to the breasts before your hormone

treatment starts.

Breast tenderness

Sleepiness • Avoid large meals, smoking, and working right before

bedtime. Avoid caffeine after noon, and avoid alcohol

close to bedtime.

• Try drinking something warm before bedtime, such as

caffeine-free tea or warm milk.

• Keep your bedroom dark, quiet, and cool. Use your

bedroom only for sleep and sex.

• Avoid napping during the day, and try to go to bed and

get up at the same times every day.

• If you wake during the night and can't get back to

sleep, get up and do something relaxing until you're

sleepy.

• Talk to your doctor about your sleep problems.

Mood swings

• Getting enough sleep and staying physically active will help you feel your best.

• Avoid taking on too many duties. Look for positive ways to ease your stress.

• Talk to your doctor. He or she can look for signs of depression, which is a serious illness that needs

treatment. You also could consider seeing a therapist to talk about your problems.

• Try a support group for women who are going through the same things as you.

Memory problems

• Some are complain of memory problems or trouble

focusing in midlife. But studies suggest that natural

menopause has little effect on these functions.

• Getting enough sleep and keeping physically active

might help improve symptoms. Mental exercises may

help too, so ask your doctor about them.

• If forgetfulness or other mental problems are affecting

your daily life, see your doctor.

•Muscle and bone changes

•Weight gain

•Headache